What does tennis elbow feel like?

The pain sits on the bony bump on the outside of the elbow. It shoots into the forearm when you grip, lift a gallon of milk, shake hands or turn a stiff doorknob. A coffee cup held at arm’s length can be enough. The elbow itself bends and straightens fine.

Most people who get it have never played tennis. They swing a hammer, run a register, drive a forklift, type all day, or pull wire. The doctor’s name for it is lateral epicondylitis. When the pain is on the inside of the elbow instead, that is golfer’s elbow, a cousin with its own page.

Why does tennis elbow last so long?

The tendon that lifts the wrist is small, and it takes every grip of the day. Over time its fibers fray faster than they can be repaired. Under a microscope it looks less like an inflamed tendon and more like a worn rope, with tangled fibers and stray blood vessels. Rest helps a fresh strain. It does little for a rope that has been fraying for a year.

Blood sugar plays a part too. High sugar stiffens collagen and slows repair, so tendon problems linger in people with diabetes or prediabetes. We check that at the visit, because a tendon in an inflamed body heals on a slower clock.

Why do smoking and belly fat raise the odds of tennis elbow?

The clearest data come from a population study in Finland that examined 4,783 adults aged 30 to 64. About 1.3% had definite tennis elbow on the day they were seen, most often between 45 and 54. Current smokers had about three times the odds of nonsmokers, and former smokers were not much better off. People whose work combined repetitive and forceful arm use had more than five times the odds of people whose work involved neither.

Two biological threads explain it. Nicotine and carbon monoxide narrow the small vessels feeding a tendon that has a thin blood supply to begin with, so less oxygen reaches the cells trying to repair it. Belly fat drives insulin up and releases inflammatory signals that slow collagen turnover in every tendon in the body. The third thread is economic. Production quotas and piece rates reward the fastest grip, not the safest one, and a worker paid by the hour cannot take a month off to rest an elbow. That is why we ask about the job before we look at the scan.

Dr. Padda has drawn his own blood and worn a heart monitor through a sauna experiment, pushing his heart into skipped beats that he then reversed with a cold plunge. He would rather measure than guess, and he takes the readings on himself first. We bring the same habit to the elbow. Progress is tracked with things you can count: how heavy a jug you can lift with a straight arm, how many minutes of mousing before the ache starts, how many nights you sleep through.

How do we confirm it is tennis elbow?

The exam does most of the work. Pressing the bony bump reproduces the pain. So does lifting your wrist or your middle finger against our hand while the elbow is straight. Then we look with ultrasound. A worn tendon shows up thick and dark, sometimes with small tears and extra blood vessels inside it. The scan also shows us exactly where to place the needle later.

A few problems can pass for tennis elbow. A nerve that runs a little lower in the forearm can be pinched by the muscle around it. Arthritis in the elbow joint can ache in the same spot. A nerve root in the neck can send pain to the outer elbow. Each one has a different fix, so we check them before treating the tendon.

Why did my tennis elbow shot stop working?

Cortisone calms the pain quickly. The price shows up later. In a 2013 trial of 165 adults with tennis elbow, more than half of those given a steroid shot had the pain come back within a year, against about one in eight given a placebo shot. It does nothing to rebuild the fibers, and steroid near a tendon can thin it. So a second shot works less than the first. That is the pattern most people describe by the time they reach us.

Does PRP work for tennis elbow?

Here is the clearest finding in this whole field. A 2025 analysis of 13 randomized trials with 791 tennis elbow patients split the studies by how many platelets the PRP actually held. The high-dose trials showed a clear drop in pain compared with other treatments. The low-dose trials showed nothing. Platelet concentration alone explained more than half of the difference between studies.

A 2024 analysis of randomized trials found PRP gave better long-term pain relief and function than other options for tennis elbow. The dose is the one thing that matters most. We prepare a concentrated product for that reason, and we place it with ultrasound into the worn part of the tendon.

What does the rehab look like after PRP?

PRP starts the repair. Rehab tells the new fibers how to line up. For the first days you rest the grip. Then you start slow, controlled wrist lifts with a light weight, often the lowering part only, which loads the tendon without tearing it. The weight goes up week by week. We also look at the job: tool grip size, wrist angle at the keyboard, how often you take a break. A small change at work can protect months of healing.

What happens on the day?

You stay awake. The skin is numbed with local anesthetic, the injection takes a few minutes, and most people drive home. Expect the elbow to ache for about two days. Some people need a second injection after the first has had time to work, and some do not. The tendon decides.

Hurt it on the job in Illinois? Illinois generally lets the injured worker choose the treating doctor. Our injured at work page explains how that works.

When does tennis elbow need surgery?

Rarely. Most cases settle with the right injection and rehab. When a tendon has torn away from the bone, or when a year of good care has failed, a surgical release is an option, and we coordinate that referral.

Which elbow symptoms should not wait for an appointment?

• An elbow that looks out of place or will not bend after a fall: go to the emergency room.
• A hot, red, swollen elbow with fever or chills, which can be an infected joint or bursa: same day.
• Numbness or weakness in the hand that is getting worse instead of better.
• A pop at the front of the elbow, then bruising and a bulge in the upper arm. A torn biceps tendon needs a surgeon within days, not months.

The full list lives on when it is an emergency.

Frequently asked questions

Do I need a referral for tennis elbow treatment?

No. Call, text or book online and the first visit is yours, no referral required. A few insurance plans, mostly HMOs, want one from your primary doctor on file before they pay, so it is worth a look at your card. What the first visit from Illinois looks like covers the rest.

How long does tennis elbow last without treatment?

Many cases settle within a year. Some last far longer, especially in people who cannot rest the grip at work. Waiting is fine if the pain is mild and improving.

Should I wear a tennis elbow strap?

A strap below the elbow can ease pain during work by changing where the muscle pulls. It does not heal the tendon. Use it as a tool, not a treatment.

How soon does PRP work for tennis elbow?

Expect slow change over six to twelve weeks. PRP is not a quick fix. It is aimed at a result that lasts.

Is PRP for tennis elbow covered by insurance?

Most plans do not cover it. That is a choice about what the plan pays for, not a verdict on the treatment. HSA and FSA funds can generally be used.

What can I do at home for tennis elbow right now?

Lift and carry with your palm facing up, which takes the strain off this tendon. Use a thicker grip on tools. Take short breaks from the mouse and keyboard. Ice after a hard day if it helps.

Can tennis elbow come from my neck?

Sometimes. A pinched nerve in the neck can cause outer elbow and forearm pain. We check the neck at the exam, as covered on cervical radiculopathy.

Related reading

• Golfer’s elbow
• Rotator cuff tendinitis
• Cervical radiculopathy
• Injured at work
• Metabolic health and pain
• Orthobiologics in the Metro East: all the conditions we treat