Tennis Elbow Causes and Risk Factors

There are a number of ways that tennis elbow can develop, and some people are at higher risk of getting the condition than others. Many types of athletes—as well as anyone who relies on heavy use of repetitive arm and/or hand motions in their daily occupations—are at risk for developing tennis elbow.


Additional causes and risk factors for tennis elbow include, but are not limited to:

Age. People age 30 and older are at increased risk of developing tennis elbow. The risk accelerates even more after age 40.1,2

Not warming up before strenuous activity. Muscles and tendons are more pliable and less prone to tear when athletes stretch and warm up before engaging in intense sports or physically demanding work. Failing to do so can increase the risk of tissue damage that can lead to tennis elbow.

Improper use of sports equipment, such as a tennis racket that is too small or too large for the athlete, or a racket that is not strung properly (for example, the head surface is too tight or too loose, or the racket is too heavy for the user).

Poor athletic technique, such as when tennis players use hitting force that is supported mostly by the elbow rather than the core (abdominal) muscles.

Recent use of certain medications, such as fluoroquinolone antibiotics (Cipro, Levaquin, Avelox).3,4


Playing tennis or other racket sports in inclement weather, including hitting rain-soaked tennis balls and/or playing into the wind.

Direct trauma to the elbow, such as colliding with another player or falling onto the elbow.1,5

Working in physically repetitive occupations, such as carpentry, bricklaying, instrumental music, clothing construction, plumbing, assembly-line production, or intensive computer work.6

Playing non-racket sports or engaging in other recreational activities that involve repetitive use of the arm and wrists, such as casting lines when fishing, rowing or paddling a boat or canoe, or overhand throwing of balls and other objects.

While the above factors will increase a person's chance of developing tennis elbow, some people will develop it for idiopathic (unknown) reasons. Additionally, some people who are at risk for developing tennis elbow never actually do.


  • 1.Kurppa K et al. Tennis elbow: lateral elbow pain syndrome. Scand J Work Environ & Health 5 (1979); suppl. 3, 15-18.
  • 2.Almekinders, L, and Matava, M. Tennis elbow. Sports Tips. Rosemont, IL: American Orthopedic Society for Sports Medicine, 2008.
  • 3.Whaley, AL, Baker CL. Lateral epicondylitis. Clin Sports Med 23 (2004); 677-691. doi:10.1016/j.csm.2004.006.004.
  • 4.LeHuec JC et al. Epicondylitis after treatment with fluoroquinolone antibiotics. J Bone Joint Surg Br (1995); 77:293-5.
  • 5.Schneeberger AG, Masquelet AC. Arterial vascularization of the proximal extensor carpi radialis brevis tendon. Clin Orthp 398 (2002); 239-44.
  • 6.Almekinders, L, and Matava, M. Tennis elbow. Sports Tips. Rosemont, IL: American Orthopedic Society for Sports Medicine, 2008.