From Overuse to Inflammation: What You Need to Know About Epicondylitis

Elbow injuries are common in both sport and daily life. Young athletes are especially vulnerable when they specialize in one sport too early, while adults often develop elbow issues from repetitive overhead or gripping tasks — frequently seen in manual labor professions. One of the most common elbow conditions is epicondylitis, a chronic overuse injury that, when properly managed, usually does not require surgery. However, ignoring symptoms or improper treatment can lead to worsening pain and long-term dysfunction.

Elbow Anatomy: Why This Area Is Vulnerable?

The elbow is a complex joint made up of three bones: the humerus (upper arm), ulna (inner forearm), and radius (outer forearm). Important bony landmarks include the medial and lateral epicondyles, which serve as attachment sites for forearm muscles.

Key stabilizing ligaments include the Ulnar Collateral Ligament (UCL), Radial Collateral Ligament (RCL), and Annular Ligament. Important muscles crossing the elbow include the brachialis, anconeus, pronator teres, pronator quadratus, palmaris longus, flexor digitorum superficialis and profundus, and extensor carpi radialis brevis (ECRB). These muscles control wrist and finger motion — which is why gripping, lifting, throwing, and swinging sports stress the elbow so heavily.

Muscles of the arm

Musculoskeletal depiction of lateral arm

What Is Epicondylitis?

Epicondylitis is irritation and degeneration of the tendon attachments at the elbow’s epicondyles. Despite often being called inflammation, it is usually more of a chronic tendon overload condition than an acute inflammatory injury.

Common Symptoms:

• Gradual onset of pain

• Pain after activity

• Pain during everyday tasks (gripping, lifting, turning doorknobs)

• Reduced grip strength

• Stiffness or limited motion

Medial Epicondylitis (Inner Elbow)

Often called Golfer’s Elbow, this condition affects the common flexor tendon on the inside of the elbow. Pain increases with wrist flexion, forearm pronation, and gripping. At-risk groups include golfers, baseball players, gymnasts, and weightlifters.

Little League Elbow is a pediatric version involving the growth plate at the medial epicondyle. It is common in young baseball athletes, especially those playing year-round. Contributing factors include pitch overuse, poor throwing mechanics, and early sport specialization.

Lateral Epicondylitis (Outer Elbow)

Better known as Tennis Elbow, this affects the extensor tendon group, most commonly the extensor carpi radialis brevis (ECRB). Pain increases with wrist extension, lifting objects with the palm down, and backhand motions. It is also common in tradespeople, office workers, and individuals with repetitive wrist extension tasks.

Why Youth Athletes Are at Higher Risk

Sports like baseball, tennis, and gymnastics show high pediatric elbow injury rates. Smart loading strategies include encouraging multi-sport participation, limiting pitch counts, avoiding advanced pitches at young ages, and emphasizing proper mechanics and strength training.

Youth baseball athlete pitching

Calvin Peete (former PGA athlete)

Jordan Chiles (American Gymnast)

Coco Gauff (pro tennis)

Conservative Treatment: First Line of Care

Most epicondylitis cases improve without surgery.

The P.I.E.C.E. approach:

Protection – braces and activity modification

Ice – manage soreness

Elevation – support circulation

Compression – reduce swelling

Exercise – progressive strength and mobility work

Manual therapies may include soft tissue mobilization, instrument-assisted techniques, cupping, and joint mobilizations.

Injection Options (When Conservative Care Fails)

If symptoms persist, physicians may consider corticosteroid injections for short-term relief, NSAID-based injections, prolotherapy, or PRP (platelet-rich plasma). These should be considered only after structured rehabilitation.

Emerging Treatment: Shockwave Therapy

Extracorporeal shockwave therapy uses sound waves to stimulate healing and reduce pain in chronic tendon injuries.

Extracorporeal Shockwave Therapy (ESWT)

The Bottom Line

Epicondylitis is common but manageable. Early intervention, proper load management, and progressive strengthening are key. Whether you're an athlete, a worker, or a weekend warrior, listening to early warning signs can prevent chronic pain and time away from activity.