Tennis elbow is a painful condition at the outer forearm, just where forearm meets the arm. This condition is also known as tennis elbow. Lately due to new evidence this condition has been brought under the umbrella of OOS (Occupational Overuse Syndromes also known as repetitive strain injury (RSI) syndromes.

Tennis elbow symptoms

Tennis elbow pain is most often connected to the activity of the arm or a wrist such as opening a jar or a door. Pain could also be quite intense with burning quality.


Latest studies have revealed a widespread mechanical hypersensitivity in patients suffering with lateral epicondilitis. Studies show that the brains perception of mechanical input such as occurs with normal activities of daily living is heightened. Patients with tennis elbow have significantly higher pain levels to pressure or cold applied over the muscles of the forearm. This evidence supports a role of peripheral sensitization mechanisms in the initiation of this syndrome.

  • In patients younger then 45 years old the cause is repetitive strain (overuse)
  • Sensitization phenomenon (also occurring in younger population)
  • In patients older then 50 years old with presence of degenerative joint disease in the cervical spine (neck arthritis) the cause is secondary to the degenerative disease disrupting neck arm nerve connection.

Types of lateral epicondilitis

There are three types of lateral epicondilitis:
  • Osteogenic – the pain is in the bony prominence of the lateral epicondyle
  • Myofascial – the muscles attaching to the lateral epicondyle are either hypotonic (weak and flaccid) or hypertonic (too tense)
  • Tendinosis – there is a degenerative process occurring in common extensor tendon (the tendons originating in the lateral epicondyle which primary function is to extend the wrist)
  • Arthrogenic – facilitated hyperactivity of elbow musculature secondary to secondary to the degenerative disease of the cervical spine
Diagnosis is clinical.
Could be confirmed by diagnostic ultrasonography.

Differential diagnosis

Following conditions could mimic tennis elbow:
  • Radial nerve impingement
  • Posterior interosseous nerve impingement
  • Elbow arthritis
  • Fracture of lateral epicondyle (trauma must be present)
  • Cervical radiculopathy

Case study

A forty-eight-year-old female writer presents with pain in the lateral elbow. She has been diagnosed with Lateral Epicondylitis (tennis elbow) and given steroid injection. She had no resolution of her symptoms and then went to see another doctor who treated her with extracorporeal shockwave and five months of physical therapy. Nine months into the problem she was still in pain.

We did diagnostic ultrasonography and did not see any tendinosis of tendons inserting over the lateral epicondyle, however we did find a compression of the Posterior Interosseous Nerve (PIN) at the entrance of the Arcade of Froshe. The PIN nerve compression is a common mimicker of a tennis elbow. This compression in the mild or even moderate form can easily be missed on MRI. Diagnostic ultrasonography is 100% diagnostic and early diagnosis is an edge between conservative care and surgical decompression of the tunnel.

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Risk factors

Postural support of the spine, shoulder and neck plays a key role in distribution of forces throughout elbow and forearm. In other words, inadequate support of the neck and shoulder blades on the spine causes further peripheral imbalance into muscles traveling across multiple joints of shoulder, elbow and wrist. Scientific evidence and clinical experience shows us that recovery time of treatment for wrist and elbow syndromes are much abbreviated when stability of shoulder blades is addressed.

Wrist mobility. Wrist and finger mobility is one of the most important factors in formation of stress to the lateral elbow.

Tissue texture quality plays an important role in development of musculoskeletal conditions of upper extremities. Women are usually more affected with painful syndromes of wrist and elbow due to different hormonal profile, which negatively affects tissue tensile quality.

Tennis elbow treatment

Deficit in grip strength is a primary physical impairment in patients with tennis elbow. This deficit is predominately due to prior weakness and disruption of coordination to shoulder-elbow -wrist connection. Therefore pain is a result of consequences of this disruption to motor function. Therefore the mainstay of successful treatment of this condition is specific therapeutic exercise. There is significant evidence to support the role of isometric exercise in reducing pain, particularly in a ‘non-compressed’ position. There is also significant evidence (up to 76%) for treatment of chronic lateral elbow pain with Extracorporeal Shock Wave therapy.

Tennis elbow treatment at NYDNRehab


For patients suffering from tennis elbow pain, we provide the most comprehensive approach. We use Dynamic Neuromuscular Stabilization (DNS), to restore alignment, mobility and stability at the elbow, wrist and shoulder. Our specialists also use many different types of fascial manipulation to improve motion control, allowing the myofascial tissue to lengthen and reduce stress to the muscles and tendons and their insertion to the bone at the lateral epicondyle. We also use acupuncture to eliminate active trigger points in the area of the forearm.


For patients suffering chronic severe pain or who have not responded well to conventional treatments, we may perform extracorporeal shockwave therapy (ESWT). Because shockwave therapy does not require a subcutaneous incision, it is non-invasive regenerative therapy. Low-intensity set of pressure and acoustic waves are used to stimulate metabolism and enhance the blood circulation in the affected area (neovasculogenesis). ESWT is a biological regenerative treatment that accelerates the healing process, gradually regenerating and restoring damaged tissue. Those hoping to treat elbow pain need look no further than the NYDNRehab.

