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What is epicondylitis
Epicondylitis is a degenerative lesion of tendons at their attachment to the epicondyles of the humerus. Contrary to the name "tendinitis" (inflammation), chronic epicondylitis is dominated not by inflammation but by degeneration — angiofibroblastic dysplasia of tendon tissue (tendinosis). This is why cortisone provides only a temporary effect.
Two types of epicondylitis
Lateral epicondylitis ("tennis elbow")
Lesion of wrist extensor tendons (primarily m. extensor carpi radialis brevis) in the area of the lateral epicondyle. Pain on the outer side of the elbow, worsens with gripping, turning a doorknob, handshake, lifting a cup. ICD-10: M77.1. Prevalence: 1-3% of the population, peak 35-55 years.
Medial epicondylitis ("golfer's elbow")
Lesion of flexor-pronator tendons in the area of the medial epicondyle. Pain on the inner side of the elbow, worsens with wrist flexion, pronation, gripping. ICD-10: M77.0. 5-10 times less common than lateral. Common in golfers, throwers, programmers.
Stages of the disease
1. Acute tendinitis (0-6 weeks)
Tendon inflammation. Pain with loading, minimal at rest. At this stage, spontaneous recovery is possible with elimination of the provoking factor.
2. Tendinosis (6 weeks - 6 months)
Degeneration of tendon tissue: collagen disorganization, neovascularization, angiofibroblastic hyperplasia. Pain with normal loads. Cortisone at this stage further damages the tendon.
3. Chronic tendinosis with partial tears (over 6 months)
Partial tendon tears, calcification. Constant pain, significant loss of grip strength. Traditional medicine offers surgery. Cells and growth factors mainly reduce inflammation and may support tissue healing; how much the tissue recovers cannot be predicted in advance.
Why cortisone is not the solution
Temporary effect
Meta-analysis by Coombes et al. (2010, Lancet): cortisone injections provide relief for 2-6 weeks, but after 6-12 months results are worse than without treatment. Cortisone suppresses inflammation but accelerates collagen degeneration.
Risk of rupture
Repeated cortisone injections into the tendon increase the risk of complete rupture. Cortisone inhibits collagen synthesis and reduces tendon strength.
Vicious cycle
Pain returns, requiring a new injection. Each time the effect is shorter, and the tendon weaker. Cells and growth factors mainly reduce inflammation and may support tissue healing; how much the tissue recovers cannot be predicted in advance.
Epicondylitis (tennis elbow): treatment options and what is known about them
The treatment plan is made by the clinic doctor after an examination and a review of your images. The table shows the options usually discussed for this diagnosis and how well they have been studied.
| Option | What to expect | How well studied |
|---|---|---|
| Exercise therapy and physiotherapy | Reduces pain, strengthens muscles, improves function; the basis of treatment | Well studied, recommended |
| Braces, splints, insoles | Offload and stabilise, reduce pain under load | Limited or conflicting evidence |
| Shockwave therapy | A course of 3–5 sessions; helps some patients with chronic pain | Limited or conflicting evidence |
| PRP / CGF | Concentrate from your own blood; may reduce pain, growth of new tissue has not been shown | Moderate evidence |
| Corticosteroid injection | Quickly reduces inflammation and pain, the effect is often temporary; frequent injections are undesirable | Limited or conflicting evidence |
| Tendon surgery (rarely) | If conservative treatment does not help or there is an indication | When indicated — the doctor decides |
We send your request to several partner clinics. Some will suggest conservative treatment or injections, others surgery; each clinic quotes its own conditions and price. We help you compare the options.
Regenerative methods: realistic expectations
In tendinopathies the basis of treatment is graded loading of the tendon: specific exercises over 3–6 months. Shockwave therapy helps some patients. Evidence on PRP is conflicting: there are studies showing benefit in tennis elbow and plantar fasciitis, but no convincing evidence for other tendons. Corticosteroids relieve pain quickly, but the effect is often short, and repeated injections into a tendon are undesirable.
