Symptoms of Tennis Elbow

Tennis elbow typically develops gradually. Patients commonly experience pain over the lateral (outer) aspect of the elbow during movement. This pain may radiate proximally (upward) toward the upper arm or distally (downward) into the forearm, often accompanied by a sensation of soreness, swelling, or discomfort, leading to reduced willingness 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 found on the lateral aspect of the elbow, sometimes with referred tenderness extending distally toward the hand. The most characteristic tender spot lies over the lateral epicondyle of the humerus; however, this tenderness is typically confined to a small area. Occasionally, it may radiate distally along the extensor tendons, where mild tenderness and pain upon movement may also be present. Mild swelling may occur, and in severe cases, bony hypertrophy or palpable bony prominences may be detected.

There is no local erythema or swelling. Elbow flexion and extension remain unaffected; however, forearm rotation (pronation/supination) elicits pain. When the affected limb is positioned with the elbow flexed and the forearm supinated, the extensor muscles relax, thereby alleviating pain. In 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 arm is flexed at the elbow and the wrist is externally rotated (supinated). A minority of patients report worsening pain during damp or rainy weather.