Epicondylitis is a painful condition affecting the tendons that attach to the bony bumps on either side of your elbow. It affects 1% to 3% of adults each year, most commonly between ages 40 and 49. Despite its name, which suggests inflammation, the condition is primarily one of tendon degeneration caused by repetitive strain rather than a true inflammatory process.
What Happens Inside the Tendon
The elbow has two epicondyles: bony prominences on the inner and outer sides where forearm muscles anchor via tendons. Lateral epicondylitis, commonly called tennis elbow, involves the tendons on the outer elbow that control wrist extension. Medial epicondylitis, or golfer’s elbow, involves the tendons on the inner elbow used for wrist flexion and gripping.
The name “epicondylitis” is somewhat misleading. When researchers examine affected tendon tissue under a microscope, they find disorganized collagen fibers, immature repair cells, and excessive blood vessel growth, but no actual inflammatory cells. What’s really happening is a cycle of repetitive micro-damage that the tendon can’t fully heal, partly because tendons have a naturally poor blood supply. The result is chronic degeneration rather than the kind of acute inflammation you’d see with a sprain or infection. Some experts prefer the term “tendinosis” or “epicondylalgia” to reflect this more accurately.
Who Gets It and Why
The peak incidence falls between ages 40 and 49, with women affected slightly more often than men in population studies. The primary driver is repetitive motion, but force matters more than repetition alone. Research on workers in food processing, assembly-line manufacturing, and supermarket cashiering found that forceful work was the strongest occupational risk factor for medial epicondylitis, more so than simply performing repetitive tasks. Lateral epicondylitis was associated with repetitive pressing motions and, interestingly, with psychosomatic or depressive problems.
You don’t need to play tennis or golf to develop these conditions. Plumbers, painters, carpenters, cooks, and anyone who regularly grips tools, turns screws, or lifts with a bent wrist can be affected. Office workers who spend long hours typing or using a mouse are also at risk, particularly for the lateral form.
What It Feels Like
The hallmark symptom is pain at the affected epicondyle that worsens with specific movements. With lateral epicondylitis, you’ll typically feel it on the outer elbow when gripping, lifting objects palm-down, or twisting a doorknob. Medial epicondylitis produces pain on the inner elbow during gripping, throwing, or flexing the wrist against resistance. In both cases the pain often starts gradually, sometimes as a mild ache after activity, and progresses to the point where simple tasks like picking up a coffee mug or shaking hands become painful.
Grip strength tends to decrease noticeably. You may feel fine at rest but experience a sharp spike of pain the moment you engage the affected muscles.
How It’s Diagnosed
Diagnosis is largely based on a physical exam rather than imaging. Two common clinical tests help confirm lateral epicondylitis. In one (the Cozen’s test), you sit with your elbow bent at 90 degrees and try to extend your wrist upward against your doctor’s resistance. Pain at the outer elbow is a positive result. In the other (Mill’s test), your doctor passively flexes your wrist while your arm is extended and your fist is closed. Pain at the outer epicondyle again confirms the diagnosis.
Imaging like ultrasound or MRI is generally reserved for cases that don’t respond to treatment or when another condition needs to be ruled out, such as nerve compression or a ligament tear.
Why Steroid Injections Can Backfire
Corticosteroid injections offer fast, noticeable pain relief within the first three to seven weeks. But the long-term picture is unfavorable. Systematic reviews comparing steroid injections to physical therapy found that injections became less effective than therapy at intermediate and long-term follow-up, both for pain and grip strength. Perhaps most concerning, recurrence rates after steroid injections ranged from 34% to 74% across multiple trials.
This pattern makes sense given the underlying biology. Because the condition involves degeneration rather than inflammation, suppressing inflammation with steroids may relieve pain temporarily without addressing the structural problem, and may even weaken the already-compromised tendon tissue further.
Physical Therapy and Exercises
Physical therapy is the most effective long-term treatment, with the best evidence supporting eccentric exercises. These are movements where you slowly lower a weight, lengthening the tendon under controlled load. This type of loading stimulates healthier collagen production and helps remodel the damaged tissue.
A straightforward eccentric exercise for lateral epicondylitis: rest your forearm on a table with your hand hanging off the edge, palm down, holding a light weight. Use your other hand to lift the wrist into extension, then slowly lower the weight under control using only the affected arm. Aim for 10 to 15 repetitions, three sets, three times a day.
Stretching complements the strengthening work. Extend your affected arm in front of you with your palm facing down, let the wrist relax downward, then gently pull the hand toward your body with your other hand. Hold for 30 to 45 seconds, rest briefly, and repeat three times. Twice daily is the recommended frequency for stretching.
These exercises can be uncomfortable at first. Mild discomfort during the exercise is acceptable, but sharp or worsening pain is a signal to reduce the load.
Braces and Supports
Counterforce braces, the strap-style bands worn just below the elbow, are a common and effective short-term tool. They work by reducing strain on the injured tendon and redistributing the forces generated by forearm muscles during gripping and lifting. Electromyographic studies show these braces alter muscle activation patterns, reducing the intensity of contractions that directly load the damaged area.
The result is meaningful pain relief and improved grip strength, particularly in the short term. A brace is most useful as a bridge: it lets you manage daily activities and perform rehabilitation exercises with less pain while the tendon gradually heals through the strengthening program.
Platelet-Rich Plasma: Limited Evidence
Platelet-rich plasma (PRP) injections, which use concentrated growth factors from your own blood, have been heavily marketed for tendon problems. However, a systematic review of six studies, four of them high-quality, found strong evidence that PRP injections are not effective for chronic lateral epicondylitis. Three of the four high-quality studies showed no significant benefit compared to control groups. The one study that did show benefit compared PRP to corticosteroid injections, which are themselves considered harmful for tendon conditions over time.
When Surgery Becomes an Option
Surgery is typically considered only after conservative treatment has failed and symptoms have persisted for more than 12 months. The procedure involves removing the damaged portion of the tendon. Most patients can return to everyday activities by about six weeks after surgery, with full recovery expected between three and six months, though functional improvement often comes well before that final milestone.
The vast majority of people with epicondylitis never need surgery. With a consistent eccentric exercise program and activity modification, most cases resolve within six to twelve months.