Tennis elbow, also called lateral epicondylitis, is a painful condition affecting the tendons on the outer side of the elbow. In my practice, I often see people assume this problem happens only to tennis players, but that is not true. Many patients in Bangladesh develop tennis elbow from repeated hand, wrist, and forearm use during office work, teaching, tailoring, manual labor, household activity, gym exercise, or using tools for long periods. [1][2]
The condition usually develops gradually. Pain often starts as mild discomfort on the outer side of the elbow and then worsens over weeks or months. Many patients notice difficulty when gripping objects, lifting a kettle, carrying shopping bags, turning a doorknob, shaking hands, or even holding a mobile phone for a long time. [1][2]
One important point I want Bangladeshi patients to understand is that tennis elbow is not usually a major joint injury. It is more often an overuse problem involving the tendon attachment of the forearm extensor muscles, especially near the lateral epicondyle of the elbow. With the right diagnosis, activity adjustment, rehabilitation, and patience, most people improve without surgery. [1]
What Is Tennis Elbow?
Tennis elbow is a condition affecting the tendons that help extend the wrist and fingers. These tendons attach to the bony prominence on the outside of the elbow, called the lateral epicondyle. Repetitive strain can lead to microscopic damage in this area and cause pain, tenderness, and reduced grip strength. [1]
Although the name sounds sports-specific, many patients who develop tennis elbow have never played tennis. In Dhaka, I frequently think about practical triggers such as:
– repeated typing with poor desk setup
– lifting or carrying items with the wrist extended
– repetitive use of screwdrivers, pliers, or hand tools
– salon or tailoring work
– childcare tasks such as lifting a child repeatedly
– gym training with poor form
– prolonged cooking, cleaning, or wringing cloth by hand
That is why the treatment plan has to fit the patient’s real daily routine rather than only the medical label.
Common Symptoms of Lateral Epicondylitis
The symptoms usually build up slowly rather than starting with one dramatic injury. [1][2]
Pain on the Outer Side of the Elbow
The most common complaint is pain or burning over the outer elbow. Some patients can point to one exact spot. Others feel the pain spread down the forearm.
Weak Grip Strength
Many patients tell me, “Doctor, my hand feels weak even though I can move it.” Grip weakness is common because gripping activities load the painful tendon area. [1]
Pain During Everyday Tasks
Pain may worsen with:
– lifting a cup or jug
– opening jars
– shaking hands
– turning a key
– carrying a bag
– using a computer mouse for long periods
– playing racket sports
– wringing clothes
– repetitive cutting or chopping work
Night Discomfort
Some people feel pain at night, especially after a heavy-use day. This does not always mean the condition is severe, but it does suggest the tendon is being irritated repeatedly. [1]
Why Tennis Elbow Happens
Tennis elbow usually develops because of overuse rather than a single major injury. The tendon becomes stressed by repetitive wrist extension, gripping, and twisting motions. [1][2]
Repetitive Overload
When the same forearm motions are repeated again and again, the tendon may not recover properly between activities. Over time, the tissue becomes painful.
Technique and Posture Problems
In sports, poor backhand technique or equipment issues may contribute. In day-to-day life, poor work posture, poorly positioned keyboards, repetitive heavy gripping, and awkward lifting technique can all make symptoms worse.
Age Group and Work Demands
Tennis elbow is common in active adults, especially when work or household tasks involve repetitive forearm strain. In Bangladesh, patients may continue working through pain because stopping work is not practical. That often turns an early, mild problem into a more persistent one.
How I Assess Tennis Elbow
When I evaluate patients with outer elbow pain, I do not assume it is tennis elbow immediately. Several other problems can mimic it, so careful assessment matters.
History Taking
I ask:
– where exactly the pain is located
– what activities bring it on
– whether the patient has neck pain, numbness, or tingling
– whether there was any trauma
– whether grip weakness is the main problem
– how long the pain has been present
– what work or household tasks are repetitive
This helps me separate tendon-related pain from nerve problems, arthritis, instability, or referred pain from the neck.
Physical Examination
On examination, I check for tenderness over the lateral epicondyle and assess pain during resisted wrist or finger extension. I also examine the neck, shoulder, elbow movement, and nerve function, because not every elbow pain is really coming from the elbow. [1]
When Tests May Be Needed
Most uncomplicated tennis elbow cases do not need many tests at the beginning. But if symptoms are unusual, severe, prolonged, or not improving, X-rays, MRI, or nerve tests may be considered to rule out arthritis, nerve compression, or other conditions. [1]
Treatment of Tennis Elbow
Most patients improve with nonsurgical treatment. In my practice, I usually explain that recovery depends not only on medicine but also on changing the activity pattern that keeps irritating the tendon. [1]
Rest Does Not Mean Complete Inactivity
The first step is reducing or modifying the movements that trigger pain. That does not mean complete bed rest or avoiding all arm use. It means stopping the specific overload.
For example, in Dhaka or elsewhere in Bangladesh, that may mean:
– reducing heavy household chores for a short period
– taking breaks from long keyboard sessions
– changing the height of the desk or chair
– using both hands for lifting
– avoiding repeated twisting with one arm
– asking family members to help with heavy tasks during a flare
