Overview
Lateral epicondylitis (Tennis Elbow) and medial epicondylitis (Golfer's Elbow) are among
the most prevalent upper-limb tendinopathies, frequently affecting IT professionals,
surgeons, homemakers, and manual workers — not just sportspeople. Lateral epicondylitis
involves degeneration of the extensor carpi radialis brevis (ECRB) tendon at its origin
on the lateral epicondyle; medial epicondylitis involves the flexor-pronator mass at the
medial epicondyle. Both result in activity-limiting forearm and elbow pain.
Symptoms & Causes
Common Symptoms
- Lateral epicondylitis: pain on outer elbow radiating to forearm
- Medial epicondylitis: pain on inner elbow, sometimes with ulnar nerve
tingling
- Weak grip strength and difficulty holding objects
- Pain with wrist extension (tennis elbow) or flexion (golfer's elbow)
- Tenderness to touch at the epicondyle
- Pain with handshake, opening jars, lifting kettles
- Stiffness in the morning or after rest
Common Causes
- Repetitive forearm use — typing, mouse work, assembly-line tasks
- Sports: racquet sports, golf, cricket bowling
- Occupational overuse — plumbers, painters, dentists, surgeons
- Eccentric overload and microtrauma to tendon origin
- Age-related tendon degeneration (collagen disorganisation)
- Poor ergonomic setup (screen and desk height)
- Sudden increase in training load without conditioning
Conservative & First-Line Treatment
- Activity modification and ergonomic correction
- Counterforce brace (epicondylitis clasp)
- Eccentric strengthening exercises (Tyler Twist for lateral)
- NSAIDs, topical diclofenac
- Physiotherapy — manual therapy, deep friction massage
- Shockwave therapy (ESWT)
How Vedant Pain Management Clinic Can Help
Our interventional pain specialists offer the following evidence-based procedures, all
performed with real-time ultrasound guidance for precision and safety:
- Ultrasound-guided PRP injection into the tendinopathic zone — supported by strong
Level 1 evidence for chronic epicondylitis
- Ultrasound-guided prolotherapy injections for recalcitrant cases
- Ultrasound-guided dry needling of tendon pathology (tenotomy)
- Diagnostic musculoskeletal ultrasound to assess degree of tendon degeneration and
presence of neovascularity
- Ultrasound-guided corticosteroid injection for acute flares (short-term relief)
- Lateral cutaneous nerve of the forearm block for refractory cases
Newer Diagnostic Concepts & Advances
The term 'tendinopathy' has largely replaced 'tendinitis' as histology consistently shows
collagen disorganisation (angiofibroblastic dysplasia) rather than inflammatory
infiltrate. Additionally, posterior interosseous nerve entrapment (Radial Tunnel
Syndrome) can perfectly mimic lateral epicondylitis — ultrasound-guided diagnostic nerve
block helps differentiate the two at Vedant Pain Clinic.
