Epicondylitis refers to degeneration and chronic irritation of the tendons that attach to the bony prominences (epicondyles) of the humerus at the elbow. Lateral epicondylitis — commonly known as "tennis elbow" — affects the outer elbow, while medial epicondylitis — known as "golfer's elbow" — affects the inner elbow. Despite the popular names, both conditions occur frequently in people who have never played these sports.
Medial epicondylitis shares the medial elbow with the UCL, and the two conditions can coexist. When medial elbow pain is prominent in an overhead athlete, a dedicated elbow MRI is often needed to determine whether symptoms are coming from the flexor tendon, the UCL, or both.
Causes
Repetitive overuse.
Epicondylitis is an overuse injury caused by repetitive gripping, wrist extension (lateral), or wrist flexion and forearm pronation (medial). Lateral epicondylitis most often involves the extensor carpi radialis brevis tendon, while medial epicondylitis involves the flexor-pronator tendon group. It is common in tennis players, golfers, manual laborers, painters, plumbers, and anyone who performs repetitive forearm and wrist motions at work or during recreation.
Degenerative changes.
Rather than true inflammation, research has shown that epicondylitis primarily involves a degenerative process called angiofibroblastic tendinosis — characterized by disorganized collagen, increased blood vessel formation, and failure of normal tendon healing. This is why the condition often becomes chronic if not properly addressed.
Symptoms
Lateral epicondylitis causes pain and tenderness on the outer side of the elbow that may radiate down the forearm. Gripping, shaking hands, lifting, or turning a doorknob typically aggravates symptoms. Medial epicondylitis causes pain on the inner elbow that may radiate along the inner forearm, worsened by wrist flexion, forearm pronation, and gripping. Both conditions are typically gradual in onset, peaking weeks to months after the repetitive activity began.
Diagnosis
Diagnosis is largely clinical. Physical examination reveals point tenderness directly over the affected epicondyle and reproduction of pain with resisted wrist extension (lateral) or wrist flexion (medial). A dedicated elbow MRI is valuable when the diagnosis is uncertain, when symptoms are severe or persistent, or when surgical planning is needed. MRI can identify the degree of tendon degeneration, partial tearing, and rule out other causes of elbow pain such as a collateral ligament injury or loose bodies.
Classification
Epicondylitis is graded based on severity of symptoms and tendon pathology:
- Grade 1: Mild tendon irritation with no structural tearing; symptoms resolve with rest.
- Grade 2: Moderate tendinopathy with partial tendon fiber disruption; symptoms persist with activity.
- Grade 3: Severe degeneration with significant partial or complete tendon tearing; symptoms present at rest.
Treatments
The vast majority of epicondylitis cases resolve with conservative management. Fewer than 10% of patients require surgical intervention.
Conservative treatment: Rest and activity modification are the first steps. Physical therapy focusing on eccentric strengthening, flexibility, and manual therapy is the cornerstone of recovery. A counterforce brace (tennis elbow strap) can reduce tendon stress during activity. Ice, anti-inflammatory medications, and topical treatments help manage pain. Most patients see significant improvement within 6 to 12 months.
Injections: Corticosteroid injections may provide short-term pain relief but have not been shown to improve long-term outcomes. Platelet-rich plasma (PRP) injections have gained favor as a biologic treatment to stimulate tendon healing, particularly in chronic or Grade 2 to 3 cases.
Surgical treatment: For the small percentage of patients who fail prolonged conservative management (typically 6 to 12 months), surgery may be recommended. The procedure involves debridement of the degenerative tendon tissue and reattachment of healthy tendon to bone. Both open and arthroscopic approaches are used. Recovery involves a structured rehabilitation program over several months.
Get an MRI to Confirm Your Diagnosis
Before surgical planning or starting treatment, a clear MRI diagnosis ensures the right path forward. First Look MRI offers self-pay Elbow MRI scans — no doctor's order or insurance required — at our locations in Georgia, Texas, and Colorado.