Epicondylitis
Tennis elbow & golfer’s elbow
Pain shaking hands or opening a door — and injections help for ever shorter periods?
The name is misleading: epicondylitis is not an inflammation. It is a tendon degeneration — and that is precisely why cortisone doesn’t help in the long run. The randomized trial by Coombes et al. (JAMA 2013, 165 patients) showed that one year after a cortisone injection, treated patients were doing significantly worse than the placebo group.
Four weeks, five appointments, one team. You’re not left alone with your symptoms.
1–3%
of the population — the most common overuse condition at the elbow
>80%
improvement with conservative combination therapy
54%
cortisone recurrence rate vs. 12% placebo after 1 year (JAMA 2013)
Your APPOINTMENT at OMC
Four weeks, five appointments, one team.
Orthopedics and internal medicine in one integrated concept — for patients who value thorough diagnostics and structured treatment.
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Final appointment: assessment and next steps
Personal review with Dr. Klein after four weeks. Three possible paths: pain-free — handover to the home maintenance program; improved but not yet complete — follow-up appointment in four weeks; insufficient improvement — further diagnostics (MRI to assess partial tears) or therapy escalation, such as a PRP injection.
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Weeks 2–4: three supervised therapy sessions
Weekly appointments in the therapy room with the three-person therapy team. Multimodal treatment package (shockwave, magnetic field, cryo), correction and progression of the eccentric training, progress review based on the pain diary. Daily internal case discussion — every patient stays in view.
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First appointment: diagnosis and immediate start of treatment
History, clinical examination, and ultrasound. Immediately afterward: treatment begins in the therapy room — shockwave, magnetic field, cryotherapy, exercise guidance from the team, and where needed a brace and ergonomics advice. You leave the practice with a plan, the pain diary, and four scheduled follow-up appointments.
Four weeks, five appointments, one team — a clear plan from day one.
Epicondylitis is fully treatable in most cases — when the therapy regenerates the tendon tissue rather than merely suppressing the pain. Those who start early and stick with the program have a very good chance of lasting freedom from symptoms.
Pain-related loss of grip strength
Not a true motor deficit, but a functional limitation — glasses slip from the hand, a bag tips off the handlebar, the weight in strength training suddenly feels twice as heavy. Very typical of advanced epicondylitis.
Radiation into the forearm — sometimes as far as the hand
Radiation along the forearm extensors. In the medial form (golfer’s elbow) the pain runs into the inner forearm; here, irritation of the ulnar nerve must additionally be ruled out.
Pain in the morning after rest — on first using the arm
Pain when gripping, typing, or turning a screwdriver
Monotonous forearm movements become a test of endurance — at the desk as on the building site, in strength training as in climbing. The spectrum ranges from the computer mouse to power tools.
Pressure pain right on the bony prominence on the outside of the elbow
Local pressure pain over the lateral epicondyle — often pinpointed to one spot. Even resting the arm or the pressure of an armrest can become uncomfortable.
Pain shaking hands, opening a door, or lifting a cup
The classic hallmark of tennis elbow. It arises when extending the wrist against resistance — whether with a wrench, a tennis serve, or a coffee cup.
"I had cortisone three times. After each shot it was better for two or three weeks — then just as bad again. The fourth time it didn’t even last a week."
This is a typical pattern. Cortisone relieves pain in the short term — but it doesn’t heal the tendon. The Coombes trial (JAMA 2013) shows: patients who receive cortisone have significantly worse results after one year than patients without cortisone. What works is therapy that regenerates the tendon tissue — not one that weakens it further.
Recognizing symptoms
Does this sound familiar?
Epicondylitis has a very characteristic pain pattern: typical gripping and rotational movements that are normally effortless become a test of endurance. Many of our patients recognize the following symptoms:
Common pitfalls
Why it often doesn’t get better
Epicondylitis often becomes chronic — not because it’s hard to treat, but because a fundamental misunderstanding of its nature is widespread: it is not an inflammation, but a tendon degeneration.
The patient is left alone with a set of exercises
An exercise sheet handed over on the way out is not a treatment plan. Without guidance, correction, and regular progress checks, half the exercises end up only half correct — and the tendon doesn’t respond. Tendon healing needs support, not just a recommendation. At OMC the therapy team supports you weekly.
