Epicondylitis, tennis elbow and golfer’s elbow

Tennis elbow and golfer’s elbow, medically called epicondylitis, are an overload of the tendon attached to the bony bump of the elbow. On the outer side it is tennis elbow, on the inner side golfer’s elbow. It rarely has anything to do with tennis: it is usually the result of repetitive hand work. In most cases it resolves without surgery, with exercise, although it takes months.

What epicondylitis is

An epicondyle is a bony bump at the lower end of the upper arm bone, near the elbow, which you can feel from the outside. The tendons of the forearm muscles that move the wrist and fingers attach to it.

Epicondylitis is an overload of this tendon where it attaches. The “-itis” ending suggests inflammation, but in long-standing cases the main problem is no longer inflammation but a change in the structure of the tendon. That is why anti-inflammatory treatment alone cannot fully cure it. On this in general: tendinopathy.

	Tennis elbow	Golfer’s elbow
Where it hurts	Outer side of the elbow	Inner side of the elbow
Which tendon	The one that lifts the wrist and fingers	The one that bends the wrist and fingers
What makes it worse	Lifting a cup, shaking hands, using a mouse, turning a screwdriver	Gripping, bending the wrist, lifting with the palm up
How common	Much more common	Less common

Why it happens

The main cause of epicondylitis is repetitive load that the tendon cannot keep up with. Most often:

• a computer mouse and keyboard, especially with the wrist in a poor position;
• working with tools: a screwdriver, a hammer, a paintbrush;
• housework and gardening: lifting pans, wringing, hoeing;
• carrying a heavy bag or a child;
• tennis, badminton or golf, especially with technique errors.

Pain often appears when this kind of work suddenly increases, for example during home renovation or when starting a new job. It most often shows up in middle age.

How the diagnosis is made

The diagnosis is usually made by examination: a tender spot on the epicondyle and pain when you try to lift the wrist while the doctor holds your hand back. Ultrasound shows thickening and structural change in the tendon, which confirms the diagnosis and rules out other causes.

Not every elbow pain is epicondylitis. Pain can come from the neck, especially if you also have numb fingers, or from a problem in the joint itself. That is why the examination does not stop at the elbow.

How it is treated without surgery

What	What it does
Change in load	Reduces the movement that irritates the tendon, without stopping use of the arm altogether
Gradual exercise	Returns load to the tendon correctly and strengthens it; this is the foundation of treatment
Forearm strap	Reduces pain during work
Workplace set-up	Position of the mouse and keyboard, tool handles
Shockwave therapy	For long-standing pain; available at the BAU rehabilitation centre
PRP	For long-standing pain, when exercise is not enough

If an injection is needed, I give it under ultrasound guidance. On PRP in detail: PRP therapy.

Exercises

Exercise starts slowly and becomes gradually harder. Mild pain during exercise is acceptable as long as it does not increase by the next day.

1. Static hold. Rest your forearm on a table, palm down. Press down on the back of the hand with your other hand while trying to lift the wrist, so that the hand does not move. Hold for a few seconds.
2. Slow lowering. Hold a light weight, such as a water bottle, palm down. Lift the wrist with the help of the other hand, then lower it slowly on its own.
3. Grip. Squeeze a soft ball or a rolled-up towel and hold for a few seconds.

For golfer’s elbow, the same exercises are done palm up.

Why I do not rush to a steroid injection

A steroid injection often reduces pain quickly, and that is tempting. But in research it does not improve the long-term result, and pain sometimes returns more often than with exercise-based treatment. That is why a steroid injection is not the first choice for epicondylitis. More detail: steroid injection.

When you should not wait

• after a fall or a blow, the elbow is swollen, its shape has changed or you cannot move it;
• the ring and little fingers go numb or the hand becomes weak;
• a soft swelling has appeared on the point of the elbow: this may be bursitis, see fluid in the joint;
• the elbow is hot and red, and you have a fever.

Key points

• Epicondylitis is tendon overload: on the outer side it is tennis elbow, on the inner side golfer’s elbow.
• It rarely has anything to do with tennis: it usually comes from repetitive hand work.
• The foundation of treatment is gradual exercise and a change in load.
• A steroid injection is not the first choice; for long-standing pain PRP and shockwave therapy are considered.
• I do not operate on elbows; when needed, I refer patients to the appropriate surgeon.

On wrist and hand pain: wrist and hand pain. If your elbow has hurt for more than a week, book a consultation.