Lateral epicondylitis, commonly known as tennis elbow, is an overuse injury affecting the tendons on the outer side of the elbow. This condition involves degeneration of the common extensor tendon, most often the origin of the extensor carpi radialis brevis (ECRB) muscle, which connects the forearm muscles to the humerus bone. Repeated strain from activities involving gripping or wrist extension leads to micro-tears and structural changes in the tendon tissue.
The First Step Primary Care and Initial Assessment
Most individuals experiencing elbow pain begin their journey with a primary care physician (PCP), such as a family doctor or an internist. This initial assessment confirms the diagnosis of tennis elbow and rules out other potential causes of pain. The physician will conduct a physical examination, noting tenderness directly over the lateral epicondyle and assessing pain with specific wrist and finger extension tests.
To achieve a differential diagnosis, the PCP may order imaging like X-rays to exclude conditions such as elbow arthritis or stress fractures. They may also use diagnostic tools like an electromyography (EMG) to ensure the pain is not caused by nerve entrapment, which can mimic tennis elbow symptoms. The primary care professional typically initiates the first line of conservative treatment, which includes rest, wearing a brace or counterforce strap, and using nonsteroidal anti-inflammatory drugs (NSAIDs) to manage pain. This initial management often serves as the gatekeeper for referral to specialized care if symptoms do not improve within several weeks.
Non-Surgical Medical Specialists
If conservative measures managed by a PCP are insufficient, specialized doctors in non-surgical musculoskeletal care become involved. Physiatrists, who specialize in physical medicine and rehabilitation (PM&R), focus on restoring function and improving the quality of life without surgery. They are experts in diagnosing and treating nerve, muscle, and bone conditions, often employing advanced interventional procedures. Physiatrists frequently administer targeted injections, such as corticosteroids for temporary pain relief or regenerative treatments like Platelet-Rich Plasma (PRP) to stimulate the body’s natural healing processes.
Sports medicine physicians also play a significant role, particularly for patients whose injury is related to athletic or occupational activities requiring repetitive motion. These specialists focus on detailed biomechanical analysis, activity modification, and developing structured return-to-play or return-to-work protocols. While many people associate orthopedic specialists with surgery, a majority of orthopedic treatment for tennis elbow is non-surgical, involving diagnosis, bracing recommendations, and coordinating conservative therapies before considering an operation.
Physical and Occupational Therapy
Physical and occupational therapists focus on rehabilitation and functional recovery. Physical therapy (PT) primarily concentrates on restoring strength, flexibility, and range of motion in the elbow and forearm. Treatment often involves highly specific exercises, such as eccentric strengthening of the ECRB muscle, which has been shown to be particularly effective for tendon injuries. Physical therapists also use modalities like ultrasound, manual therapy, and dry needling to reduce pain and improve tissue mobility.
Occupational therapy (OT), in contrast, centers its approach on improving a patient’s ability to perform daily living tasks and work-related activities. Occupational therapists assess and modify functional patterns, focusing on grip techniques, tool usage, and ergonomic adjustments at home or in the workplace. By adapting the environment or the activity itself, the occupational therapist reduces the strain on the injured tendon, preventing re-injury during routine tasks like lifting, typing, or gardening.
When Surgical Intervention is Required
Surgery for tennis elbow is typically reserved as a last resort, indicated only after a period of six to twelve months of comprehensive, failed conservative treatment. The specialists who perform these procedures are orthopedic surgeons, often those with sub-specialty training in hand and upper extremity surgery. The procedure generally involves removing the diseased, degenerated tendon tissue and reattaching the healthy tendon back to the bone. This can be performed through traditional open surgery, requiring a single incision, or via arthroscopic techniques using smaller incisions and a camera. Following the operation, a structured and prolonged rehabilitation program with physical or occupational therapy is always initiated to restore full strength and movement.