Tennis elbow, or lateral epicondylitis, is a common condition affecting the tendons on the outside of the elbow. It is typically caused by the repeated extension of the wrist and gripping motions, which place excessive strain on the forearm muscles. This persistent overuse leads to microscopic tears and the gradual breakdown of the tendon structure where it attaches to the elbow. Ignoring the symptoms and continuing the causative activity can lead to a progressive worsening of the injury.
Escalation to Chronic Pain
The most immediate consequence of neglecting tennis elbow is the shift from temporary discomfort to chronic, persistent pain. Initially, the pain may only appear during specific activities, but without intervention, it can become constant, radiating down the forearm even when the arm is at rest.
When pain lasts for three months or longer, the nervous system can become hypersensitive, a phenomenon known as central sensitization. The continuous pain signals strengthen the pain pathways, causing the nervous system to remain in a heightened state. This hypersensitivity means that activities that should only cause mild strain, such as picking up a coffee cup or turning a doorknob, trigger a disproportionately severe pain response.
This persistent neurological activation can lead to widespread mechanical hypersensitivity, making the affected arm more sensitive to pressure. The pain, which often begins as a localized ache on the outer elbow, becomes a constant source of distress that interferes with sleep and daily life. Ignoring the underlying issue prevents the body from prioritizing the soft tissue healing process.
Structural Damage to the Tendon
The pathological changes within the tendon move far beyond simple inflammation. The chronic condition is better described as tendinosis, which indicates a degenerative process. The initial microtears progress into a disorganized and weakened tissue structure.
This degeneration is characterized by a condition known as angiofibroblastic hyperplasia, which involves a combination of immature fibroblasts and an increase in new, often disorganized, blood vessels. Instead of producing the strong, parallel-aligned Type I collagen fibers found in healthy tendons, the body produces weaker, disorganized Type III collagen. This structural breakdown leaves the tendon vulnerable and less able to withstand normal mechanical loading.
As the degeneration continues, the tendon tissue can accumulate scar tissue, and in rare cases, calcification may occur, further reducing the tissue’s elasticity. The advanced stages of this degeneration can progress through distinct grades, culminating in a gross structural disruption or mechanical failure of the tendon. While uncommon, the ultimate consequence of unaddressed, long-term stress is the risk of a partial or complete tendon rupture, which is the final stage of tissue failure.
Long-Term Functional Impairment
The combination of chronic pain and severe structural degeneration leads directly to significant, long-term functional impairment in the affected arm. A primary consequence is a severe loss of grip strength. This weakness makes routine tasks that require a firm grasp—like opening a jar or carrying groceries—painful and often impossible.
To avoid pain, individuals unconsciously alter their movement patterns, leading to muscle weakness and deconditioning in the forearm due to disuse. This protective guarding can also cause imbalances in the entire upper limb musculature, potentially leading to overcompensation injuries in adjacent areas like the wrist or shoulder. The reduced muscle function contributes to a decreased range of motion, further limiting the arm’s overall capability.
For those whose work or hobbies require repetitive arm movements, such as manual laborers or certain athletes, untreated tennis elbow can result in a permanent loss of work capacity. If the underlying tissue damage is allowed to progress into chronic degeneration, the resulting limitations may become permanent, severely affecting the individual’s quality of life and potentially leading to persistent disability.