Elbow tendinopathy and tennis elbow in Clarksville, starting with an exam

Lateral elbow tendinopathy, better known as tennis elbow, is pain on the outside of the elbow where the tendons of the forearm muscles that straighten your wrist and fingers attach to the bone. It usually comes from overuse, and you don't have to play tennis to get it: gripping, lifting, tools and computer work can all bring it on. At Source Chiropractic in Clarksville, Dr. Jeff, Dr. Cindy and Dr. Ali examine and treat painful, stiff muscles and joints, including muscles and joints strained by sports and overuse, and the neck, which can send pain down the arm. If your elbow hurts when you grip, lift or turn a handle, a first visit starts with your history and an exam, and the plan depends on what the exam finds. Other problems can hurt in the same spot, so we name elbow pain after an exam, not before.

Golfer's elbow, the same kind of problem on the inside of the elbow, has its own section below.

What does tennis elbow feel like?

The main symptom is pain on the outside of the elbow. The NHS describes it as anything from mild discomfort when you move your arm to constant pain that can affect your sleep, usually worse when you lift or bend your arm, grip something or move your wrist. Other symptoms include tenderness or swelling at the elbow, pain in the forearm, and trouble fully straightening the arm.

It usually creeps up. According to AAOS, the American Academy of Orthopaedic Surgeons, the pain often starts mild and slowly gets worse over weeks and months, usually with no single injury to blame. A weaker grip and pain or burning on the outer elbow are common, some people have pain at night, and it's usually the dominant arm, though both arms can be affected.

Why does my elbow hurt when I grip something?

The muscles that pull your wrist and fingers back start at a bony bump on the outside of the elbow, the lateral epicondyle. AAOS explains that the tendon most often involved, the extensor carpi radialis brevis, belongs to a forearm muscle that helps hold the wrist steady when the elbow is straight. When that muscle is weakened by overuse, tiny tears can form where its tendon attaches to the bone, and the pain sits right over the outside of the elbow.

That's why gripping is the classic trigger. Holding a racquet, turning a wrench and shaking hands all ask those forearm muscles to work, and AAOS lists them among the activities that often make the symptoms worse. AAOS describes the tendons wearing down, and in some cases tearing, from overuse. You'll see the same problem called lateral epicondylitis, tennis elbow or lateral elbow tendinopathy.

Who gets tennis elbow?

Athletes aren't the only people who get it. AAOS says painters, plumbers and carpenters are particularly prone, and that auto workers, cooks and butchers get it more often than the rest of the population. The NHS adds typing or using a mouse, sewing, using a screwdriver and playing a musical instrument. AAOS says most people who get it are between 30 and 50, though anyone can, and that it can also turn up with no repetitive task anyone can point to.

If it started with a job, our work injury page covers how repeated tasks build up. If it started with a sport, our sports and chiropractic article covers when a sports injury needs medical care first.

What happens at your first visit for elbow pain?

Your first visit starts with a detailed history. You'll sit down with Dr. Jeff, Dr. Cindy or Dr. Ali and go over your health history, your symptoms, your concerns and your goals, such as holding a coffee cup without wincing, getting through a shift with tools, carrying the groceries in one trip or getting back to a round of golf. We'll ask which grip or lift sets it off, how quickly it came on, and what changed at work, in a hobby or in training before it started. The pattern helps point to the cause.

Then comes a full evaluation, with full-spine X-rays when they're clinically appropriate. Because elbow and forearm pain can start at the tendon, at a nerve or in the neck, the exam may look at the elbow, the forearm, the wrist and the neck: how the joints move, where muscles are tight or swollen, and for signs of an irritated nerve. You'll hear what we found before we recommend anything, and the plan is built around your condition and those goals.

The new-patient chiropractic offer has its own terms. Book online or contact us.

What care do we use for elbow pain from overuse?

Care depends on what the exam finds, because pain at the elbow can come from the tendon, a nerve or the neck. A plan may include:

• Class IV laser therapy. We commonly use our Summus Horizon Class IV laser on muscles and joints strained by sports and overuse. The manufacturer intends it for temporary relief of minor muscle and joint pain, stiffness and muscle spasm, and we use it alongside other care, not on its own.
• Rehab exercises for weakness and movement problems the exam finds, such as a grip that has lost strength, to build strength and movement back up.
• Chiropractic adjustments when the exam finds joints in the neck or upper back that aren't moving well. An adjustment is a controlled force applied to a specific joint, usually by hand.

A licensed massage therapist also works out of our office, and we'll put you in touch when soft-tissue work fits.

What does the research show for lateral elbow tendinopathy?

Here's what the reviews closest to that care found in lateral elbow tendinopathy:

• High-intensity laser. A 2023 review of six randomized trials with 344 people with persistent symptoms found low-quality evidence that high-intensity laser reduced pain a little more than the comparison groups, both during activity and at rest, and slightly improved the physical part of a quality-of-life score. Grip strength, hand function and overall quality of life didn't differ significantly from the other therapies. A 2026 analysis of 12 randomized trials found that pain improved from where people started with both high-intensity and low-level laser, and that function and grip strength improved with both, with high-intensity laser showing the greater gains in grip strength and low-level laser the more consistent results for pain. Against placebo, though, high-intensity laser's advantage for pain wasn't statistically significant.
• Exercise. A 2021 review of 30 randomized trials with 2,123 people found that exercise did better than passive treatments, with or without injections, but the effect was small. Against steroid injections, exercise did better on every outcome at every time point except short-term pain. Against waiting to see, it did better only on some outcomes.