Physiotherapy without a loading analysis
Physiotherapy helps — when it addresses the biomechanical cause. Wrong gripping technique on a tool, a keyboard positioned too low, a tennis backhand with too much wrist: without analyzing the work situation and the movement, the loading persists — and the tendon cannot heal.
Rest instead of targeted loading
Complete immobilization is counterproductive in tendinopathies. The tendon needs mechanical stimulus to regenerate its collagen fibers. Eccentric strength training of the forearm extensors is the evidence-based training approach — it must be introduced early, not only once the pain is "gone."
Cortisone — better in the short term, worse in the long term
This is not conjecture but evidence: Coombes et al. (JAMA 2013) showed in a randomized trial of 165 patients that the cortisone group had significantly worse results after one year than the placebo group — with a recurrence rate of 54% vs. 12%. Short-term relief at the price of long-term deterioration.
The OMC approach
What’s different at OMC.
Tendons don’t heal through isolated measures but through the right system: ultrasound as the foundation, multimodal therapy, and support over four weeks — consistent and structured.
Internal-medicine perspective as routine
Thyroid function, diabetes status, vitamin D supply, and medication history (certain antibiotics as a risk factor) — those who know these factors treat not just the elbow but create the conditions for real healing.
Movement and ergonomics analysis
What loads the tendon every day? Gripping patterns, working posture, computer mouse, tools, tennis backhand — without this analysis the triggering force isn’t removed. Cause-based medicine instead of symptom treatment.
Multimodal treatment package as standard
Shockwave, magnetic field therapy, and cryotherapy combined in every session — that is the OMC standard for every tendon patient. Eccentric training is guided and corrected weekly. PRP is used specifically as an escalation when the standard package isn’t enough.
Differentiation before therapy
Lateral or medial? Acute or chronic? Tendon structure intact or partial tear? Ulnar nerve irritation ruled out? These questions are answered with ultrasound and clinical tests — before therapy begins. Therapy is decided, not guessed.
Specialist in
Internal
medicine
Assessment of thyroid function, vitamin D status, diabetes status, and medication history. Whatever blocks tendon regeneration from within is found and treated." und „Ultrasound, clinical differential diagnostics, ESWT, PRP injection, eccentric training protocol, ergonomics advice — all from a single source.
Specialist in
Orthopedics &
trauma surgery
Ultrasound, clinical differential diagnostics, ESWT, PRP injection, eccentric training protocol, ergonomics advice — all from a single source.
What we examine
Diagnostics at the OMC practice
With typical symptoms, the clinical diagnosis of epicondylitis is usually clear — ultrasound and targeted tests confirm the findings and form the basis for the individual treatment plan.
01
History — occupation, sport, prior treatment
Occupation, sport, gripping habits, computer-mouse use, duration of symptoms, previous treatments (particularly cortisone injections: how many, how long did they help?). Internal medicine: vitamin D status, thyroid function, diabetes status, medication history.
> Training and load management is a building block of therapy
02
Clinical provocation tests
Lateral: Thomson test (pain on resisted dorsiflexion), Cozen test, Mill test (passive). Medial: pain on resisted flexion/pronation. In the medial form additionally: Tinel’s sign over the ulnar nerve canal, sensory testing of the hand. Differentiation from nerve compression and cervical spine syndromes.
> Distinguishes epicondylitis from other causes of elbow pain
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Ultrasound of the elbow
Tendon structure (collagen disorganization, thickening), neovascularization (ingrowing vessels as a source of pain), partial tears (decisive for treatment planning and prognosis), calcifications, bursal status. Ultrasound confirms the diagnosis, rules out other pathologies, and serves for progress monitoring: has the tendon responded to therapy?
> The basis for targeted therapy rather than guesswork
The OMC advantage: structured therapy instead of isolated measures
Ultrasound confirms the diagnosis and differentiates lateral / medial / partial tear. The multimodal treatment package (shockwave + magnetic field therapy + cryotherapy) is the standard for every patient — combined with guided eccentric training. PRP is used specifically when the standard therapy isn’t enough.
Treatment concept
Therapy approach.
Individual & multimodal
Epicondylitis follows a clear phase model: from pain reduction through structural tendon rebuilding to a load-capable return to work and sport. Four weeks, five appointments, one team at your side — each phase with clear goals.
