In tennis elbow, the shared attachment of the wrist and finger extensor tendons at the outer bony bump of the elbow (the lateral epicondyle) becomes irritated. The medical name for the condition is epicondylitis radialis humeri — but that name is misleading: the ending “-itis” stands for inflammation, and inflammation is usually exactly what is not found in the tissue. Under the microscope what shows up instead is remodelling and wear within the tendon, with barely any classic inflammatory cells. That is why specialists increasingly speak of an epicondylopathy or tendinopathy (a tendon disorder).¹,²
This distinction is more than quibbling over words — it explains why simply suppressing inflammation disappoints over time: an overloaded tendon in the middle of remodelling needs above all measured, progressive loading, not permanent rest and not ever stronger medicines.
The most important message first. Tennis elbow is a nuisance and often drags on, but it is benign: the great majority of cases settle without surgery — patient information puts it at roughly nine out of ten cases within a year.¹ Patience and consistent training are half the treatment.
Incidentally, only a minority of those affected actually play tennis — far more often work and everyday life are behind it, from the computer mouse to the assembly line. Where symptoms are unclear, it is also worth looking at other causes of joint pain.
2. Tennis elbow, golfer’s elbow, mouse arm: the forms
Several related overload conditions occur around the elbow and forearm, and in everyday use they often get muddled up:
Name
Where it hurts
Typical trigger
What sets it apart
Tennis elbow (epicondylopathy, radial side)
Outer side of the elbow, radiating into the extensor region of the forearm
Repeated extension of the wrist and fingers, forceful gripping
The most common form; the subject of this article
Golfer’s elbow (epicondylopathy, ulnar side)
Inner side of the elbow
Repeated bending of the wrist, pulling and holding work
Less common; the treatment principle is very similar, with the exercises mirrored
“Mouse arm” (RSI complaints)
Variable: hand, forearm, elbow, shoulder
Long, monotonous work at a screen and mouse
An umbrella term for overload complaints; can end up as a tennis elbow
Table scrolls to the right
3. Symptoms and typical course
The typical symptoms
Tenderness at the outer elbow — pinpointed over the bony prominence, often on the lightest touch.
Pain on extension against resistance — lifting the wrist or a finger while something holds it back.
Weakening grip — the coffee cup, a handshake, wringing out a cloth or opening a screw-top jar all become a problem.
Radiating into the forearm — a dragging pain along the extensor muscles towards the wrist.
Pain at rest is rather rare — tingling in the fingers at night points more towards another cause (more on this below).
Course and possible consequences
Tennis elbow usually creeps up over weeks: first a pulling sensation after activity, then pain during activity, and finally pain with everyday grips. It is not dangerous in the sense of damaging the joint — the elbow joint itself stays intact. The most relevant consequence is the condition becoming chronic through unhelpful rest: if you barely use the arm for months, you lose strength and resilience, and the tendon never gets the stimulus it needs in order to remodel.
4. Causes and risk factors
At the start there is almost always a mismatch between the load on the tendon and what it can take. The following count as typical triggers and risk factors:²,³
Repetitive, monotonous handwork — screwing, assembling, scanning at a checkout, playing an instrument: many small movements involving gripping and extension add up.
Screen and mouse work — hours of clicking with the wrist held straight or bent back keeps the extensor muscles under constant tension.
Racket and throwing sports — in tennis above all the one-handed backhand, poor technique, strings that are too stiff or an unsuitable grip.
A sudden increase in load — the house move, the weekend of decorating, the return to training after a long break.
Age and tendon quality — between 35 and 55 the tendon tissue changes and forgives overload less readily.
Medicines as a contributing cause of tendon problems. Fluoroquinolone antibiotics such as ciprofloxacin can in rare cases trigger tendon pain, up to and including tendon rupture — particularly in combination with corticosteroids and in older age. If tendon symptoms appear during or shortly after such a course, that belongs in the medical search for causes. More on this in the guide Medication side effects.
5. Diagnosis: tests rather than X-rays
Tennis elbow is a clinical diagnosis — it is made with the hands, not with machines. A typical sequence looks like this:
History: your job, mouse use and sporting load, when the symptoms started and how they have developed, and your current medicines.
Clinical tests: tenderness over the outer epicondyle plus provocation tests — for instance extending the wrist or middle finger against resistance. If that reproduces the familiar pain, the diagnosis is very likely.
