Tennis Elbow

Tennis elbow, known clinically as lateral epicondylitis, is a condition where the tendon connecting your forearm extensor muscles to the bony prominence on the outer elbow becomes damaged and painful. The result is localised pain on the outside of the elbow, often with weakened grip strength.

Despite the name, you do not need to play tennis to develop this condition. Current clinical understanding recognises tennis elbow as a degenerative tendinopathy rather than simple inflammation, a distinction set out in the review of lateral epicondylitis. Think of it less like a sprained ankle and more like a fraying rope: the collagen fibres in the tendon gradually break down and fail to repair themselves properly.

This distinction is clinically relevant because it shapes management strategies, emphasising progressive load management over short-term symptom relief alone. It also explains a pattern seen often in clinics, where the tendon has been changing for some time before pain becomes noticeable enough to prompt a consultation.

Tennis elbow is caused by repetitive microtrauma to the forearm extensor tendons from gripping, twisting, and wrist extension movements. Over time, these small repeated stresses accumulate faster than the tendon can heal, leading to the degenerative changes that cause pain.

Occupational And Lifestyle Risk Factors

• Hawker centre and food preparation workers: Repetitive chopping, stirring, and gripping of utensils place sustained load on the forearm extensors throughout a long working day.
• Desk-bound professionals: Sustained mouse and keyboard use keeps the wrist in a fixed, slightly extended position for hours, creating low-level but continuous tendon stress.
• Construction and manual tradespeople: Using hand tools such as screwdrivers, hammers, and wrenches involves forceful, repetitive gripping and forearm rotation.
• Domestic and caregiving roles: Repeated lifting, wringing, and carrying tasks contribute to cumulative tendon load.

Sports-Related Risk Factors

• Racket sport players: Tennis, badminton, and squash players are at risk due to repetitive wrist extension and forearm rotation during strokes, particularly with poor technique or ill-fitted equipment.
• Golfers: The follow-through motion places eccentric load on the lateral forearm extensors.
• Weightlifters and gym goers: Pulling and gripping exercises, especially at high volume, can overload the extensor tendons.

Symptoms usually build gradually rather than starting with a single injury. Typical presentations include:

• Pain and tenderness on the outer point of the elbow, often sharply localised to one spot
• Pain that travels down the back of the forearm towards the wrist
• Weakened grip, noticed when lifting a kettle, pouring, carrying shopping, or shaking hands
• Pain triggered by gripping combined with wrist extension, such as turning a doorknob or lifting a mug by the handle
• Discomfort when straightening the arm fully or when the elbow is held in one position for long periods
• Morning stiffness around the elbow that eases with gentle movement
• In more established cases, aching that is present at rest, or that disturbs sleep

Symptoms that are worse at night or that come with numbness and tingling deserve assessment, since those features point away from straightforward tendinopathy.

If left untreated, tennis elbow may progress from intermittent discomfort to persistent pain with significant grip weakness. What begins as soreness after activity can become pain that is present at rest and limits even light daily tasks.

The underlying issue is that prolonged tendinopathy leads to progressive collagen disorganisation within the tendon. Healthy tendon fibres run in neatly aligned bundles; in chronic tennis elbow, those bundles become disordered, and the body’s repair mechanisms struggle to restore the original structure. The longer this continues, the slower conservative treatment tends to work, and the more often interventional options come into the discussion.

Tennis elbow is a degenerative tendon condition rather than a simple inflammatory one, and that single fact shapes almost everything about how it should be managed. Treatments aimed at inflammation may quieten pain without addressing the tendon itself, which is why structured loading through physiotherapy remains the foundation of care at every stage. The condition affects far more office workers, tradespeople, and hawker centre staff in Singapore than it does tennis players.

Symptoms caught in the first 6 weeks respond differently from those left for a year, and the range of options is widest earlier in the process. Most people with tennis elbow recover without surgery, and surgery is considered only after a trial of non-operative care. If outer elbow pain persists beyond 2 weeks of rest or if grip strength is affected, a consultation with an orthopaedic specialist can help evaluate your condition and determine appropriate care options.