Do you have a feeling that one of your elbow tendon muscles hurts especially after during sports activities?
Every month thousands of people wonder on the web if it could be elbow tendonitis? And if it is, how can you treat the pain?
As a diagnostic radiographer, I rely on my professional knowledge as well as my research in scientific studies dedicated to treatment of elbow tendonitis.
Enjoy reading and feel free to ask questions in the comments or share your own experience.🙏Last updated: March, 2025. Written by Juliet Semakula, a diagnostic radiographer.
▶️First, what is tendonitis/tendinopathy?
Tendons are tough bands of tissue that connect muscle to bones, there are several types of tendon problems called tendinopathies.
Repetitive activities and sudden trauma can injure tendons which leads to inflammation, pain, and difficulty using the joint. And this is called tendonitis or tenosynovitis
In medical terms, when tendons cause pain, injury or discomfort, we use:
⚫Tendonitis: is an inflammatory reaction that accompanies tendon injury.
⚫Tendinopathy: refers to tendon pain without specifying a particular problem.
⚫Tendinosis: Tendon pain with damaged tendons degenerative state with few or no inflammatory cells.
▶️What exactly is elbow tendonitis?
There are several tendons located in and around the elbow, therefore, theoretically any of them can be the site of tendonitis.
Research teams have given names of the various types of elbow tendinopathies based on their location or mechanism of their occurrence.
▶️There are four types of elbow tendonitis:
1️⃣Lateral epicondylitis also known as (tennis elbow)
Lateral tendonitis, also known as lateral epicondylitis or tennis elbow is a common cause of lateral elbow pain caused by overuse of the wrist for a long period of time (Tosti,2013)
It affects the origin of the extensor carpi radialis brevis (ECRB) muscle, exacerbated by wrist and finger extension against resistance (Konarski,2023)
2️⃣Medial epicondylitis also known as (golfer’s elbow or golfer’s tendonitis)
This is most often known as golfer’s or baseball elbow. It occurs much less frequently than lateral epicondylitis.
It involves the muscles originating on the medial epicondyle of the humerus, it affects the flexor carpi radialis muscle and tendon of the pronator teres muscle (Konarski,2023)
3️⃣Distal biceps tendonitis.
Distal biceps tendonitis is pain at the front of the elbow and upper arm caused by inflammation (swelling) of the biceps tendon
This involves the tendon of the biceps brachii muscle at the elbow.
4️⃣Distal triceps tendonitis
This involves the tendon of the triceps brachii muscle at the elbow, it is a rare type of tendonitis.
Image showing medial and lateral epicondylitis tendon: from:drugs.com
Now let’s see how you can tell if you have one or the other of these tendonitis conditions
▶️How is elbow tendonitis diagnosed: Tests and examinations.
Your doctor may recommend additional tests to rule out other causes of your pain.
⚫ x-ray:
You doctor may decide to request an x-ray to look at arthritis
⚫Ultrasound scan:
Is also used to diagnose tennis elbow or evaluate degeneration tendon.
The hook test used to diagnosis the distal biceps tendon
⚪The patient is asked to flex the elbow to 90 degrees and fully supinate their forearm
⚪The examiner’s index finger is brought in from the lateral aspect of the antecubital fossa to ‘hook’ the biceps tendon.
⚪If the biceps tendon is completely avulsed there is no cord-like structure under which the examiner may hook their index finger, and the hook test is “abnormal”.
The hook test – when the biceps tendon is intact, as above, the examiner can fully insert the finger under the lateral edge of the biceps tendon. The finger passes between the biceps tendon and underlying brachialis muscle ( Beazley,2017)
▶️What causes elbow tendonitis?
🟪Specific arm movements can trigger medial epicondylitis development and are typical for some sports such as golf, baseball, tennis and bowling.
🟪Work-related issues that cause extreme flexion of the elbow, posture with extended elbows, high repetition of movements of the elbow, grasping or lifting of objects with high impact.
🟪Jobs such as carpenters, bricklayers, hammerman’s, painters are prone to this kind of pain.