Imaging only where needed: X-ray, ultrasound or MRI are not routinely required. They come into play if the course is atypical or stubborn, or if another suspicion needs clarifying.²
Important distinctions: tingling and numbness, above all at night, in the thumb, index and middle finger point to carpal tunnel syndrome — there a nerve is compressed at the wrist rather than a tendon irritated at the elbow. If the pain radiates from the neck along the whole arm, the cervical spine may be the source (more under neck pain). A nerve entrapment in the forearm (radial tunnel syndrome) and — rarely at the elbow — osteoarthritis can produce similar symptoms too. Persistent tingling or numbness always needs a medical assessment.³
6. Treatment: exercises first
Treatment follows a stepped plan: active and conservative measures first, passive procedures as add-ons, surgery as a rare exception. Which of these makes sense and in what order is decided by your treating practice together with you — depending on how long it has lasted, how much you are suffering and the demands of your job.²
First lineManage the load, train the tendon
Load management rather than immobilisation
Reduce and rework the movements that set the pain off, but carry on using the arm. Complete rest over weeks weakens the tendon further and delays healing.
Eccentric and progressive strength training
The core of treatment: slow, braking exercises for the wrist extensors — for example lowering the wrist under control with a light weight — built up over weeks. Physiotherapy will show you which exercises to use and how to progress; what matters is doing them regularly over several months.
Ergonomics and technique
Adapt your workstation, tool handles and sporting technique — otherwise you are training against the daily overload. Practical tips are in the everyday-life section below.
Second lineAdd-ons, honestly assessed
Epicondylitis clasp or brace
A clasp worn just below the elbow spreads the pull on the tendon attachment and can reduce pain during loading you cannot avoid. It is an aid for the transition, not a cure — the evidence on how well it works is mixed. If you use one, do not wear it all the time and not at rest.
Pain gel (topical NSAIDs)
Because the tendon attachment lies close to the surface, this is a sensible first choice against the pain — details in the section on medicines.
Shockwave therapy (ESWT)
Can be tried in stubborn cases; the evidence is limited and the study results partly contradict one another. As a rule this is a self-pay service in Germany — ask beforehand about the number of sessions, the cost and when you would stop.
Manual therapy and stretching
Alongside the training, hands-on treatment can ease pain in the short term and make it easier to exercise.
Third lineSurgery as a rare exception
Surgical procedures
Only considered once conservative treatment has been followed consistently for many months and the burden of symptoms remains high. Since the great majority of cases settle by themselves, surgery for tennis elbow is clearly the exception.¹,²
A realistic time frame. Tendons remodel slowly: noticeable improvement often takes several weeks, and full healing months. That is not a sign that treatment is failing — it is the normal biology of a tendon.
7. Medicines for tennis elbow
In tennis elbow, medicines ease the pain — they do not speed up the remodelling of the tendon. They are a bridge so that you can exercise, work and sleep, not a permanent solution.
Pain gel first: topical NSAIDs
Because the tendon attachment sits directly beneath the skin, NSAIDs as a gel or cream — such as diclofenac or ibuprofen — are a sensible first choice here: they can ease the pain in the short term and put considerably less strain on the stomach, the kidneys and the circulation than tablets do.¹
Tablets only for a short time
Where irritation is more severe, NSAIDs as a tablet are an option, for example ibuprofen or naproxen — according to the product information, for as short a time as possible and at the lowest effective dose. Our painkiller comparison offers help in weighing this up.
Keep an eye on stomach, kidneys and blood pressure. NSAID tablets can encourage stomach problems, a rise in blood pressure and a worsening of kidney function — particularly with longer use, in older age, or together with blood pressure tablets and water tablets. Where risk factors are present, stomach protection such as pantoprazole is often added. You will find practical pointers under Stomach problems from medications.
What medicines cannot do
Tennis elbow is a remodelling process in the tendon, not a classic inflammatory condition. So the rule is: if you only dampen the pain and do not adjust the load, you are shifting the problem — and risk carrying on overloading the tendon under the cover of painkillers.
No long-term use on your own. If the pain relief you have been prescribed is no longer enough, speak to your practice rather than raising the dose yourself or carrying on for weeks. And prescribed medicines — a course of stomach protection you have started, for instance — should not be stopped on your own initiative: the guide Stopping medications explains how to come off them in an orderly way.
How long have you actually been rubbing and swallowing?
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8. Cortisone injections: good short term, worse long term
Hardly any treatment for tennis elbow works as quickly as a corticosteroid injection at the tendon attachment: the pain often eases markedly within a few days. That is precisely why it was the standard for a long time — and precisely why it is worth looking at the evidence.
