Purpose We investigated technical and physiological responses along with their relationships during an incremental field test to exhaustion specific to tennis (TEST) in elite players. Methods Twenty male elite tennis players completed TEST, which consisted of hitting alternatively forehand and backhand strokes at increasing ball frequency (ball machine) every minute. Ball accuracy (BA), ball velocity (BV), and tennis performance (TP) index (TP = BA × BV) were determined by radar and video analysis for each stroke, in addition to cardiorespiratory responses and blood lactate concentrations. Results At low intensities (less than 80% of maximal oxygen uptake [VO2max]), technical performance was steady. From 80% to 100% of VO2max, significant and steady decreases in BV (-9.0% and -13.3%; P = 0.02 and P = 0.002), BA (-19.4% and -18.4%; both P < 0.001), and TP (-27.4% and -29.15%; both P = 0.002) occurred for forehands and backhands, respectively. Changes in TP and blood lactate concentration from 60% to 100% of VO2max were inversely correlated (r = -0.51, P = 0.008). BV was 5.2% higher (P = 0.042) for forehand versus backhand, and there was no difference between strokes for both BA (P = 0.930) and TP (P = 0.536). Conclusion Technical alterations (i.e., decrease in BV, BA, and TP) in elite players undergoing TEST only occurred at high intensity (>80% of VO2max), presumably because of the use of compensatory strategies to overcome fatigue. Above this intensity, all technical indices decreased steadily until exhaustion, independently of the stroke nature.