Tennis Elbow Symptoms: Early Signs & Warning Signs

Quick Glance: Common Tennis Elbow Symptoms

Tennis elbow mainly causes pain around the outside of the elbow that becomes more noticeable when the forearm muscles are used. Common tennis elbow symptoms include:

Pain or aching on the outside of the elbow
Tenderness around the outer bony part of the elbow
Pain extending from the elbow into the outer forearm
Pain while gripping or squeezing an object
Discomfort when lifting or carrying objects
Pain while twisting the wrist or forearm
Pain when extending the wrist against resistance
Reduced grip strength because gripping becomes painful
Difficulty with tasks such as opening jars, turning door handles or holding a cup

Symptoms often develop gradually and may initially occur only during activities that load the affected tendons. Persistent stiffness, marked swelling or an inability to fully move the elbow is less typical and may suggest another cause of elbow pain.

Symptoms of Tennis Elbow That Should Not Be Ignored

Tennis elbow can remain uncomfortable for several weeks or months. However, certain changes require assessment as they may indicate significant functional limitation or another elbow, nerve or joint condition.

The table below lists tennis elbow symptoms that should not be ignored and what they may indicate:

Symptoms	What They May Indicate
Pain that continues to worsen	Ongoing tendon overload or another cause of elbow pain
Persistent pain even when the arm is resting	More troublesome symptoms or another underlying condition
Noticeably reduced grip strength	Pain-related loss of function or another muscle, tendon or nerve problem
Pain interfering with work or everyday activities	Increasing functional limitation
Numbness or tingling in the arm or hand	Possible nerve involvement rather than uncomplicated tennis elbow
Marked swelling, redness or warmth	Another elbow condition, inflammation or infection requiring assessment
Locking, catching or significant restriction of movement	Possible joint or structural problem rather than typical tennis elbow
Persistent symptoms despite reducing aggravating activity	A need to reassess the diagnosis or investigate another cause

Why Do Tennis Elbow Symptoms Occur?

Tennis elbow symptoms occur because repeated or excessive loading of the forearm tendons can cause small structural changes in the tendon tissue where it attaches to the outer elbow. One of the commonly affected tendons is the extensor carpi radialis brevis, which helps extend and stabilise the wrist during gripping, lifting and twisting movements.

These tendon changes can make the area around the outer elbow more sensitive and painful when the forearm muscles are used. This is why activities such as holding a cup, opening a jar, shaking hands, carrying a bag or using tools can trigger or worsen discomfort.

Symptoms of Tennis Elbow That Require Immediate Medical Attention

Tennis elbow itself rarely causes a medical emergency. Sudden severe symptoms, particularly following an injury, may instead indicate a fracture, dislocation, major tendon injury, nerve injury or another acute problem.

Seek urgent medical attention if there is:

Severe elbow pain after a significant injury
A visibly deformed elbow or arm
A bone visible through a wound
Sudden inability to move the elbow or arm
Severe or rapidly increasing swelling after an injury
A sudden snapping sensation followed by major weakness or loss of function
New numbness or loss of sensation after a significant injury
A hand or arm that becomes unusually pale, blue or cold
A very hot, red and swollen elbow accompanied by fever or feeling severely unwell

These symptoms are not characteristic of uncomplicated tennis elbow and should not be attributed to tendon overuse without appropriate assessment.

Symptoms of Tennis Elbow Based on Type

Tennis elbow, also called lateral epicondylitis or lateral elbow tendinopathy, does not have several formally recognised types with completely different symptom patterns. However, symptoms can differ depending on whether the condition is relatively recent or has become persistent.

The table below explains how tennis elbow symptoms may vary according to the clinical course:

Clinical Presentation	Typical Symptoms
Recent-onset tennis elbow	Pain and tenderness on the outside of the elbow, usually triggered by gripping, lifting, wrist extension or repetitive forearm activity
Persistent or chronic tennis elbow	Longer-lasting outer elbow pain, tenderness, reduced pain-free grip strength and increasing difficulty with work, exercise or everyday activities
Recurrent tennis elbow	Outer elbow pain that improves but returns when gripping, lifting or repetitive wrist and forearm movements are resumed

Symptoms of Tennis Elbow-Specific Conditions

Tennis elbow specifically affects the tendon attachment on the outer side of the elbow. However, similar tendinopathies can affect the inner side of the elbow, and some people may have both lateral and medial tendon involvement at the same time.

The table below compares related elbow tendinopathy patterns and their typical symptoms:

Condition	Typical Symptoms
Lateral epicondylitis (tennis elbow)	Pain and tenderness on the outside of the elbow, particularly with gripping, lifting, wrist extension or repeated forearm movements
Medial epicondylitis (golfer's elbow)	Pain and tenderness on the inner side of the elbow, commonly aggravated by gripping, wrist flexion or forearm pronation
Combined medial and lateral epicondylitis	Pain and tenderness on both the inner and outer sides of the same elbow, with symptoms triggered by activities involving gripping and repeated wrist or forearm movements

Having symptoms on both sides does not represent a separate type of tennis elbow. Instead, lateral and medial epicondylitis can occasionally occur together in the same elbow.

