Symptoms of Tennis Elbow

Tennis elbow typically develops gradually. Patients commonly experience pain during movement at the lateral (outer) aspect of the elbow joint. This pain may radiate upward toward the upper arm or downward toward the forearm, often accompanied by a dull, achy discomfort and reluctance to move the affected limb. Activities requiring grip strength—such as lifting a bucket, twisting open a bottle cap, or knitting—exacerbate the pain.

A localized tender point is usually present over the lateral epicondyle of the humerus. Occasionally, tenderness may radiate distally toward the hand. This tender point is typically confined to the lateral epicondyle but may extend distally along the extensor tendons, where mild tenderness and pain upon movement may also be elicited.

Mild swelling may be present; in severe cases, bony hypertrophy may be palpable. There is no local erythema or swelling, and elbow flexion and extension remain unaffected. However, forearm rotation elicits pain. Pain is alleviated when the affected limb is held in elbow flexion combined with supination of the forearm—a position that relaxes the extensor muscles. In more severe cases, even simple actions such as extending the fingers, dorsiflexing the wrist, or holding chopsticks can provoke pain. Conversely, pain tends to subside when the elbow is flexed and the wrist is externally rotated. A small number of patients report increased pain during damp or rainy weather.