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Two tendon attachments to distinguish
The muscles of the forearm join the arm bone through tendons near the elbow. On the external side, muscles are attached in particular which raise the wrist and participate in the grip. Pain in this area is often called lateral epicondylitis or tennis elbow.
On the inner side are attachments of muscles that flex the wrist and turn the forearm toward the palm down. We talk about epitrochleitis or golfer’s elbow. The term tendinopathy describes a painful tendon with changes in its load tolerance. It does not mean that inflammation alone explains all the symptoms.
Understand the picture
Outside and inside of the elbow
External side
Tendons of muscles that raise the wrist attach here.
Internal side
Tendons involved in wrist flexion and forearm rotation attach here.
Hand grip
Holding an object uses the muscles of the forearm, even if the pain is felt in the elbow.
How pain manifests
The pain can be quite specific on the bony bump, then extend into the forearm. Shaking hands, holding a pan, using a screwdriver or carrying something with your arm outstretched can become difficult. The strength sometimes seems reduced because the pain slows down the movement.
Pain on the outside of the elbow is often caused by the grip and work of the muscles that raise the wrist. Pain on the inside of the elbow may increase when you bend your wrist or rotate your forearm against strain. These descriptions guide the examination, but are not diagnostic tests to be performed alone. Permanently numb fingers or a locked elbow are not automatically explained by the tendon.
Why this can happen
There is no need to play tennis or golf. Repeated efforts, increased manual work or rapid return to sport may contribute to symptoms. Sometimes there is no specific trigger. Sleep, recovery possibilities and daily constraints also influence the way you manage your efforts.
It is rarely helpful to look for a single causal action. Instead, ask yourself if the quantity, intensity or duration of tasks has changed. For example, repainting several rooms over a weekend requires more than just a few minutes of DIY work. This helps to organize the recovery without concluding that your arm is fragile or that you should definitely avoid this activity.
When to ask for medical advice quickly
After a fall or blow with severe pain, deformity or significant difficulty moving, have the elbow evaluated. A red, hot, swollen joint, especially with fever or malaise, requires a consultation the same day. A new mass or unexplained symptoms that progress should also be reported.
A real weakness that appears, persistent tingling in the ring finger or little finger, or loss of sensation warrants rapid medical evaluation. The ulnar nerve passes near the inner elbow area and may be involved separately. Do not continue a strengthening program assuming that any arm symptoms are from epicondylitis.
Examination and place of imaging
The interview specifies the troublesome tasks, the affected side, the onset of symptoms and their evolution. The exam looks for painful movements and checks for other possible causes, including nerve or joint damage. It can include neck, hand and grip strength, without trying to put you through maximum pain.
An x-ray, an ultrasound or an MRI are not routinely needed for a usual presentation of tennis elbow. They can become useful if the diagnosis remains uncertain, after trauma or in the face of an atypical evolution. A tendon abnormality on an image alone does not measure your pain or the time needed to return to work.
Chapter sources [1]
Adapt efforts without immobilizing all of daily life
Identify the tasks that are causing clear and lasting aggravation, then change one element at a time. You can lighten a load, carry it with both hands, bring the object closer to the body or split a task. Keep activities bearable so as not to unnecessarily lose all your abilities.
A strap or splint can sometimes improve comfort during an activity, but its benefit is not guaranteed. Check that it does not cause compression or tingling. For a medication or gel, ask the doctor or pharmacist what is compatible with your health. Temporary relief does not mean that the tendon can immediately withstand maximum stress.
In everyday life
Carry groceries with less discomfort
Lighten
Temporarily divide groceries into small loads.
Bring closer
Use both hands and keep the load close to your body if that is more comfortable.
Resume
Then increase one stress at a time and watch the reaction the next day.
What physiotherapy can do
The physiotherapist can explain the problem, observe important movements and build a progression of movement, strength and endurance. The dose depends on the irritability of the elbow: someone who is sore at rest does not necessarily start out like someone who is only bothered after a long workout. Progress is also judged on daily tasks.
For lateral epicondylitis, the BESS recommendation supports physiotherapy, while recognizing the limitations of the long-term evidence. Manual techniques may possibly help with comfort; they do not instantly repair the tendon. Knowledge about tennis elbow should not be presented as equally robust for all forms of pain on the inside of the elbow.
Injections and other treatments: ask the right questions
For tennis elbow, BESS recommends against corticosteroid injections: early improvement may be followed by poorer results. This recommendation concerns lateral tendinopathy and should not be automatically extended to all hand diseases. Blow waves are not recommended in this same guideline.
For PRP, dry needling or tennis elbow surgery, a benefit greater than placebo is not established by this recommendation. If you are offered a treatment, discuss the objective, uncertainty, risks and cost. Persistent pain on the inside of the elbow deserves its own re-evaluation rather than the automatic application of a treatment chosen for the external side.
Chapter sources [1]
Exercise, work and sport
Our exercises section can help maintain comfortable arm and wrist movements. Targeted strengthening of the flexors or extensors requires choosing the right direction and appropriate resistance. Vigorous stretching is not necessarily helpful; do not insist if it triggers electrical pain or tingling.
At work, discuss alternating tasks and difficult-to-hold tools. For sport, start with a short duration and a reduced intensity, then increase a single element. Check the reaction after the activity and the next day. Being able to do a few movements without pain does not yet mean being able to repeat a powerful movement for an entire match.
Developments and time to reassess the situation
Improvement may take several weeks or months. Some people recover more slowly, even with a appropriate programme. Observe the ability to carry, grasp and work, in addition to pain. A difficult day after an unusual activity does not necessarily mean that all progress is lost.
If no favorable trend appears, if discomfort still prevents your activities despite adaptations, or if new signs develop, reassess the situation. The reassessment may modify the charge, look for another cause or lead to a specialist opinion. It must be anticipated with the clinician; There is no need to wait a fixed time frame when faced with a weakness or worrying change.
Your questions
Should I stop using the arm completely?
Not usually for confirmed tendinopathy without other injury. Reduce efforts that aggravate symptoms in the long term and keep what remains bearable. A fracture, an operation or a specific instruction may require different protection.
Chapter sources [1]
Why does my hand seem weak?
Pain can slow down the grip. But a loss of strength independent of pain, falling objects or sensory disturbances require an evaluation. The ulnar nerve or a problem coming from the neck can give other explanations.
Chapter sources [3]
Should the painful area be heavily massaged?
Strong repeated pressure is not a mandatory part of recovery. If a massage significantly increases pain or irritates the skin, stop it. The ability to resume tasks is more important than the sensitivity gained from putting pressure on the tendon each day.
Chapter sources [1]
When to pick up a racket or DIY again?
When you can start a short and lighter version without lasting aggravation, with an adapted plan if necessary. Gradually increase duration, load and frequency. A complete return depends on the action, your reaction and your abilities, not just the number of weeks that have passed.
Chapter sources [1]
Sources and references
- [1] BESS patient care pathway: Tennis elbow (2023)
- [2] AAOS OrthoInfo: Medial epicondylitis
- [3] BSSH: Cubital tunnel syndrome
- [4] NHS Inform · Exercises for elbow problems
- [5] CGDIS · Appeler le 112
Text updated on
Medical review: awaiting Hasib Selimovic.