Lateral Epicondylitis (Tennis Elbow)
Lateral epicondylitis, commonly called tennis elbow, is a painful inflammatory condition felt at the outside of the elbow. While the condition is often associated with tennis, it can also occur from occupational overuse from repetitive twisting motions.

Tennis Elbow Symptoms

Tennis elbow is marked by pain, burning and tenderness at the outside of the elbow, usually on the dominant arm. Inflamed tissue may feel warm to the touch. Pain may escalate when carrying objects with an extended elbow, or during rotating motions like opening a jar or turning a doorknob.

Causes of Tennis Elbow

  • Tennis elbow is most commonly caused by repetitive wrist and arm movements, particularly in young and middle aged adults.
  • In older adults, tennis elbow may be associated with joint degeneration, cervical nerve compression, and a heightened sensitivity to pain stimuli.

There are four subcategories of lateral epicondylitis:

  • Osteogenic, originating from the bony prominence of the lateral epicondyle
  • Myofascial, stemming from too tight or too lax muscle tension at the elbow
  • Tendinosis, caused by degeneration of the common extensor tendon that extends the wrist
  • Arthrogenic, hyperactivity of the elbow musculature secondary to cervical spine degeneration

Diagnosis of Lateral Epicondylitis

Clinical diagnosis begins with a health history and physical exam. Diagnostic ultrasound may be used to confirm diagnosis and rule out other causes of elbow pain.

Some conditions that mimic tennis elbow include:

  • Impingement of the radial nerve
  • Arthritis of the elbow
  • Cervical nerve compression
  • Lateral epicondyle fracture
  • Posterior interosseous nerve impingement

Case Study

A 48 year old female writer presented at our clinic with pain in her lateral elbow. She had been diagnosed with lateral epicondylitis, and treated with steroid injections. When her symptoms were not resolved, she went to another practitioner who treated her elbow with extracorporeal shock wave therapy (ESWT) and five months of physical therapy. Nine months later, she was still in pain.

We used diagnostic ultrasonography to examine her elbow, and found no evidence of tendinosis at the lateral epicondyle, but we did discover a compression of the posterior interosseous nerve (PIN), which is a common mimicker of tennis elbow, and which is easily missed on MRI. Diagnostic ultrasound provides a clear image of the structures of the elbow in motion, in real time, offering precise insight into the nature and cause of the patient’s elbow pain. Early diagnosis with ultrasound can spare the patient ineffective conservative treatment approaches, and unnecessary surgery.

Risk Factors

There are several risk factors that predispose a patient to tennis elbow:

  • Postural support: The distribution of forces along the elbow and forearm are directly affected by postural support of the spine, shoulder and neck. Inadequate support of the neck and shoulder blades contributes to muscle imbalances at the shoulder, elbow and wrists. Clinical evidence shows that recovery time for tennis elbow is shortened when shoulder blade stability is also addressed.
  • Wrist mobility: Wrist and finger mobility are key factors that contribute to lateral elbow strain.
  • Tissue texture quality: The quality of soft tissues can affect upper extremity musculoskeletal health. The presence of knots, adhesions and scar tissue can inhibit fluid joint movement. Weakened or tight tissues can cause muscle imbalances that increase injury risk.
  • Female gender: Women are at higher risk of painful wrist and elbow conditions due to a hormonal profile that affects the tensile quality of soft tissues.

Treatment for Tennis Elbow Pain

Poor grip strength associated with disrupted coordination of the shoulder-elbow-wrist connection is a primary dysfunction of people with tennis elbow, which in turn leads to pain in the lateral epicondyle. Therapeutic exercise has long been the mainstay of treatment for severe elbow pain. Isometric exercise is sometimes effective in reducing pain when held in a non-compressed position. Extracorporeal shockwave therapy has been shown to have a high rate of success in treating lateral epicondylitis.

Tennis Elbow Treatment at NYDNRehab

At NYDNR, we use a holistic and comprehensive approach to treat our patients with tennis elbow pain. After diagnosis using real-time ultrasound, we follow up with innovative therapeutic treatments, including:

  • DNS (Dynamic Neuromuscular Stabilization) to restore alignment, stability and mobility to upper body structures
  • Myofascial manipulation to improve motor control and lengthen myofascial tissue
  • Acupuncture to eliminate active trigger points in the forearm
  • ESWT (Extracorporeal Shock Wave Therapy) to enhance circulation and promote cellular regeneration

For the best elbow pain treatment to help you heal quickly and improve your performance, contact NYDNR today. We are the very best clinic to treat tennis elbow in NYC.

130 West 42 Street, Suite 1055, New York, NY 10036
130 west 42 street, suite 1055 New York, NY 10036

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