Sluiter,2001
▶️What are the symptoms of each type of elbow tendonitis?
Although elbow tendonitis is not life threatening and does not cause severe disability, it may be very bothersome in your everyday life.
Lateral epicondylitis symptoms
🟠lateral elbow pain, pain with wrist extension, and weakened grip strength.
According to clinical studies, pain that originates from about the lateral elbow occurs because of dynamic stabilization of the wrist and repetitive loading of the tendons, and muscle activity during tennis (Tosti,2013)
🟠Patients often report a unique discomfort with shaking hands, shaving, lifting luggage or groceries with an extended elbow, or raising a coffee mug.
Medial epicondylitis symptoms
🟠Pain of insidious onset along the medial elbow, which is worsened by resistance to forearm pronation and wrist flexion
🟠Tenderness to palpation usually occurs over the pronator and Sometimes pain radiate distally to the forearm
🟠Joint stiffness, weakness of hand, wrist and numbness or tingling which may radiate into one or more fingers
🟠The pain can come on suddenly or gradually, be intermittent or persistent and localized at the inner side of the elbow
Ciccotti,2004
Distal biceps tendonitis symptoms
🟠Initially, the tendon will become red and swollen with pain or soreness being the primary complaint
🟠The pain is usually located in the front crease of the elbow known as the antecubital fossa.
🟠Tenderness worsens with activity and snapping sensation or sound may happen occasionally.
Distal triceps tendonitis symptoms
🟠You will feel tenderness at the insertion of the triceps muscle, and pain is exacerbated with active or resisted elbow extension.
▶️How do you know if you have tennis elbow / tendinitis?
You can’t know for sure you have tennis elbow without visiting a healthcare provider for a diagnosis
Appearance of tendinitis during clinical examination.
When you go to the doctor usually an examination of the elbow will be done based on your description of pain.
What does tendonitis look like during a clinical examination? There are two main symptoms that help recognise tendonitis:
1️⃣Presence of activity-related pain:
Pain will be localised in a typical area; the side of the elbow at the forearm level is a typical area. This is not the case, for example, with pain in the middle of the forearm.
2️⃣Overuse of the muscles in the affected area, whether in a professional, sports, or artistic context.
Note: after a period of intense activity, for example, a tennis match, tendonitis can transiently cause resting pain
▶️What can be misdiagnosed as tendonitis?
Regardless of the type of elbow tendonitis, there is always activity- related pain that is isolated. The problem is that it is not always easy to judge how isolated the pain really is
The diagnosis of any tendonitis therefore requires carefully ruling out any other possibility.
Here are some of these possibilities
Other issues which can sometimes accompany tendonitis such as:
♦️Nerve compressions
♦️Cervical radiculopathies
♦️ Partial or complete tendon tears
♦️Instability of the elbow
♦️Synovial fold syndrome
Problems that are not urgent but still require specific management promptly.
♦️System rheumatic disease
Problems that require urgent attention such as:
♦️Injuries such as fractures, dislocation and muscle
Systemic rheumatic diseases affecting the whole body for example rheumatoid arthritis.
The good news is if you have been diagnosed with elbow tendonitis, it means that all these problems have been ruled out! At least theoretically remembering mistakes is inevitable.
Kheiran,20
▶️ What happens if you ignore elbow tendonitis?
First, you should know that tendonitis can not heal on its own, although it can heal naturally.
The longer you take to see a doctor for your elbow tendonitis, this will lead to acute pain which can very quickly turn into chronic pain-meaning that it’s more persistent and difficult to treat.
▶️How do you treat elbow tendonitis?
The objective of conservative care is to relieve pain and reduce inflammation, allowing sufficient rehabilitation and return to activities.
Treating lateral epicondylitis can be frustrating for both patients and clinicians. Patients may feel frustrated about the prolonged duration of their pain and functional impairment
Treatments will aim at:
🟡To relieve acute symptoms.
🟡Rehabilitate the pathologic tendon.
🟡Prevent disease recurrence
Appropriate education of patients regarding the nature of the illness, lifestyle modifications to avoid aggravating activities and appropriate use treatment options are critical in early effective management (John,2020)
This may be achieved with various non-surgical and surgical treatment options.