Eccentric training and load adaptation
Eccentric strength training of the forearm extensors (lateral) or flexors (medial) is the most effective conservative building block of therapy. Three sets of 15 repetitions daily, progressively over 8–12 weeks, with a dumbbell or resistance band. In addition: adapt everyday gripping patterns, optimize computer-mouse position, check sports equipment.
Treating internal-medicine cofactors as well
Whatever blocks tendon regeneration from within must be treated too:
Assess thyroid function — hypothyroidism slows tendon healing.
Diabetes status — hyperglycemia inhibits collagen synthesis.
Vitamin D3 + K2 — essential for connective tissue regeneration.
Medication history — certain antibiotics (ciprofloxacin, levofloxacin) are known risk factors for tendon degeneration.
Ergonomics, bracing, and everyday adaptation
Ergonomics advice: mouse and keyboard position, tool grip, tennis backhand, strength-training technique. Epicondylitis brace: applied correctly 4–5 cm below the bony prominence — as a bridging aid in the acute phase, not a substitute for therapy. Kinesiotaping for temporary relief. Everyday rule: don’t force painful gripping movements.
ESWT · magnetic field · cryotherapy
The multimodal standard package at OMC — as a fixed combination in every therapy session.
Focused shockwave therapy (ESWT) — at the tendon insertion; stimulates collagen reorganization and reduces neovascularization; typically 3–5 sessions.
Pulsed magnetic field therapy (PEMF) — adjunctive to ESWT; supports tissue regeneration.
Cryotherapy — local pain relief and reduced irritation after loading.
PRP — as an escalation when the standard package isn’t enough; ultrasound-guided into the altered tendon tissue; several RCTs show better medium-term results than cortisone.
PRP is superior to cortisone in the long term
Several studies (including Gosens et al. 2011; Creaney et al. 2011; Mishra et al. 2014) show that PRP for lateral epicondylitis delivers better results than cortisone at 6 months and 1 year. Combined with eccentric training and shockwave therapy, this forms an effective treatment concept.
Healing perspective
What you can realistically expect
The prognosis for epicondylitis is good — with a structured, phased program, over 80% of patients become permanently symptom-free. Patience is the most important variable: tendon regeneration takes months, not weeks.
"Cortisone is a bridge — but not a cure. Anyone who has had three injections and still has pain didn’t get the wrong medication — they got the wrong concept. Multimodal therapy, eccentric training, and removing the cause — that is what the tendon needs. This isn’t alternative medicine, it’s the current evidence."
Dr. Roman Klein, MD, Ortho Motion Concept
Repeated cortisone injections into the tendon tissue
Continued overuse movement without correction
Partial tendon tear — possibly PRP escalation or surgical assessment
Untreated cofactors (thyroid, diabetes, antibiotic history)
Early start of treatment before it becomes chronic
Consistent daily eccentric training
Ergonomic and load corrections implemented
Internal-medicine cofactors treated
<5%
of patients ultimately require surgery
3–6
months to sustained improvement with consistent therapy
>80%
lasting freedom from symptoms with combination therapy
Frequently asked questions
What patients ask us
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I’ve already had cortisone — is it too late now?
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How long until I’m pain-free again?
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What is the difference between tennis elbow and golfer’s elbow?
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What does PRP achieve in epicondylitis?
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Do I need surgery?
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Could a vitamin D deficiency or my thyroid have contributed?
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What is the difference between the OMC Tendon Center and a standard orthopedic practice?
Your next step
Injections didn’t help.
Now comes tendon therapy.
Book your first appointment now. You leave the practice with a clear diagnosis, a written four-week plan, and the start of your therapy. You don't come in for an examination — you enter a structured program with a team that won't leave you on your own.
What you actually get:
- Ultrasound-confirmed diagnosis — tendon, structure, and partial tears made visible
- Multimodal treatment package: shockwave, magnetic field, cryo available on site
- Eccentric training protocol coached and corrected weekly
- Internal-medicine assessment of systemic cofactors included
Medical note
This content serves general medical information and does not replace individual medical advice or examination. For persistent, unclear, or worsening complaints, please consult a physician. Dr. Roman Klein, MD, Specialist in Orthopedics & Traumatology and Internal Medicine · Ortho Motion Concept · Europastraße 3 · 67433 Neustadt an der Weinstraße.