Tennis Elbow / Lateral Epicondylitis / Extensor Tendonopathy

August 13th, 2022

Lateral Epicondyle

  • lateral epicondyle is very focal point of insertion of wrist, hand, and finger extensor muscles (non-contractile tendons couple muscles to bone) concentrating stresses of contraction of these muscles at this small area with use of hand

Tennis Elbow/Lateral Epicondylitis/Extensor Tendonopathy

  • condition only occasionally attributable to playing tennis (due to modern racquet technology); may otherwise result from incorrect stroke technique (backhand), overuse (specific repetitive pattern, excessive force) of forearm/hand, improper biomechanics, or persistence of use beyond initial strain (e.g., use of computer keyboard may perpetuate)
  • condition often acute and can severely limit grip strength, causing objects to be dropped on occasion
  • typical persistence of condition may be due to presence of scar tissue within tendon tissue matrix (provoking ongoing irritation/inflammation due to tissue tension differential at interface between uninjured flexible tissue and scarring), relative weakness and/or inflammation of tendon tissue matrix or periosteum (membranous attachment of tendon to bone)

Physical Therapy Treatment

  • relative rest (respect pain) application of electrotherapeutic modalities and ice
  • deep transverse frictions and massage
  • stretches and selective, progressed strengthening exercises; gradual resumption of pain-provoking activities (respect pain)
  • variety of tennis elbow bands/straps designed to attenuate tension from muscle contraction and thereby reduce stress delivered to tendon-bone interface (i.e., at epicondyle)

Other Treatments

  • prolotherapy, injection directly into tendon, administered by physician, if problem is unrelenting
  • lithotripsy, pulsed high intensity ultrasound waves (also used to break up kidney stones) may be tried if problem is unrelenting
  • cortisone injection employed only with extreme caution as incidence of spontaneous rupture following injection is high
  • acupuncture may reduce pain
  • surgery


  • few weeks to months to resolution; tendency to persist due to late reporting and continued over/misuse
  • continued overuse or misuse of extremity (arm/hand) may well serve to limit or counter possible benefit from treatment; problematic as condition tends to occur in highly motivated, active individuals
  • gradual resumption of offending activity, as indicated, with direction given by therapist (variable timeline)
  • main concern is that tissue is not stressed (i.e., flexibility around elbow is maintained and positioning and general use is such that tissue repair is facilitated)

Physio Note: Stretch and Strengthen; Computer Use

Stretching and strengthening muscles of forearm is very important. Your physical therapist will show you stretches and assign appropriate strengthening exercises according to stage of healing

Pay special attention to ergonomics of your workstation. Your therapist will advise you re principles of workstation ergonomics and discuss these with reference to your particular situation