A persistent burning or aching pain on the outside of the elbow that worsens when you grip, lift, or turn your wrist is the defining symptom of tennis elbow. Its counterpart, golfer’s elbow, produces the same type of discomfort on the inner side of the elbow. Both conditions are common causes of elbow pain in adults across all activity levels, not just those who play racquet sports or golf.
What is Elbow Epicondylitis (Tennis Elbow and Golfer's Elbow)?
Elbow epicondylitis is an overuse tendinopathy affecting the common extensor or flexor tendon origins at the elbow. Lateral epicondylitis, or tennis elbow, affects the extensor carpi radialis brevis tendon at its origin on the outer bony prominence of the elbow. Medial epicondylitis, or golfer’s elbow, affects the flexor-pronator tendon origin at the inner bony prominence.
Modern understanding recognises these as degenerative tendinopathies rather than purely inflammatory conditions, with disorganised collagen and failed tendon healing at a microscopic level. This distinction matters for treatment, as anti-inflammatory approaches alone are often insufficient.
Types of Elbow Epicondylitis (Tennis Elbow and Golfer's Elbow)
Causes
Repetitive wrist extension and gripping in tennis, badminton, squash, and padel are the classic triggers for lateral epicondylitis. Padel in particular has seen a significant rise in epicondylitis presentations in recent years. Medial epicondylitis is associated with wrist flexion and forearm pronation, seen in golf, cricket bowling, and javelin throwing. Manual workers performing repetitive gripping and lifting tasks are also commonly affected.
- Lateral epicondylitis: aching or burning pain on the outer side of the elbow, worsening with gripping, lifting, and wrist extension, particularly picking up a kettle or turning a door handle
- Medial epicondylitis: pain on the inner side of the elbow, worsening with wrist flexion, pronation, and squeezing activities
- Tenderness directly over the affected epicondyle on palpation
- Grip strength reduction
- Pain that has persisted for several weeks or months despite rest and basic treatment
Diagnosis
Clinical examination with palpation of the epicondyle and provocative testing, including resisted wrist extension or flexion, reproduces the characteristic pain. Ultrasound identifies tendon degeneration, partial tears, and neovascularisation. MRI is used when the diagnosis is uncertain or when a partial tear needs to be characterised.
Treatment
Elbow Arthroscopy with Epicondylitis Debridement
For patients with persistent epicondylitis that has not responded after 6 to 12 months of conservative management including physiotherapy, bracing, and injections, Dr. Kushalappa performs arthroscopic debridement of the degenerate tendon tissue. The diseased tendon origin is identified and the degenerate tissue is removed using arthroscopic instruments, stimulating healthy tendon healing. This is a minimally invasive procedure with a shorter recovery than open surgery. Return to sport is expected at 3 to 4 months.
Why Choose Dr. Kushalappa Subbiah in Bangalore?
Dr. Kushalappa Subbiah completed a Fellowship in Shoulder Surgery at the Sydney Shoulder Research Institute, where he trained in advanced arthroscopic shoulder procedures including labral repair and reconstruction. He holds the International Olympic Committee (IOC) Diploma in Sports Medicine, and has direct clinical experience managing shoulder injuries in Indian athletes across cricket, swimming, tennis, and contact sports. He is appointed as a Consultant Shoulder Surgeon at NH Hospital, Bangalore.