Epicondylitis

Overview

Epicondylitis is pain and tendon irritation at the bony bumps on the sides of the elbow, called the epicondyles, where the forearm muscles attach. There are two main types. Lateral epicondylitis, on the outer side, is widely known as tennis elbow. Medial epicondylitis, on the inner side, is known as golfer's elbow. Despite the names, most people who get these conditions do not play tennis or golf.

The condition develops from repetitive use of the forearm muscles and tendons, particularly gripping and wrist movements, which leads to small areas of tendon damage and pain rather than simple inflammation. Although it can be persistent and limiting, epicondylitis usually improves with rest, activity changes, and rehabilitation, and most people recover without surgery.

Symptoms

Symptoms center on the affected side of the elbow and often radiate into the forearm. They tend to come on gradually.

• Pain and tenderness over the outer elbow (tennis elbow) or inner elbow (golfer's elbow)
• Pain that spreads down the forearm
• Discomfort with gripping, lifting, twisting (such as opening a jar), or shaking hands
• A weak or unreliable grip
• Stiffness in the elbow, especially in the morning

In golfer's elbow, some people also notice tingling or numbness into the ring and little fingers if a nearby nerve is irritated.

Causes

Epicondylitis is caused by overuse that strains the forearm tendons at the elbow.

• Repetitive gripping and wrist motion: Activities that repeatedly bend or straighten the wrist or rotate the forearm.
• Sports: Racket sports for tennis elbow, and throwing or club sports for golfer's elbow, especially with poor technique.
• Occupational tasks: Jobs using tools, typing, assembly work, painting, or other repetitive hand activities.
• Sudden overload: A rapid increase in activity or an unaccustomed task.

Over time these strains cause small areas of tendon breakdown, which is the source of the persistent pain.

Risk Factors

• Repetitive arm and wrist activities at work or in sport
• Age, with both forms most common in middle adulthood
• Poor technique or improper equipment in sport
• A sudden increase in activity level
• Forceful, repetitive gripping tasks

Diagnosis

Epicondylitis is usually diagnosed from the history and examination, with imaging used selectively.

• Physical examination: The doctor locates tenderness over the epicondyle and checks for pain when the wrist is moved against resistance.
• Symptom review: Identifying the activities that bring on the pain.
• Imaging: X-rays, ultrasound, or MRI may be used if the diagnosis is unclear or to rule out other causes such as arthritis or a nerve problem.

Treatment

Most cases improve with non-surgical treatment, though recovery can take several weeks to months.

• Rest and activity modification: Reducing or changing the movements that cause pain.
• Ice and pain relief: Cold packs and over-the-counter pain relievers to ease symptoms.
• Physical therapy: Stretching and progressive strengthening exercises, which are central to long-term recovery, plus technique correction.
• Bracing: A counterforce strap or wrist support to reduce strain on the tendon.
• Injections and procedures: Corticosteroid injections may give short-term relief; other options are considered for stubborn cases. Surgery is rarely needed and reserved for persistent, severe symptoms.

Sticking with a rehabilitation program and avoiding aggravating activities give the best chance of lasting improvement.

Prevention

Reducing repetitive strain on the forearm tendons helps prevent epicondylitis and recurrence.

• Warm up and stretch before activities that use the forearm
• Use proper technique and well-fitted equipment in sport
• Strengthen the forearm and wrist muscles gradually
• Take regular breaks during repetitive tasks
• Increase activity levels gradually rather than suddenly

When to See a Doctor

See a doctor if elbow pain persists despite rest and self-care, interferes with daily tasks or work, or is accompanied by weakness, numbness, or tingling in the hand. Prompt evaluation can confirm the diagnosis, rule out other causes such as arthritis or nerve problems, and start a treatment plan that supports recovery and prevents the condition from becoming long-lasting.

Related Topics

Frequently Asked Questions

References

1. American Academy of Orthopaedic Surgeons (AAOS). Tennis Elbow and Golfer's Elbow.
2. Mayo Clinic. Tennis elbow — Symptoms and causes.
3. MedlinePlus, U.S. National Library of Medicine.
4. American Society for Surgery of the Hand.