Lateral Epicondylitis (Tennis Elbow)

Outer elbow pain that hurts when you grip, lift, or shake hands?

Tennis elbow is one of the most common upper limb complaints we see, and it’s one of the conditions that responds best to focused shockwave therapy in combination with a structured rehabilitation programme. Most people who’ve tried rest, strapping, or steroid injections without success see real improvement with this approach.

What is lateral epicondylitis?

Lateral epicondylitis, commonly known as tennis elbow, is a common cause of pain on the outer side of the elbow. It involves irritation or degeneration of the tendons that attach to the lateral epicondyle - the bony prominence on the outside of the elbow, where the forearm extensor muscles originate. Despite the name, tennis elbow is not limited to tennis players. It is frequently seen in people whose work or daily activities involve repetitive gripping, lifting, or wrist extension movements. As with other tendinopathies, longer-standing cases often reflect tendon overload and reduced healing capacity rather than simple inflammation.

Common Symptoms

Symptoms are usually well-localised to the outer elbow, though pain can radiate down the forearm. Common features include:

Pain on the outer side of the elbow, often well-localised
Discomfort when gripping, lifting, or carrying
Pain when shaking hands or turning a door handle
Weakness in the forearm or wrist
Tenderness when pressing into the lateral epicondyle
Pain that worsens with repeated use and eases with rest

Who does it commonly affect?

Tennis elbow is one of the most common upper limb complaints presenting in clinical practice. It most frequently affects people in their 40s to 60s, but can occur at any age. It is particularly associated with:

• Repetitive gripping, lifting, or twisting activities at work or in sport

• Manual workers, tradespeople, and those who use hand tools

• Computer users who adopt poor wrist or forearm postures

• Racket sports players, particularly those with poor technique or equipment fit

• Gardeners and those engaged in repetitive household tasks

It often develops gradually without a single identifiable injury.

How is lateral epicondylitis usually treated?

Most cases improve with appropriate conservative care, but this often requires a combination of approaches rather than a single treatment.

Common elements include:

Load management and activity modification to reduce strain on the tendon
Targeted strengthening exercises for the forearm extensors and wrist
Addressing grip strength, shoulder mechanics, and contributing factors
Supportive bracing where appropriate
Manual therapy to the elbow, wrist, and cervical spine where indicated

For persistent or long-standing symptoms that have not settled with time or basic care, focused shockwave therapy is commonly used as part of a structured care pathway. Focused shockwave therapy is more comfortable than radial shockwave therapy and requires fewer sessions overall.

Why our approach is different

At Tenby Health & West Wales Ultrasound, we focus on understanding the problem properly before deciding on treatment. Where clinically appropriate, we use diagnostic ultrasound to assess the extensor tendons, confirm the diagnosis, and rule out other causes of elbow pain.

This allows treatment to be targeted and appropriate, rather than applied on a trial-and-error basis. For suitable cases, focused shockwave therapy is used alongside a structured rehabilitation programme. Our approach combines:

A structured clinical assessment
Diagnostic imaging where indicated
Supervised rehabilitation sessions
A progressive exercise plan targeting the tendon and contributing muscle groups
Guidance on activity modification and return to sport or work

What to do next

If outer elbow pain or tennis elbow is affecting your daily life, the most important first step is a proper assessment.

Book a new patient consultation (£65) and we’ll assess your symptoms, confirm the diagnosis, and explain your options clearly - whether that’s shockwave, rehabilitation, diagnostic ultrasound, or a combination. Most people leave their first appointment knowing what’s going on for the first time.