The two reviews that graded their evidence rated it low or very low in certainty, the effects are small, and the trials tested laser and exercise in general rather than our own care, so they describe groups of people, not what your elbow will do.

Is the care safe?

The main risk with a Class IV laser is to the eyes and skin from the beam, which is why eye protection and correct operation matter. For adjustments, NCCIH, the National Institutes of Health center for complementary health, says mild to moderate side effects such as increased pain or discomfort, stiffness or headache often follow spinal manipulation, and most go away within 24 hours. Serious side effects, including serious spinal or neurological problems and strokes involving arteries in the neck, have been reported. They are very rare, and there's no accurate estimate of how often they happen.

Your history and paperwork are part of how we check for any reason an adjustment, or another treatment, isn't right for you before we start.

What other options are there for tennis elbow?

AAOS says approximately 80 to 95% of patients have success with nonsurgical treatment: rest from the activities that bring on the pain, pain relievers such as acetaminophen or anti-inflammatory medicine, physical or occupational therapy with forearm strengthening exercises, and a brace centered over the back of the forearm. AAOS also lists steroid injections, which it advises using very sparingly, and surgery if symptoms don't respond after 6 to 12 months of nonsurgical treatment. We'll go over the options that fit you at your exam.

Is golfer's elbow the same as tennis elbow?

It's the same kind of problem on the other side of the elbow. Golfer's elbow, or medial epicondylitis, is pain on the inside of the elbow, where the tendons of the muscles that bend the wrist and fingers and turn the forearm inward attach. AAOS says it can come from overuse or overexertion in golf, throwing, tennis and weightlifting, and from repetitive everyday tasks such as some household chores, usually in adults between 40 and 60. It typically brings pain or burning on the inner elbow, sometimes shooting toward the hand, a weaker grip and less wrist or elbow movement because of the pain.

The ulnar nerve, the "funny bone" nerve, runs just behind that inner bump, and AAOS notes it is occasionally irritated along with golfer's elbow, which can bring numbness and tingling in the ring and little fingers. The research above is about the outside of the elbow, and our inner elbow guide covers how tendon and nerve symptoms differ on that side.

Could my elbow pain be a nerve or my neck?

Sometimes. AAOS notes that many nerves travel around the elbow, and the symptoms of nerve compression there are similar to those of tennis elbow, and that a herniated disc or arthritic changes in the neck can also produce arm pain. Tingling, numbness or a changing grip may not be the tendon at all, so our exam also looks for an irritated nerve. New or worsening hand weakness, or numbness that keeps getting worse, needs a prompt medical assessment before anything else. Pain that runs from the neck or shoulder into the arm, or that changes when you move your neck, points the exam toward the neck. Our arm pain guide explains why location alone can't settle it, and the carpal tunnel and forearm guides cover hand and forearm symptoms.

Do you need an X-ray or MRI for tennis elbow?

AAOS describes a diagnosis built on how the symptoms developed, your work and sports, and an exam that checks for tenderness over the bony bump and for pain when you straighten your wrist and fingers against resistance with the arm straight, and says a doctor may recommend other tests to rule out other causes. X-rays may be taken to rule out arthritis of the elbow, an MRI can show the extent of tendon damage or another injury, an MRI of the neck can look for a disc or arthritic problem there, and a nerve test (EMG) can rule out a compressed nerve.

At our office, X-rays at the first visit are full-spine X-rays, taken when they're clinically appropriate. If what we find calls for elbow imaging, a nerve test or a specialist's opinion, we'll tell you and refer you.

When does elbow pain need urgent care?

Most elbow pain from overuse isn't urgent. These are the exceptions.

Call 911 if elbow or arm pain comes with chest discomfort, shortness of breath, nausea or a cold sweat. A heart attack can cause pain or discomfort in one or both arms, the back, shoulders, neck or jaw, and MedlinePlus says to call 911 even if you're not sure it's a heart attack.

Call 911 or go to an emergency department after an injury if you heard a crack, the elbow or arm has changed shape or is pointing at an odd angle, it's numb or tingling, or the skin has turned blue or grey or is cold to touch. These are among the NHS signs of a possible broken bone.

Get a prompt medical assessment, not a routine appointment with us, if after an injury the pain is severe or getting worse, there's a large or growing amount of swelling or bruising, the elbow is very stiff or hard to move, or you also have a very high temperature or feel hot, cold or shivery, which the NHS says could be an infection.

Get urgent medical help, even without an injury, if the elbow suddenly becomes very painful, hot, swollen or red, or it hurts and you feel unwell with a high temperature. The NHS says a joint infection needs to be checked straight away.

How do you know if your elbow is getting better?

Tennis elbow usually gets better with rest but can sometimes last over a year, so it helps to have a way to tell. When tennis elbow hangs on, checking one everyday task, like carrying groceries, at a set point shows if things are moving. If progress stalls, the diagnosis or the plan may need another look. Our outer elbow guide and arm and elbow section cover the problems nearby.

Book a visit

If your elbow hurts when you grip, lift or turn a handle, and none of the warning signs above fit, a first visit in Clarksville is where we start working out what's behind it. If you're not sure it's tennis elbow at all, the exam is how we look for what else it could be. If we are not able to help you with your problem or are unable to reduce your pain levels, we will make sure to give you a recommendation to another experienced provider. Book online or contact us.