Tennis elbow

What is happening

The extensor carpi radialis brevis and nearby tendon fibers develop microscopic degeneration at their attachment. Despite the name epicondylitis, chronic cases often show tendinosis rather than active inflammation.

Diagnosis

The diagnosis is usually clinical. The examination reproduces pain with resisted wrist or finger extension and checks the elbow joint, radial nerve, neck, and grip. X-rays or advanced imaging are reserved for an unusual history, trauma, stiffness, nerve findings, or persistent symptoms.

Nonsurgical care

• Reduce the activity or technique that repeatedly loads the tendon
• Use pain medication when medically appropriate
• A counterforce strap or wrist brace for selected activities
• Progressive stretching and tendon-loading exercises
• Discuss the benefits and limitations of injections before proceeding

Time and expectations

Symptoms commonly fluctuate and can take months to settle. The goal is to reduce provocative load without completely resting the arm, then rebuild tendon capacity in a controlled way. Smoking, heavy manual work, and high baseline pain may slow recovery.

When surgery is considered

Surgery is rarely needed. It may be discussed when clearly localized lateral elbow pain remains disabling after a prolonged, well-directed nonsurgical program and other diagnoses have been excluded. The procedure removes diseased tendon and repairs healthy tendon to bone as needed.