The Tennis Elbow Syndrome

The Tennis Elbow Syndrome

The term “tennis elbow” or humeral epicondylitis refers to a pain syndrome localized on the lateral epicondyle of the elbow, sometimes radiated distally to the forearm musculature, secondary to the repeated micro-traumatic action of the tendons of the extensor muscles of the wrist and hand. forearm supinators at the level of their origin.

The term “tennis elbow” or humeral epicondylitis refers to a pain syndrome localized on the lateral epicondyle of the elbow, sometimes radiated distally to the forearm musculature, secondary to the repeated micro-traumatic action of the tendons of the extensor muscles of the wrist and hand. forearm supinators at the level of their origin.

In tennis the pain symptomatology almost never arises abruptly but in most cases the symptoms have a subtle and slow beginning with a diffuse pain in the lateral part of the elbow that radiates along the forearm or, sometimes, with a sensation of fatigue that disappears with rest; in many cases these modest signs are underestimated by the sportsman who does not understand the extent of the condition and therefore continues in his activity.

With the passage of time sporting practice becomes more and more difficult as all the movements of grasping of the hand are extremely painful, hindering not only the sporting activity, but also the common gestures of life such as, for example, shaking hands, pouring water from a bottle or even writing.

This affection is not exclusive to tennis but may also appear in other sports such as golf, polo, hockey and fencing.

Its presence is also observed in sedentary subjects who, for their working activity, functionally abuse epicondylar muscles; most frequently affected are workers with jackhammers, tailors, typists and violinists.

For this reason it is necessary a rigorous clinical and diagnostic evaluation, as well as a precise application of therapeutic measures and preventive modalities.


Epicondylitis is characterized by pain on the elbow, which can radiate to the muscles of the forearm and increase during the extension of the wrist and hand.
The pressure exerted on the lateral epicondyle causes intense pain as well as the maneuver of extension against resistance of the wrist and the third finger of the hand awaken pain.
The diagnosis of this condition is essentially based on the clinical aspects and the instrumental investigations are aimed at confirming the suspicion and demonstrating the evolutionary stage of the lesion.


The humeral epicondylitis is commonly framed in the field of tendinopathies of mechanical etiology, that is to say among those pathological forms of the tendon in which, the functional hyperuse repeated over time, assumes the predominant pathogenetic value.

The presence of factors favoring both endogenous and exogenous must be carefully taken into account keeping in mind that, if the overload is associated with an accentuated rigidity or poor elasticity of the muscles of the forearm, the pathogenic effects of muscle contraction at the level of the osteo-tendinous junction they are inevitably exalted.

It should also not be forgotten, as a causal factor, a possible individual predisposition to be sought in a generic condition that makes the organism more susceptible to encountering pathologies of this type.

It is known, in fact, that overlapping mechanical factors of intensity and duration do not always produce the same effects due to a different individual response that results in clinical manifestations of variable entity.

The most important external factors able to condition and favor the appearance of an epicondylitis are to be found both in the athletic gesture and in the use of sports equipment unsuitable for the athlete’s technical characteristics.

Among these it is worth mentioning:

