Elbow pain that flares during a game and fades when you stop is a pattern most players dismiss for months. First it’s a twinge on a backhand. Then it shows up earlier in every session. Then it starts hurting when you lift a cup. By that point the tendon has been degenerating without recovery for a long time.The culprit is almost always lateral epicondylitis, tennis elbow. It is not a joint problem and not a muscle cramp. It is tendon damage at a specific point on the outer elbow, and it responds to specific treatment.

According to Dr. Arpit C Dave, Arthroscopic Surgeon in Dahisar, “Patients assume it will settle with rest. Often it doesn’t. By the time they come in, the tendon has been under load for months and the window for simple treatment has already narrowed.”

Tennis and badminton both involve repeated gripping, wrist extension and forearm rotation movements that load the extensor carpi radialis brevis tendon at the outer elbow. Repeated eccentric stress causes micro-tears that accumulate faster than the tendon can recover.

Why only during sport: Everyday tasks stay below the load threshold most of the time. Racquet strokes push past it because of grip force, speed and torque.

Outer elbow location: Pain and tenderness sit directly on the bony bump on the outside. Gripping and lifting with the palm down hurts. This is different from golfer’s elbow, which affects the inner side.

Technique and equipment: A heavy racquet, wrong grip size, or a late backhand where the wrist absorbs impact instead of the shoulder puts disproportionate strain on the tendon. Recreational players with less refined technique are more commonly affected than professionals.

When it spreads: Carrying bags, shaking hands and typing all start causing pain as the tendon degenerates further. When elbow symptoms also involve clicking or instability, elbow ligament damage needs to be ruled out alongside the tendon problem.

Diagnosis is clinical in most cases. Tenderness on the lateral epicondyle and pain with resisted wrist extension confirm it. Ultrasound or MRI is added when the presentation is atypical or a partial tendon tear needs to be graded.

Activity modification: Reduce the provocative load. Adjust technique, grip size and training volume.

Physiotherapy: Eccentric wrist extensor strengthening drives tendon remodelling. A counterforce brace offloads the attachment during activity.

Injections: PRP has good evidence for promoting tissue healing when physio alone is not achieving progress. Corticosteroids reduce pain short-term but do not address the underlying degeneration.

Arthroscopic release: For cases that have not responded after six months of proper conservative management, arthroscopic removal of the degenerated tendon tissue is highly effective. Recovery follows a structured phased plan consistent with post-arthroscopic rehabilitation principles.

The longer it is left, the more the tendon degenerates and the harder it becomes to treat without surgery. Early assessment keeps options open.

Dr. Arpit C Dave holds an MBBS, DNB and Diploma in Orthopaedics with over 15 years in orthopaedic practice and fellowship training in shoulder and elbow surgery across Italy, Spain and France. He has managed lateral epicondylitis across the full spectrum, from early conservative care to arthroscopic release in resistant cases.

Every patient gets a clear assessment before any treatment decision. Where physio and load management are the right answer, that is what is prescribed with a structured plan and review points. Where injection or surgery is needed, the reasoning is explained before anything is agreed. If your elbow has been flaring through every game for months, get it assessed properly.