A gradual onset of pain is felt on the outside of the elbow and forearm. Initially, it may only be painful following use of the wrist or hand. Stiffness or tightness in the elbow and forearm region may also be present. These early signs of tennis elbow are often ignored, as they quickly disappear with use of the arm or applying heat (i.e. a hot shower) over the elbow and forearm. However, over time, the damage to the tendon progresses and the pain becomes worse. If you continue to use the arm, the tendinopathy usually worsens and your pain may begin to be present for longer periods until it is present all of the time.