Can You Have a Tennis Elbow Without Symptoms?

Changes within a forearm tendon can exist without causing noticeable discomfort. However, clinical tennis elbow is generally recognised when such changes are associated with characteristic pain, tenderness or functional symptoms.

Mild tennis elbow symptoms can also be easy to overlook. A person may initially experience discomfort only when lifting, gripping or performing a particular repetitive task and continue normal activities without considering it significant.

As tendon loading continues, pain may become more noticeable or start interfering with everyday activities. Persistent outer elbow pain should still be assessed when the cause is uncertain, as several other conditions can resemble tennis elbow.

When Can Tennis Elbow Symptoms Become Life-Threatening?

Tennis elbow itself is not life-threatening. However, pain around the elbow or arm can sometimes occur with other serious conditions. Symptoms such as rapidly increasing swelling, spreading redness or arm pain accompanied by chest or breathing symptoms should not be assumed to be tennis elbow.

The table below lists symptoms that may resemble or occur alongside tennis elbow and explains why they can be serious:

Symptoms	Why They Are Serious
Rapidly increasing redness, warmth and swelling around the elbow with fever or chills	May indicate a spreading infection that can become serious if it enters the bloodstream
Redness spreading along the arm or fluid draining from the affected area	May indicate a worsening skin or soft-tissue infection requiring urgent treatment
Arm or elbow pain with chest pressure, shortness of breath, sweating, dizziness or nausea	May indicate a cardiovascular emergency rather than a musculoskeletal elbow problem
Sudden marked swelling of the arm with warmth, pain or changes in skin colour	May indicate a blood clot affecting a deep vein in the arm
Arm swelling or pain followed by sudden shortness of breath, chest pain or fainting	May indicate that a blood clot has travelled to the lungs and requires emergency care

How are Tennis Elbow Symptoms Diagnosed?

Tennis elbow is usually diagnosed based on the pattern of symptoms along with a physical examination. A doctor may ask about work, sport, repetitive activities, previous injuries and movements that make the pain worse.

The table below explains the assessments used when evaluating tennis elbow, along with their purpose:

Diagnostic Test or Assessment	Purpose
Medical history	To understand when the pain started, which activities trigger it and whether an injury or repetitive activity may be involved
Physical examination	To locate tenderness and assess elbow, wrist and forearm movement and function
Grip-strength assessment	To determine whether gripping reproduces pain or whether pain-free grip strength is reduced
Resisted wrist or finger extension	To check whether loading the forearm extensor tendons reproduces characteristic outer-elbow pain
X-ray	To investigate suspected bone or joint problems when symptoms or examination findings are atypical
Ultrasound	To assess the common extensor tendon and surrounding soft tissues in selected persistent or uncertain cases
MRI	To examine tendons and other elbow structures when the diagnosis remains uncertain or another condition is suspected
Nerve testing	To investigate a possible nerve-related cause when significant weakness, numbness or other neurological features are present

FAQs

Q1. What is the first symptom of tennis elbow?

Ans: Pain or tenderness on the outside of the elbow is often the first noticeable symptom. It may initially occur only while gripping, lifting or repeatedly moving the wrist.
Q2. How is tennis elbow different from golfer's elbow?

Ans: Tennis elbow causes pain mainly on the outside of the elbow, while golfer's elbow causes pain on the inner side. Both involve forearm tendons but affect different tendon attachments.
Q3. How does tennis elbow cause pain in the wrist?

Ans: Pain from tennis elbow can extend down the outer forearm towards the wrist because the affected muscles and tendons run between these areas.
Q4. Does tennis elbow cause a weak grip?

Ans: Yes. Pain when the forearm muscles are activated can reduce grip strength and make holding, lifting or squeezing objects difficult.
Q5. Are tennis elbow symptoms different in men and women?

Ans: No. Tennis elbow generally causes the same symptoms in men and women, including outer elbow pain, tenderness and discomfort during gripping or lifting.
Q6. Can tennis elbow pain spread into the forearm or wrist?

Ans: Yes. Tennis elbow pain can extend from the outer elbow into the forearm and towards the wrist, especially during gripping or lifting.
Q7. Can tennis elbow symptoms vary in intensity?

Ans: Yes. Symptoms of tennis elbow can range from mild discomfort during certain activities to persistent pain and reduced grip strength that interfere with work, exercise or everyday tasks.
Q8. When should I see a healthcare professional for a tennis elbow injury?

Ans: Seek medical assessment if tennis elbow pain persists, keeps worsening, limits everyday activities or does not improve after reducing the activities that trigger it.