Home » tennis elbow

tennis elbow


Tennis elbow or lateral epicondylitis is painful condition in lateral epicondyle then pain spread into the forearm and wrist. it is pathological inflammation occur in extensor tendons of hand as extensor carpi radialis longus and brevis as well as extensor digitorum communis. The most muscle affected in tennis elbow is extensor carpi radialis brevis . the inflammation is present in all extensor muscles of hand but in specific in extensor carpi radialis brevis .


Tennis elbow is consider over use syndrome or in another meaning it occur due to repeated movement. The repeated movement leads to microtears. This disease starts with inflammation in acute stage then finally in chronic stage, the inflammation converts to fibrosis. So, it is so important, this problem is treated in acute stage before the inflammation convert into the fibrosis.

  • In the fact, tennis elbow occur commonly  in repeated motion of gripping activities . it occur from sports as tennis, Racquetball, squash, fencing and weight lifting.
  • Not only sports but also other jobs that require repetitive arm movements or gripping such as carpentry, typing, painting, Raking, knitting and Dentist.

signs and symptoms:


2-Tenderness in the lateral epicondyle

3-The pain may radiate on the forearm and that will affect on the functional activities .

How to diagnose:

By special tests , its aim to aggravate pain by doing either resist action or stretch the muscle.

The first special test is mills test ( stetch extensor carpi radialis brevis )

  • Do extention elbow, flexion wrist , flexion finger and ulnar devition.

The second special test is cozen test ( resist action )

  • Do extention elbow and radial deviation with pronation

the third special test called maudsley test ( this test is high sensitivity for patient with tennis elbow )

  • Give order to patient to do extention in wrist and extention in the middle finger.also you can give resistance to patient on the middle finger.
NB: this test concentrate on the middle finger because this is the insertion of extensor carpi radialis brevis  ( base of middle metacarpal )


The most important ttt in tennis elbow is activity modification:

Try to avoid repetitive pronation and supination. Avoid grasping in pronation and do substitution controlled supination lifting .

In acute stage:

The goal in this stage to reduce pain and inflammation , promote healing and increase flexibility.
1-Tennis elbow support
by stretch position ( extention elbow, flexion wrist and ulnar deviation ) , one band of kinesio is put without stretch , the second piece will be stretched 50% in the middle
3-Myofascial release:
By longitudinal traction, wedding or by ball,

put it on the affected area for 10-15 min for 4-6 time per day

5- Iontophoresis – phonophoresis
6-Stretch wrist extensor
just do extention elbow then flex your wrist and sustain then relax, repeat this movement

In sub acute or chronic stage ( once pain sub side):

The goal in this stage to stretch and strength the muscles.
The program:
1- Deep friction massage:
in this video, demonstrate how can we do deep friction massage in tennis elbow? ( do deep friction in and relax out, then repeat this movement)
2- Stretch the wrist and elbow extensors
3- strength the muscles ( concentric eccentric strength)

NB: the most recent researches proved that importance of eccentric contraction in preventing the recurrent injury

use weight in your hand slowly flex and slowly extend your wrist. ( this exercise concentrate mainly on wrist exrensor)

also, we should concentrate on hand grip by squeez the tennis ball and hold in this position for 15 sec.we should strength the supination movement by weight.also, we should do strength after the stretching of muscles due to the stretch do some weakness in the muscle so we should strength it.

4- Return gradually to function
5- Mill’s manipulation

it is very common and useful in treatment of tennis elbow. it is used after Deep friction massage , the combination between Deep friction massage and mills manipulation called cyriax method .

it demostrates how we can do mills manipulation.

also readhttps://ptpainite.com/ankle-sprain/



  1. Selvier T, Wilson J. Methods utilized in treating lateral epicondylitis. Physical Therapy Reviews 2000;5:117–24.
  2. Wright A, Sluka K. Nonpharmacological treatments for musculoskeletal pain. Clin J Pain 2001;17:33–46.
  3. Chamberlain G. Cyriax’s friction massage: a review. J Orthop Sports Phys Ther 1982;4:16–22.
  4. Pienimaki T, Tarvainen T, Siira P, et al. Progressive strengthening and stretching exercises and ultrasound for chronic lateral epicondylitis. Physiotherapy 1996;82:522–30
  5. Vicenzino B, Wright A. Lateral epicondylalgia. I. A review of epidemiology, pathophysioogy, aetiology and natural history. Physical Therapy Reviews 1996;1:23–34
  6. Stasinopoulos D, Johnson MI. Cyriax physiotherapy for tennis elbow/lateral epicondylitis. Br J Sports Med. 2004;38:675-677
  7. 5. Tennis Elbow – MayoClinic.com. Mayo Clinic Medical Information and Tools for Healthy Living – MayoClinic.com. 15 Oct. 2008. Web. 10 Oct. 2010.
  8. Stasinopoulus DI, Stasinopoulos I. Comparison of effects of Cyriax physiotherapy, a supervised exercise programme and polarized polychromatic non-coherent light (Bioptron light) for the treatment of lateral epicondylitis. Clinical Rehabilitation. 2006;20(1):12-23.
  9. Anap DB, Shende ML, Khatri S. Mobilization with Movement Technique as an Adjunct to Conventional Physiotherapy in Treatment of Chronic Lateral Epicondylits-A Comparative Study. Jaurnal of Novel Physiotherapies. 2012;2(7):1-3.
  10. Thakare PS, Babu VK, Kumar S, Ayyappan NVR. Long term effect of cyriax physiotherapy with supervised exercise program in subjects with tennis elbow. Inernational journal of physiotherapy. 2014;1(2):74-82.

Article Name
Tennis elbow
tennis elbow is one of the most common injury due to repetitive movement. it is about inflammation that occurs in the tendon of common extensor . so it is important to manage the tennis elbow in the acute stage before this inflammtion converts into fibrosis in chronic stage. the modification of activity has an important role in preventing injury.
Publisher Name
Menna-t-allah mohammed ibrahim

Leave a Comment

Your email address will not be published. Required fields are marked *

تواصل معنا
السلام عليكم 👋
كيف يمكنني مساعدتك ?