Tennis elbow is a common condition that generally occurs in middle age, characterised by pain on the outside of the elbow.  The condition is aggravated by contraction of the muscles that extend the wrist and fingers.  The pain can be severe and tends to vary in rough proportion to activity.  The problem usually resolves as the patient sooner or later modifies their activity to avoid loading the involved muscles.

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The quality of tendon attachment to bone slowly deteriorates through adult life.  Muscle strength however is entirely proportional to use, until very late in life.

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The muscles that extend the wrist and fingers attach to the outside of the elbow.  This attachment is called the “extensor origin”.  Significant repetitive load through these muscles may lead to overload of the extensor origin.  This will lead to a process called inflammation which is the body’s “repair process”.  It involves movement of tissue fluid and cells into the zone of injury which increases the pressure in the tissues and causes discomfort.  As the swelling resolves, the process leads to the production of scar tissue.  If the scar tissue is allowed to mature, it gains strength and the extensor origin is fit to be loaded again.  The tennis elbow will have resolved.

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Unfortunately, even under ideal circumstances, the process of inflammation and scar repair can take many months.  Occupational, domestic and recreational demands may overload the maturing scar repair causing disruption and delay of the repair process, associated with fluctuating discomfort.