Nonoperative measures are often successful in treating elbow tendonitis and these consist of:
🟡The RICE method is used: You will be advised to rest, apply cold ice compression and elevate your elbow.
🟡Activity modification and flexible exercises may help to improve elbow and wrist mobility and relieve your symptoms in the short term.
🟡Arm Bracing or orthoses: wearing a tennis elbow brace or strap applies pressure to the muscles of the forearm, reducing pressure on the injured tendon in the elbow. Which can be worn for 6 weeks (Struijs,2001)
🟡Physical therapy: A physical therapist will give you stretches and exercises to strengthen the muscles around your elbow and increase your flexibility.
However, the type of exercises matters – eccentric exercise may be helpful, but isometric exercises seem to be no more effective than ice therapy (Clifford,2020)
🟡Shockwave therapy is one of the most common electrotherapeutic modalities recommended for tendinopathy.
A specific pressure frequency will be applied to your injured tendon. The shockwaves encourage your body to speed up the healing.
This method should not be applied for acute epicondylitis but is recommended for patients when symptoms lasting for more than six months or when other treatment options are ineffective (Stasinopoulo,2018)
Multiple physiotherapy methods have been described. For example,
🟡“Deep transverse friction” and Mill’s manipulation, which is essentially a deep tissue massage over the point of maximal tenderness combined with stretching manoeuvres.
🟡The usage of nonsteroidal anti-inflammatory drugs (NSAIDs) Injections such as corticosteroids:
It was estimated that such conservative treatment alleviates symptoms in 88-96% of cases of elbow tendinitis. and are particularly effective in reducing the synovitis associated with flexor-pronator tendon degeneration (Gabel,1995)
🟡Injections such as corticosteroids are the most common applied form of therapy for epicondylitis
May reduce pain and improve arm function, although their mechanism of action remains uncertain, they provide a short-term effect of only for a short period of time about 8 weeks.
Some studies have shown that corticosteroids injection might impair the physiological healing response of local tissues, leading to progression of the disease (Millar,2021)
Image from: (Tosti,2013)
Although they offer good short-term relief it is more likely that the pain will come back and last longer overall (than if no injection was given).
🟡The second commonly injected substance is platelet-rich plasma (PRP)
Treatment with PRP relieves pain, improves recovery of structure and function in epicondylitis patients, but also has a positive effect on quality of life during the recovery process.
Effects of PRP therapy do not appear immediately but they seem to be long-term improvement in patients with epicondylitis pain
Tarpada,2018
Surgical treatment
Usually, surgical management is applied when you fail to respond to conservative methods after 3 to 6 months and all other possible pathological causes for the pain of tendonitis are excluded.
🟡Arthroscopic surgery: can be used for Tennis elbow to be repaired using tiny instruments and small incisions. Like open surgery, this is a same-day or outpatient procedure.
Rehabilitation. Following surgery, your arm may be immobilized temporarily with a splint. About 1 week later, the sutures and splint are removed.
After the splint is removed, exercises are started to stretch the elbow and restore flexibility. Light, gradual strengthening exercises are started about 2 months after surgery.
▶️What is the fastest way to heal elbow tendonitis? How long will pain and discomfort last?
You should start feeling better as soon as you start resting your elbow and avoiding the activity that caused tennis elbow
It can take several months for your elbow to heal. It depends on what caused the injury, how severely it damaged your tendon and how long you’ve had pain.
🔵Pain medication prescribed by your doctor will help with elbow pain.
🔵Stretching and strengthening exercises for your wrist and forearm.
🔵Ultrasound therapy is known to help relieve the pain.
🔵Avoid or reduce activities that make your symptoms worse for at least 2 to 4 weeks and gradually increase your activity levels.
🔵Wear a forearm strap or wrist or elbow brace to help stabilise the elbow.
Elbow tendonitis usually gets better after resting your arm for a few weeks, but it can sometimes last longer.
