Tennis elbow: when the grip pain is the tendon, and when it is your neck

Tennis elbow is wear of the tendon that attaches to the bony bump on the outside of the elbow. It hurts when you grip, lift a cup or turn a key, and most people who have it never played tennis. PRP placed into the tendon has the strongest evidence of any orthobiologic use and tends to outlast cortisone.

What does tennis elbow feel like?

The pain sits on the outside of the elbow, on the bony bump, and can spread into the back of the forearm. Shaking hands, lifting a gallon of milk with the palm down, opening a jar, or using a mouse all day can set it off. Grip may feel weak. Morning stiffness is common.

The tendon involved is the one that pulls your wrist back. Every grip uses it to hold the wrist steady. That is why office work, carpentry, painting and lifting a toddler cause far more tennis elbow than tennis does.

Could my elbow pain be coming from my neck?

Sometimes, and this site exists for that reason. The C6 and C7 nerve roots supply the outer forearm. A pinched nerve at those levels can cause outer elbow pain that looks like tennis elbow. People with neck problems also seem more likely to have stubborn tennis elbow, perhaps because an irritated nerve makes the tendon more sensitive.

• Tennis elbow is tender at one spot on the bony bump. Gripping and lifting with the palm down bring it on.
• Neck-driven pain spreads, comes with tingling in the thumb or fingers, and changes with neck movement.
• Both at once is common. If elbow treatment keeps failing, the neck needs a look.

We examine the neck at every elbow visit. A nerve study helps when the picture is mixed; see EMG and nerve conduction studies. For the nerve on the inner side of the elbow, read cubital tunnel or the neck.

Why does tennis elbow last so long?

Tennis elbow is not mainly inflammation. Under the microscope the tendon shows tangled collagen and failed repair. The tendon tried to heal and stalled. That is why many cases drag on for a year or more.

Anything that slows repair makes it worse: smoking, high blood sugar, insulin resistance, and the same grip every day with no time to recover. Repeated cortisone shots belong on that list too.

Why not just get a cortisone shot?

Because the relief is borrowed. Cortisone often brings fast relief, which is why it stays popular. But trials show its edge fades within a few months, and people who got it are more likely to have the pain come back. The steroid quiets pain while slowing the cells that rebuild the tendon. The video above explains why that trade rarely pays off.

We still use it now and then, such as a short-term need with no other path. It is not our first choice for a tendon that is already failing to heal.

How does PRP treat tennis elbow?

We draw your blood, spin it, and collect a measured dose of platelets. Under ultrasound, we place it into the worn part of the tendon. We often use several small passes so the whole damaged area gets it. Platelets release growth factors that restart the stalled repair.

Dose matters. A low-platelet preparation is a weaker treatment, and placement by feel alone can miss the damaged area. We guide every injection and measure what we deliver. For long-standing, badly scarred tendons we may discuss bone marrow concentrate.

Dr. Padda has a habit of testing things on himself first. He has drawn his own blood and worn a heart monitor through his own sauna experiments, once triggering an irregular rhythm that he reversed with a cold plunge. That habit is why the platelet dose gets counted here instead of assumed. A tendon cannot report what it received; a lab count can.

What does the research say about PRP for tennis elbow?

This is the strongest evidence in the orthobiologic field. A 2024 review of 11 randomized trials with 730 patients compared PRP with cortisone. Cortisone won in the first two months. At six months and later, PRP gave clearly better pain relief and function.

A 2025 European review listed tennis elbow among the conditions where PRP improves how patients feel and function. A 2026 international expert panel reached consensus on PRP for tennis elbow. A 2024 multispecialty pain guideline reached a similar view for tendon problems.

What can you change at work and at home for tennis elbow?

• Grip lighter. Most people squeeze a mouse, a steering wheel or a hammer far harder than the task needs.
• Lift with the palm up when you can. That shifts load away from the sore tendon.
• Use a thicker handle on tools and pans. A fat grip needs less squeezing force.
• Break up long stretches of typing or tool use with a short pause every 30 minutes.
• Check the neck and the desk. A forward head and a low screen load the C6 nerve and the forearm at the same time.

