Merck Manual

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Lateral Epicondylitis

(Tennis Elbow)


Paul L. Liebert

, MD, Tomah Memorial Hospital, Tomah, WI

Last full review/revision Feb 2020| Content last modified Feb 2020
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Lateral epicondylitis is inflammation of the tendons of muscles that extend the hand backward and away from the palm.

  • Pain develops in the outer aspect of the elbow and back side of the forearm.

  • Ice, rest, analgesics, and exercises are usually effective.

The forearm muscles that are attached to the outer part of the elbow can become sore when stressed repetitively (see Figure: When the Elbow Hurts ). The tendon that attaches these muscles to the elbow can become inflamed and very sore.


Lateral epicondylitis can be caused by repetitive backhand returns in tennis. Other activities (for example, rowing and doing forearm curls while holding weights or repeatedly and forcefully turning a screwdriver) can also cause lateral epicondylitis.

Factors that increase the chance of developing lateral epicondylitis among tennis players include having weak shoulder and forearm muscles, playing with a racket that is too tightly strung or too short, hitting the ball off center on the racket (out of the sweet spot), and hitting heavy, wet balls. Hitting backhanded and allowing the wrist to bend increase the chance of developing lateral epicondylitis.


Pain occurs in the outside of the forearm when the wrist is extended away from the palm. Pain can extend from around the elbow to the middle of the forearm. Pain may be increased by firm gripping (handshaking) or even turning door knobs. Continuing to stress the forearm muscles can worsen this condition and result in pain even when the forearm is not being used.


  • A doctor's evaluation

Doctors make the diagnosis based on the symptoms and results of a physical examination. The outer elbow hurts when the person places the arm and hand palm down on a table and tries to raise the hand against resistance by bending the wrist backward.


  • Rest

  • Rehabilitation

Ice is applied to the outer elbow, and exercises that cause pain are avoided. Exercises that do not use the wrist extensor muscles primarily, such as jogging or cycling, can be substituted to maintain physical fitness. As pain decreases, elbow and wrist flexibility and strengthening exercises can be started. Use of a tennis elbow brace (usually for a few weeks) can be beneficial. When pain due to lateral epicondylitis is severe, a health care practitioner may inject a corticosteroid into the outer elbow. Surgery is rarely needed.

Elbow and Wrist Flexibility and Strengthening Exercises
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