  1. The level of technical ability: epicondylitis is more frequent among low level athletes and occasional tennis players than among professionals, even if in the latter the training and competition activity lasts for many hours every day; from this it follows that a correct technical gesture, supported by a harmonious balance of the agonist and antagonist muscles, minimizes the risk of damage due to the functional stimulus; the most frequently affected stroke in the genesis of this condition is the reverse especially when it is performed incorrectly with poor coordination between body rotation, leg bending and arm movement or when the execution of the movement is too late or too rigid.
  2. The use of rackets with unsuitable structural characteristics can negatively affect the resistance of the tendinous tissue to functional stimuli; for example a very heavy racquet is difficult to maneuver especially in shots that require high speeds of movement as in the net game; if it is too rigid it can favor the appearance of vibrations that are too high in width; moreover, a damaged racket can considerably alter the response of the frame, considerably increasing the amplitude of the vibrations. The modern materials with which rackets are made today have meant that the older wooden ones are now completely abandoned; racquets in graphite, light alloys, boron, kevlar (often combined) with tubular-structure handles filled with elastomeric foams allow effective control of weight, balance and ultimately better vibration absorption; in the old wooden racquets, moreover, the handle is an integral part of the frame, while in the others, the possibility of using different materials capable of absorbing the elastic responses of the shaft greatly reduces the effects of vibrations.
  3. The size of the racket handle must be proportionate to the hand to allow an immediate recognition of the position at the moment of the stroke. It should be remembered that while on the one hand a small diameter handle allows better control of the racket, on the other hand the effects linked to an intense isometric contraction and therefore greater tension of the muscles of the hand and forearm can significantly increase the effects of the overload on the osteo-tendon junctions; even the handle which is too large, not allowing a firm grip, forces the player to exert greater effort with his hand and forearm muscles; in general the distance between the ends of the fingers and the palm of the hand must be about 5 mm. when it is closed on the handle.
  4. Also the way to grip the racket by conditioning the movements of flexion and extension of the wrist can significantly accentuate the effects of the loads carried out on the elbow.
  5. The tension of the strings, the material with which the racket is made, the quality of the balls are all causes that can influence the intensity of the impact during the game. Gut strings, for example, unlike those made of synthetic material, are capable of absorbing most of the vibrations caused by the impact of the ball on the string plate; in general the tension should not exceed 24 Kg. for classic size rackets (which, moreover, are almost completely abandoned) and 26-27 Kg. for mid size. In the event of resumption of activity after an episode of epicondylitis, it is advisable not to exceed 19-20 kg for the former and 20-21 kg for the latter. It should not be forgotten that over time the strings lose their elasticity and for this reason it is advisable to replace them even though they are apparently intact, preferably using hybrids or those in multifilament that greatly absorb the vibrations of the racket.


The fundamental therapeutic aid in the treatment of humeral epicondylitis is not only athletic rest of variable duration but in any case not less than 30 days, to be continued until the painful symptoms disappear; this is associated with medical and physical therapies with the aim of favoring the repair of anatomical damage.

In acute pain phases, non-steroidal anti-inflammatory drugs taken systemically or locally applied (ointments, gels, patches, etc.) associated with ice packs (applications of twenty minutes at least twice a day, with cycles of eight to ten days). During treatment the patient must stop specific sports and avoid those daily movements that involve the muscles of the forearm.

Physiotherapy, by means of hyperthermia, laser and contact diathermy treatments, can favor a positive evolution of this condition.

Local infiltration with cortisone-based preparations can be used, but only in cases where symptoms persist after the treatments mentioned above, and in any case should only be performed for a limited number of times.
It is very important that, once the pain has ceased and the active recovery is verified, the resumption of the normal sporting practice occurs only after a period of suitable and sufficient athletic reconditioning, which must consist of strength exercises (isometric and isotonic contractions for the muscles of the ‘forearm) alternated with stretching exercises.

In this way the risks of recurrences that are always lurking will be reduced if the athlete, not feeling any more pain and considering himself wrongly cured, resumes the agonistic activity without observing the rehabilitation instructions described above.


In any case, despite compliance with all therapeutic measures, a small percentage (about 5%) of epicondylitis cases does not heal and in these cases arthroscopic or arthrotomic surgical therapy can be considered.

14 thoughts on “The Tennis Elbow Syndrome

  1. Venly1984 says:

    I open this post for all those who want to give me advice on how they recovered from epicondylitis, epitrocliteitis, tendinitis … thanks to which racket did you start playing again?

  2. Thomas Gottlieb says:

    Wondering if anyone can tell me if l4 prokennex (handle I mean) is like l3 dunlop head babolat etc.

