Why does the outside of my elbow hurt when I grip?

What it feels like

A specific, tender point on the bony bump on the outside of the elbow, with pain on gripping, lifting with the palm down, turning a doorknob or holding a coffee cup. Grip strength is often noticeably reduced, and the pain can radiate down the forearm.

What is actually happening

The tendons of the wrist extensors — most often extensor carpi radialis brevis, sometimes with extensor carpi radialis longus — attach at that point, and repeated gripping loads them at the attachment. Like other tendinopathies, the tissue has lost load tolerance rather than become inflamed.

It is usually driven by desk work, trades, lifting, or a recent change in training, far more often than by racquet sports.

How it is treated

Progressive isometric and then heavy slow resistance loading of the wrist extensors, combined with grip retraining and modification of the aggravating task. Shoulder and scapular strength are assessed too, because a weak shoulder increases the demand on the forearm.

Where symptoms have persisted for months, extracorporeal shockwave therapy is added alongside the loading programme, typically as a course of five weekly sessions.

A note on anti-inflammatories

Over-the-counter anti-inflammatories are not appropriate for everyone, particularly if you take medication for blood pressure or are on blood thinners. That is a conversation for your physician or pharmacist rather than something to self-prescribe.