Tennis elbow (lateral epicondylitis) often develops over a long period of time, and its symptoms can also appear gradually. It is also common for symptoms to wax and wane over time, with flare-ups occurring during periods of increased activity. While its common symptoms are a gradual buildup of pain and stiffness, it is also possible for symptoms to be non-specific, with the only indications of the condition showing up as a drop in athletic or work performance.1American Academy of Orthopedic Surgeons. Tennis elbow (lateral epicondylitis). September 2009: OrthoInfo. Accessed December 30, 2014.

Symptoms of tennis elbow include, but are not limited to:

Pain and/or stiffness in the dominant arm. For example, a right-handed person may notice more pain in the right arm.

Pain, burning, or stiffness that gradually worsens over time. Pain in the outer elbow, radiating to the forearm, wrist, and/or fingers that starts out as an intermittent nuisance and then intensifies and becomes more constant. In severe cases, the pain is completely debilitating, making activities of daily living difficult or impossible.2Reynolds, G. Phys ed: an easy fix for tennis elbow? August 25, 2009: The New York Times, WELL Blog. Accessed December 29, 2014.

Pain that increases with activity but improves with rest. For example, an assembly-line worker may experience arm or elbow pain during the workday, but symptoms stop after leaving work.3Walrod, BJ. Lateral epicondylitis clinical presentation. June 13, 2014: Medscape. Accessed December 29, 2014.

A painful burning sensation in the outer elbow. This sensation often worsens when bending or flexing the arm, such as when swinging a tennis racquet or when using a knife and fork.

Pain, burning, and/or stiffness in both elbows and/or forearms. Patients who use both elbows/forearms equally in their daily activities, such as weightlifters or assembly-line workers, may experience symptoms in both arms.


Pain originating in the elbow that radiates down the forearm. This pain is typically felt on the outer elbow and runs along the outside of the arm and into the wrist.4Walrod, BJ et al. Lateral epicondylitis overview. June 13, 2014: Medscape. Accessed December 30, 2014

Elbow stiffness and aching in the morning. Elbow stiffness and aching are worst in the morning upon waking, with aching continuing at some level throughout the day.5Almekinders, L, and Matava, M. Tennis elbow. Sports Tips. Rosemont, IL: American Orthopedic Society for Sports Medicine, 2008.

Difficulty gripping or holding items in the hand. Muscle weakness may develop in the wrist, palm, and fingers, impairing one's ability to grip objects. For example, tennis players may have difficulty holding their racquets tight, or carpenters may have trouble holding or using a hammer or drill6Whaley, AL, Baker CL. Lateral epicondylitis. Clin Sports Med 23 (2004); 677-691. doi:10.1016/j.csm.2004.006.004.. In regular daily activities, patients may also experience pain when shaking hands or lifting up a purse or briefcase.

Elbow and/or wrist that is tender to the touch. Tenderness is felt when the affected area is touched, even if swelling, pain, or other symptoms are not present.


Difficulty turning or flexing the wrist. For example, patients may have trouble turning a screwdriver or doorknob, stirring a pot, or doing a backhand return in tennis or racquetball.

Pain triggered by squeezing motions. For example, making a fist, shaking hands with another person, or squeezing a stress ball may cause the pain to flare up.

Pain during athletic activity. Athletes may feel pain, burning, or stiffness when doing certain types of upper-body exercises, such as push-ups, planks/arm balances, weightlifting, or when using fitness equipment designed to strengthen the arms and wrists, such as isometric resistance bands or kettlebells.

Because several different elbow and forearm injuries have similar symptoms, patients experiencing one or more of the above symptoms are advised to seek medical attention, so a doctor can either diagnose or rule out tennis elbow.

Dr. Nikhil Verma is a sports medicine physician and orthopedic surgeon at Midwest Orthopaedics at Rush University. He specializes in treating shoulder, elbow, and knee injuries. In addition to maintaining an active clinical practice, Dr. Verma serves as a team physician for the Chicago White Sox and the Chicago Bulls.