GPAtlas🧭 When to suspect
Suspect tennis elbow (lateral epicondylitis) in an adult presenting with pain and tenderness over the outer (lateral) aspect of the elbow, characteristically provoked by gripping or wrist extension – lifting a kettle, shaking hands, turning a key, or using tools. Despite the “-itis” in its name, it is a degenerative tendinopathy of the common extensor origin (principally extensor carpi radialis brevis, ECRB), not an inflammatory condition – histology shows angiofibroblastic change and a notable absence of inflammatory cells.
It is the most common cause of persistent elbow pain in primary care (around two-thirds of cases), with a peak incidence between 35 and 54 years and affecting men and women equally. Only about 5% of cases relate to actual racquet sports; most follow repetitive manual or occupational loading. Reassuringly, it is self-limiting in the great majority: episodes last 6–24 months and around 80–90% resolve within a year, though roughly 1 in 5 have symptoms persisting beyond 12 months.
The two key skills in primary care are to make the diagnosis clinically and to recognise the mimics – a small but important group of conditions present with lateral elbow pain and must not be labelled tennis elbow.
| Consider instead | Discriminating feature |
|---|---|
| Radial tunnel syndrome / PIN entrapment | Pain maximal 4–5 cm distal to the epicondyle (not over it); worse on resisted supination and middle-finger extension; aching, sometimes nocturnal. |
| Cervical radiculopathy (C6–C7) | Neck pain, dermatomal radiation, sensory disturbance or weakness; reproduced by neck movement. |
| Elbow osteoarthritis / loose body | Restricted or painful range of movement, crepitus, mechanical locking – the elbow itself is the problem, not the tendon. |
| Septic arthritis / olecranon bursitis | Hot, swollen, very tender joint with systemic upset – a same-day concern. |
| Golfer’s elbow (medial epicondylitis) | Pain and tenderness on the medial side, worse on resisted wrist flexion and pronation. |
|
🧠 Clinical pearl The “-itis” is a misnomer: this is a degenerative tendinopathy, not inflammation. That single fact explains the management – rest and anti-inflammatories do not cure it, they only ease pain, whereas progressive loading exercise rebuilds the tendon’s capacity and is the most effective treatment. Frame the consultation around load, not rest. |
Source: BESS Patient Care Pathway (Tennis Elbow)
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