“The outer side of my elbow’s been painful for weeks — it hurts to grip, lift the kettle or shake hands”

LATERAL EPICONDYLITIS (tennis elbow) is an overuse TENDINOPATHY of the common extensor origin at the lateral epicondyle, recognised by lateral elbow pain with local tenderness, worse on GRIPPING/lifting and resisted wrist/finger EXTENSION (e.g. positive Cozen’s test), typically from repetitive forearm use and coming on without acute injury. Distinguish it from medial epicondylitis (golfer’s elbow), radial tunnel syndrome (more distal, no point epicondyle tenderness), referred cervical/neurological pain (neck symptoms, paraesthesiae) and elbow osteoarthritis (older, stiffness/crepitus) — clinical features usually suffice and imaging is not routinely needed. Finger-drop weakness suggests posterior interosseous nerve entrapment and is urgent; a hot swollen joint suggests septic or inflammatory arthritis. Manage conservatively, as it is largely self-limiting over months (about 89% improve within a year without active treatment, Ikonen 2022): load management/activity modification without complete rest (reduce aggravating gripping), topical NSAIDs for up to about 4 weeks, a forearm (counterforce) strap that may be offered but may not help, and physiotherapy with progressive ECCENTRIC strengthening exercises, plus ergonomic advice on tools and technique and a fit note for amended duties where needed — these are first-line (BESS pathway, Singh 2023). A corticosteroid injection may give short-term relief but worse outcomes at a year (recovery 83% vs 96% with placebo, recurrence 54% vs 12%, Coombes, JAMA 2013), so BESS advises against it; refer to MSK/orthopaedic services for refractory cases after several months of well-done exercise-based care (shockwave only with special arrangements, NICE HTG201). Set realistic, slow-recovery expectations, reassure about the favourable course, and safety-net for atypical/neurological features that would prompt reconsideration.