Tennis elbow is primarily a degenerative tendinopathy, not an inflammatory one.^3,4 Repetitive gripping, lifting, or wrist extension leads to microscopic tendon disruptions that fail to heal normally.⁴ Over time, the tendon may show:³

• Collagen disorganisation
• Vascular proliferation (abnormal new blood vessel growth)
• Hypertrophic or abundant fibroblasts (repair cells)

These structural changes contribute to persistent pain and reduced grip strength.^5–7

Several factors have been linked to an individual’s risk of developing tennis elbow:^2,4,5

• Activity demands: The risk is highest in activities that involve high-load demands, high force, or highly repetitive movements, particularly with inadequate recovery time^2,6
• Biomechanical and equipment factors: Risk can be elevated by poor workplace ergonomics or the use of inadequate equipment, such as heavy tools or improper technique during sports^2,6
• Intrinsic health factors: An individual’s personal health status can be a major contributor. Identified risks include obesity, metabolic conditions (such as diabetes mellitus and hyperlipidaemia), and a family history or genetic predisposition^2,8
• Age-related tendon changes: The prevalence of tendinopathy increases with age. This is often attributed to a natural decline in the tendon’s elasticity and its ability to self-repair, making it more vulnerable to damage^1,2,5,7,9
• Other medications: Use of certain drugs, including fluoroquinolone antibiotics and excess corticosteroid use, has been associated with an increased risk for tendinopathy^2,4–6

You should see a healthcare professional if:

• Pain and tenderness interfere with your daily activities, work, or sleep^2,8
• You experience a decline in your grip strength^5,6
• Symptoms are severe or persist for several months despite rest and activity modification^1,5,8

Diagnosis is typically clinical, including a physical exam to check for tenderness and to see if pain is reproduced by specific movements, such as extending your wrist against resistance.^1,2 Imaging may be used to evaluate severity or rule out other conditions.^2,5,6

Management aims to relieve pain, promote tendon recovery, and restore normal arm function.^2,3,5 Treatment typically begins with conservative (non-operative) approaches.³

Conservative Approaches

• Rest and activity modification: This includes resting the arm and avoiding or modifying the repetitive occupational or recreational activities that trigger the pain^2,5,6
• Bracing and ice: A counterforce brace worn on the forearm may help reduce strain on the tendon. Ice may be used for acute exacerbations^1,5,6,8
• Physical therapy: Exercise regimens are a cornerstone of treatment. Specific protocols, including eccentric strengthening and stretching of the forearm muscles, are used to build tendon resilience and restore function^1,5,6,8
• Extracorporeal shockwave therapy (ESWT): This non-invasive therapy is used in some chronic cases to support the management of symptoms and assist in the return to normal activity^1,5,6