  3. Johnston55 says:

    Epitrocleite. Fixed with 4 sessions of “shock wave”s (one per week) and another 5 months of total rest of the arm. Back to play with a Pro Kennex P5 260 gr (the current Ki15) strung for the first time with gut, then with soft multifilament and then with alupower. Always max 22/23 Kg. After another 4 months of ProKennex I was cured. Anyway my elbow was really bad. The Resonance said that there was a lesion with a diameter of 1 cm (I had played it above despite the pain).

  4. Collardelectric says:

    I have the Compex and I noticed that among the “pain” programs there is the one indicated for the epicondylitis!

  5. Norma G. Reed says:

    I have had pain for a week, it all started with a pang of pain, as if I had a pin in my elbow. The sports doctor gave me a cortisone injection and then I continued with anti-inflammatories, Oki and voltaren gel, plus ice and physiotherapist!

  6. Ewee9Thah6 says:

    Similar situation here, from today, no more Oki and I only continue taking Voltaren and ice!

  7. eksistensi says:

    Cortisone and Pain killers, The pain in my elbow is diminished, but today I feel a slight soreness in my fingers, perhaps due to the fact that I used the PC a lot.

  8. William R. says:

    I discovered that tennis was not a cause, it was perhaps an accelerator in sharpening the problem but the causes were different.
    First of all “Wrong posture”, mainly at work (PC mouse), but also a wrong posture in a thousand other daily actions.

    And I did everything to solve the acute problem:

    – Cortisone
    – Meso Therapy
    – Shiatsu
    – Different massages
    – Rest
    – Kennex
    – Tecar

    I certainly forgot mentioning something

  9. Jerryguess says:

    I had classic epicondylitis many many years ago
    I stopped for several months
    cure: iontophoresis electrostimulation and anti-inflammatory
    when back on the field I set the two-handed backhand
    and I swapped my racket with a pro kennex
    currently I play with a pro kennex ki15 300 because if I play with different rackets I always feel a small pain in the elbow while with the pk no

  10. Shaw says:

    Good morning everyone, I would like to make my small contribution on elbow problems:
    in the last five years I have “cured” my epicondylitis so well that it has turned into an interesting osteoarthritis with a lot of calcifications …
    I think there is NO SOLUTION, but every case is a story in itself.
    This is mine:
    after appropriately treating the acute phase with cortisone infiltration, I started stretching very rigorously, before and after sports.
    For the racket I tried a little of everything and I realized that there is a lot of ignorance on the subject:
    I tested the Head Protector, with disappointing results; I found old Snauwaert Ellipse Touch-Hs, which went a little bit better;
    short passage with Babolat PD Cortex, devastating;
    Head prestige 600 and 660 with suspension grip, for me ineffective, even if excellent rackets;
    Dunlop with the ISIS system, better the old MAX 200 and 300, which have a composition of graphite and nylon, very elastic.
    I then switched to the Wilson with Triad system and the Volkl c10 with sensor handle … always without major success …
    I also tested a grip in Sorbothane produced in the nineties by gosen.
    From all these tests I came to the conclusion that a very soft frame, with a weight of around 380 400 grams, vertical ropes in natural gut 20 kg and horizontal multi-strand 19 kg, rather large grip to distribute the impact shock on a greater possible surface , was my solution.
    for two years I have resumed playing and having fun, without suffering;
    my current rackets?
    4 Rossignol f200 and two ProKennex Kinetic 5g, all brought to 398 grams and balanced slightly on the handle (on the 30 cm the Prokennex that push them, 31.5 le Rossignol that are lazier for age and composition)
    I hope I have been helpful …

  11. Vant1973 says:

    M. Shaw I have no words !!! a hallucinatory story …………….. on the one hand (change of rackets, pain in the elbow, calcifications and chronic disease …) ……… … on the other hand an extraordinary perseverance and courage: like a real tennis player, and whoever plays atennis knows what I’m talking about !!
    I am sorry to hear about your long epicondylal calvary …..

    courage, you have been brave, I understand you and ………….. I support you: among those who have epicondylitis a spontaneous solidarity is instantly formed !!

    damn tennis elbow !!! 🙁

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