Randomised trials with longer follow-up show a recurring pattern: in the first few weeks the cortisone group does better than comparison groups given watchful management or physiotherapy — but after six to twelve months the picture reverses. Those injected at the outset then have poorer recovery rates and more frequent relapses.¹,² Two mechanisms are discussed as explanations: rapid freedom from pain tempts people to load the tendon fully again too soon, and glucocorticoids can weaken the tendon tissue itself — which is why repeated injections at the same spot are regarded as particularly problematic.
The consequence in the current guideline: corticosteroid injections are assessed with caution in tennis elbow and are at most an option in exceptional cases — for instance where a pronounced flare of irritation makes any exercise therapy impossible.² The general picture on the benefits and risks of glucocorticoids is set out in our cortisone guide.
Three questions to ask before an injection. What is the aim of the injection, what is the plan for afterwards — and what happens if we train consistently for two months instead? The guide Prepare for a doctor’s appointment offers good preparation for that conversation.
9. Everyday life: mouse, office and manual work
Take the sting out of mouse and keyboard — wrist in a neutral position, forearm supported, mouse close to the body; a vertical mouse or a trackpad can noticeably relieve the extensor muscles.
Build in micro-breaks — every 30 to 60 minutes shake out your hands, circle your wrists, change position. A timer helps more than good intentions.
Thicken handles, spread the load — chunkier tool handles, carrying with both hands close to the body, shopping in a rucksack rather than in a bag at the end of an outstretched arm.
Have your sporting technique checked — in tennis the grip size, string tension and backhand technique; a single technique session can achieve more than weeks off.
Make the exercises a routine — a set time, a set reminder, a short record. With tennis elbow it is not the hardest exercise that wins, but the most regular one.
Keeping a record pays off with the medicines too: many people use pain gel and tablets “as needed” for weeks and underestimate the total amount. How to keep a clean record of what you apply and take is set out in How to take medications.
Exercises, physio appointments, pain gel — without the paper chaos
Reminders and a record of the coming months in one place.
Often several months — that is normal and not a sign that the treatment is wrong. The great majority of cases settle within a year without surgery. Consistent training and adapted loading can influence the course for the better.
No, as a rule not. Complete immobilisation over weeks weakens the tendon and delays healing. What makes sense is to reduce the loads that set the pain off while training the arm in a targeted way at the same time — pain-adapted and built up step by step.
An epicondylitis clasp can spread the pull on the tendon attachment and reduce pain during loading you cannot avoid. It does not cure tennis elbow, though, and the evidence on how well it works is mixed. As a stopgap it is worth a try — as a permanent solution it is not.
In the short term usually a marked easing of the pain — but in the longer term randomised trials show poorer recovery rates and more relapses than with watchful management or physiotherapy. That is why cortisone is used cautiously today and is at most an option in exceptional cases.
In tennis elbow the irritated tendon attachment lies directly beneath the skin, so an NSAID gel is usually the more sensible first choice: it can ease the pain in the short term and puts less strain on the stomach, the kidneys and the circulation than tablets. Tablets are kept for more severe irritation — for as short a time as possible and under medical supervision.
Very rarely. Surgery is only considered once conservative treatment has been followed consistently for many months and the symptoms continue to restrict everyday life severely. Since the great majority of cases settle by themselves, an operation is clearly the exception.
In tennis elbow what stands out is tenderness and pain on loading at the outer elbow. Carpal tunnel syndrome, by contrast, typically announces itself with tingling and numbness at night in the thumb, index and middle finger. Where altered sensation persists, a doctor should establish the cause.
Gesundheitsinformation.de, German Institute for Quality and Efficiency in Health Care (IQWiG): Tennis elbow — overview and treatment — German source. Accessed 2026. gesundheitsinformation.de
German S2k guideline on epicondylopathia radialis humeri (DGOOC/DGOU, AWMF reg. no. 033-019, 2019) — German source. awmf.org
gesund.bund.de, the national health portal of the German Federal Ministry of Health: Tennis elbow (epicondylitis) — German source. Accessed 2026. gesund.bund.de
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Medical disclaimer: This article is for general information and does not replace medical advice, diagnosis or treatment. Sudden severe pain after a fall, persistent tingling or numbness in the arm, and swelling, redness or fever should all prompt a prompt medical examination of the arm. Do not take painkillers long term on your own — the choice of medicine and the dose are always determined individually by your treating practice. Last updated: August 2026.