When surgery is discussed. Surgery is discussed for a complete tendon rupture or if pain persists for more than 6–12 months despite proper treatment.
If an injection helps, the effect usually builds up over 6–12 weeks, and the result is assessed after 2–3 months. No clinic can guarantee a result.
Good to know: diagnosis, self-help, outlook
How to tell epicondylitis from similar conditions
In lateral epicondylitis (tennis elbow) the outer elbow hurts when gripping, shaking hands, lifting a cup and using a mouse; in medial epicondylitis (golfer’s elbow) the inner side hurts. Pain from the neck usually comes with numbness in the fingers, and radial tunnel syndrome hurts below the epicondyle. The diagnosis is clinical; ultrasound shows tendon changes.
What you can do yourself
Reduce the load that causes pain: lift objects palm up and use tools with thick handles. A forearm strap reduces load on the tendon. The basis of treatment is progressive exercise for the wrist extensors, including eccentric exercise.
Outlook and timelines
Epicondylitis often resolves on its own within 6–12 months, and exercise speeds this up. A corticosteroid injection relieves pain quickly, but after a year results are worse and recurrences more frequent than without it. PRP and shockwave therapy help some patients; surgery is rarely discussed.
Who it is not suitable for and possible risks
Contraindications
- Active infection — at the injection site or systemic, with fever.
- Active cancer or ongoing chemotherapy.
- Blood clotting disorders or a low platelet count. Anticoagulants are discussed with the physician.
- Pregnancy and breastfeeding — the procedure is usually postponed.
- A corticosteroid injection into the same area in recent weeks.
- A complete tendon or ligament rupture with loss of function — surgical repair is usually needed.
Possible risks
- Pain and swelling at the injection site for 1–3 days.
- Bruising where blood or fat tissue is taken.
- Rarely, infection. The procedure is therefore performed under sterile conditions with ultrasound or X-ray guidance.
- The effect may be absent or smaller than expected.
If any of these apply to you, mention it in your request. The coordinator will check with the clinic physician whether treatment is possible. Contact a coordinator.
Scientific evidence
Studies of regenerative methods show mixed results. Clinic physicians rely on research including the following:
- Catapano M et al. Effectiveness of Platelet-Rich Plasma Injections for Nonsurgical Management of Carpal Tunnel Syndrome: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Arch Phys Med Rehabil, 2020.
- Sheth U et al. Efficacy of autologous platelet-rich plasma use for orthopaedic indications: a meta-analysis. J Bone Joint Surg Am, 2012.
Next steps: Treatment methods · Treatment cost · How treatment in Germany is organised
Questions about epicondylitis
RegenPAS is a patient service centre in Munich, not a clinic. We review your images and symptoms and send a request to several partner clinics at once. Clinics that can accept you send their own conditions and price; prices differ between clinics, and you choose the option that suits you. The coordinator replies within 24 hours, and a clinic physician’s preliminary opinion follows in 1–3 business days. We then arrange the appointment, visa invitation, interpreter, transfers and accommodation. Treatment decisions are made by the clinic physician. Contact a coordinator.
Your MRI (or CT, X-ray) report and the images if you have them, plus a short description of your symptoms and previous treatment. Send them via the form on the website — the assessment is free and without obligation: the coordinator replies within 24 hours, and the clinic physician’s preliminary opinion follows in 1–3 business days.
The cost depends on the method, the diagnostics needed and the clinic itself: prices differ between clinics. We request offers from several clinics and send you their conditions and quotes so you can compare. Price guidance is on the treatment cost page. For an outpatient procedure, 2–3 days in Munich are usually enough: examination, procedure and follow-up visit.
Clinic and method matching — free of charge
Describe your case and attach your MRI report. We will identify clinics that use the relevant methods and forward your request to them. No obligation; we reply within 24 hours.
Send a request