Elbow problems can happen if you torque or place pressure on the elbow by turning your forearm to hit with topspin (pronate purposely).
Many players with a Western grip and torque their arm to do the "windshield" wiper motion, stress the tennis elbow area. Sometimes it gets so bad that surgery is needed to repair the area.
Former USPTA Teaching Professional
Volkl Tour 10 V-Engine Mid/Luxilon Big Banger