We have come to the end of this article, any comments share in the comments section. wishing you a quick recovery!🙋
📚Source:
Konarski W, Poboży T, Poboży K, Domańska J, Konarska K. Current concepts of natural course and in management of medial epicondylitis: a clinical overview. Orthop Rev:2023 . doi:10.52965/001c.84275
Tosti R, Jennings J, Sewards JM. Lateral epicondylitis of the elbow. Am J Med. 2013 Apr;126(4):357.e1-6. doi: 10.1016/j.amjmed.2012.09.018. Epub 2013 Feb 8. PMID: 23398951.
Millar NL, Silbernagel KG, Thorborg K, Kirwan PD, Galatz LM, Abrams GD, Murrell GAC, McInnes IB, Rodeo SA. Tendinopathy. Nat Rev Dis Primers. 2021 Jan 7;7(1):1. doi: 10.1038/s41572-020-00234-1. Erratum in: Nat Rev Dis Primers. 2021 Feb 3;7(1):10. doi: 10.1038/s41572-021-00251-8. PMID: 33414454.
Kheiran A, Pandey A, Pandey R. Common tendinopathies around the elbow; what does current evidence say? J Clin Orthop Trauma. 2021 May 21;19:216-223. doi: 10.1016/j.jcot.2021.05.021. PMID: 34150494; PMCID: PMC8190485.
Ciccotti MC, Schwartz MA, Ciccotti MG. Diagnosis and treatment of medial epicondylitis of the elbow. Clin Sports Med. 2004 Oct;23(4):693-705, xi. doi: 10.1016/j.csm.2004.04.011. PMID: 15474230.
Johns N, Shridhar V. Lateral epicondylitis: Current concepts. Aust J Gen Pract. 2020 Nov;49(11):707-709. doi: 10.31128/AJGP-07-20-5519. PMID: 33123709.
Beazley JC, Lawrence TM, Drew SJ, Modi CS. Distal Biceps and Triceps Injuries. Open Orthop J. 2017 Nov 30;11:1364-1372. doi: 10.2174/1874325001711011364. PMID: 29290876; PMCID: PMC5721327.
Struijs PA, Smidt N, Arola H, van Dijk CN, Buchbinder R, Assendelft WJ. Orthotic devices for tennis elbow. Cochrane Database Syst Rev. 2001;2002(2):CD001821. doi: 10.1002/14651858.CD001821. Update in: Cochrane Database Syst Rev. 2002;(1):CD001821. doi: 10.1002/14651858.CD001821. PMID: 11406011; PMCID: PMC8407516.
Clifford C, Challoumas D, Paul L, Syme G, Millar NL. Effectiveness of isometric exercise in the management of tendinopathy: a systematic review and meta-analysis of randomised trials. BMJ Open Sport Exerc Med. 2020 Aug 4;6(1):e000760. doi: 10.1136/bmjsem-2020-000760. PMID: 32818059; PMCID: PMC7406028.
Gabel GT, Morrey BF. Operative treatment of medical epicondylitis. Influence of concomitant ulnar neuropathy at the elbow. J Bone Jt Surg. 1995;77(7):1065-1069. doi:10.2106/00004623-199507000-00013
Tarpada SP, Morris MT, Lian J, Rashidi S. Current advances in the treatment of medial and lateral epicondylitis. J Orthop. 2018 Feb 2;15(1):107-110. doi: 10.1016/j.jor.2018.01.040. PMID: 29657450; PMCID: PMC5895908.
Stasinopoulos D. Can extracorporeal shock-wave therapy be used for the management of lateral elbow tendinopathy? World J Methodol. 2018 Nov 29;8(3):37-39. doi: 10.5662/wjm.v8.i3.37. PMID: 30519537; PMCID: PMC6275556.
Sluiter JK, Rest KM, HW Frings-Dresen MH. Criteria document for evaluating the work-relatedness of upper-extremity musculoskeletal disorders. Scand J Work Environ Health. 2001;27:1-102. doi:10.5271/sjweh.637
Image 1: https://www.drugs.com/health-guide/tennis-elbow-lateral-epicondylitis.html