The tendon heals on the days you are not overloading it. If the same grip habits come back the week after an injection, so does the pain. That is not a failed treatment. It is a tendon that was never given the room to finish the job.

What is recovery like?

You stay awake. Local anesthetic numbs the area, with no sedation, so most people drive themselves home. The elbow will be sore for about 48 hours. Skip ibuprofen and similar pills for a while. Light use is fine. Gentle tendon loading starts within the first two weeks and builds over two to three months. Whether a second injection is needed depends on your response.

We perform PRP at our regenerative clinic, 4477 Woodson Rd in St. Louis, and staff route you at the front desk. PRP is not covered by insurance. HSA and FSA funds are generally eligible.

Over 90% of our accepted case-study patients see significant improvement. These are practice-reported figures from our own population, not trial outcomes, and individual results vary.

What happens at the first visit for elbow pain?

An examination of the elbow and the neck together, with no injection that day. We press along the bony bump and the muscle just below it, then ask you to lift the wrist against resistance with the elbow straight. Pain at one point on the bump during that test is the tendon. Then we turn and tip the neck and check the reflexes in both arms, because a C6 or C7 root can paint the same picture.

Ultrasound in the office shows the tendon itself: thickening, small tears inside it, and new blood vessels growing into the worn area. When the pain sits a few fingers below the bump, in the muscle rather than on the bone, we look at the radial nerve where it passes through the forearm. That nerve is a less familiar cause, and an injection aimed at the tendon misses it completely. If tingling or weakness is part of the story, a nerve study settles it. You leave with a named source rather than a label.

Which elbow symptoms should be seen the same day?

Tennis elbow itself is never an emergency. These are different problems that can be mistaken for it:

• A sudden pop at the front of the elbow while lifting, followed by bruising and a bulge that moves up the arm. The lower biceps tendon can tear, and the repair is time-sensitive.
• A hot, red, swollen elbow, especially with a fever. Infection in the joint or the bursa needs treatment within hours, not weeks.
• A fall onto the arm followed by swelling, an odd shape, or an elbow that will not straighten.
• Weakness in the hand or fingers that is getting worse week by week. Neck causes are covered on when a neck problem is urgent.

Frequently asked questions

Do I need a referral for tennis elbow treatment?

No. You can book directly, online or by phone. Some insurance plans want a referral on file before they pay for a specialist visit, so it is worth checking yours. PRP is not covered by insurance, so a referral does not change that part. What the injection actually feels like, minute by minute.

Can tennis elbow come from a pinched nerve in the neck?

Neck nerve problems can cause pain in the same area, and people with neck problems tend to have more stubborn tennis elbow. If the elbow is not improving, we check the neck. See cervical radiculopathy.

How long does PRP take to work for tennis elbow?

Expect slow change over six to twelve weeks. In trials, PRP pulled ahead of cortisone by six months and stayed ahead.

Do I need surgery for tennis elbow?

Very few people do. Surgery is for cases that fail long, well-run care without surgery, including guided injections and rehab.

Does a tennis elbow brace help?

A forearm strap can ease pain during work by spreading the load. It does not repair the tendon, so pair it with a loading program.

What exercises help tennis elbow?

Slow wrist lifts with a light weight, lowering more slowly than you lift, build the tendon. Grip work and forearm turning follow. Mild discomfort is fine. Sharp pain is not.

Why does tennis elbow keep coming back?

Usually because the tendon never finished healing. Cortisone, rest without loading, and going back to the same grip habits all set up a repeat. Fixing the tendon and the habit together breaks the cycle.

Related reading

• Cubital tunnel, or the neck?
• Which nerve root, C5 to C8
• EMG and nerve conduction studies
• Neck pain from desk work
• When your hands are the problem
• PRP and orthobiologics: the full list of conditions we treat

Grip something in front of us and point to where it hurts. We check the elbow and the neck in one visit.