How Is Tennis Elbow Diagnosed?

Because tennis elbow (lateral epicondylitis) is a condition resulting from overuse, it develops over time, with symptoms appearing gradually.  It's not uncommon for these symptoms to fluctuate, mainly manifesting during periods of increased effort. Even if the buildup of stiffness and pain in the elbow is progressive, some of the symptoms may be non-specific to the condition, with the patient only noticing a reduction in the ability to perform athletic or occupational activities.  

Common Symptoms

  • Pain/stiffness in the dominant arm
  • Pain/stiffness that gradually intensifies
  • Pain that increases with effort and decreases with rest
  • Pain in the elbow’s exterior
  • Pain/stiffness during mornings
  • Complications with gripping or maneuvering items
  • Tenderness in the elbow and/or wrist


If these symptoms are experienced, it's recommended to consult with a physician. The condition is diagnosed through a physical exam and may involve imaging to rule out other elbow injuries that manifest similar symptoms to tennis elbow. If the condition is more severe, the physician may make a referral to an experienced physical therapist or surgeon specializing in sports medicine. 

The physician will go over the patient's history to assess potential risk factors, including sports and occupations, when the symptoms began manifesting, what area is most affected, how the pain is spread and radiates, and checking for numbness or tingling in the digits. 

During the exam, the physician will visually and manually inspect the affected elbow and arm, testing nerve reflexes, bone and joint alignment, and range of motion to dismiss joint damage or potentially trapped nerves.

Even though diagnostic imaging isn't usually required, its use may be necessary to exclude other factors that might influence a patient's symptoms:

  • X-rays – can detect bone fractures/chips, a misaligned joint, or arthritis affecting the elbow.
  • MRI – magnetic resonance imaging may be conducted to rule out symptoms resulting from other afflictions and identify tears in the tendon, thus excluding other possible causes like damaged cartilage or ligaments.
  • EMG – An electromyography may be required to test nerve conduction and rule out nerve entrapment or compression.