Tennis elbow and golfer's elbow in Vienna
A stabbing pain on the outside or the inside of the elbow that shoots in when you grip, carry or shake hands: tennis elbow and golfer's elbow are irritations of the tendon attachments, and they arise at work just as they do in sport. I establish the cause with ultrasound and treat it step by step.
In short
Tennis elbow (epicondylitis lateralis) and golfer's elbow (epicondylitis medialis) are painful irritations of the tendon attachments at the outer and the inner bony prominence of the elbow. Typical signs are tenderness over the bony prominence, pain when gripping and carrying, and fading strength in the hand. I make the diagnosis in conversation, with functional tests and with the ultrasound in the practice. Treatment is conservative first: adjusting the load, physiotherapy with targeted tendon training, and in addition shockwave therapy, an ultrasound-guided injection, PRP therapy or magnetic field therapy. If the symptoms persist, a procedure at the tendon attachment is possible — arthroscopic or open.
What is a tennis elbow, what is a golfer's elbow?
At the lower end of the upper arm bone sit two small bony prominences. On the outside (epicondylus lateralis) the extensors of wrist and fingers attach, on the inside (epicondylus medialis) the flexors. If one of these attachments is loaded one-sidedly or in an unaccustomed way over a longer period, the tendon tissue no longer withstands the pull: fine damage appears, the tendon remodels and becomes sensitive to pain (tendinosis).
Because it is not the classic inflammation that dominates here, resting alone is rarely enough — the tendon needs a measured stimulus in order to carry load again. The triggers often lie far away from the tennis court: work at mouse and keyboard, manual trades, hairdressing and nursing, playing an instrument, gardening, and alongside them tennis, golf, climbing, strength and throwing sports.
Typical symptoms
- Tenderness at the bony prominence — on the outside with tennis elbow, on the inside with golfer's elbow.
- Pain when gripping and holding — a cup, a shopping bag, a tool, a handshake.
- Pain against resistance — extending the wrist (outside) or flexing and rotating it (inside).
- Pain radiating into the forearm, less often as far as the hand.
- Fading grip strength — objects slip out of the hand, fine work tires quickly.
- Start-up pain and stiffness, above all in the morning.
- Pain at rest or at night — a sign of a pronounced state of irritation.
How I make the diagnosis
At the beginning there is a detailed conversation: which movement brings on the symptoms, what has changed recently at work, in sport or in everyday life? The clinical examination follows, with functional tests that put the affected tendon attachment under tension. Ultrasound is available in the practice: with it I assess the tendon attachment while it moves and pick up zones of remodelling or partial tears. Where it is needed I arrange an X-ray or an MRI — both take place outside the building; I organise the referral and go through the findings with you.
The distinction matters. Numbness or tingling in the ring and little finger point to a nerve being compressed, that is, to cubital tunnel syndrome. A loss of extension or a feeling of blocking fits better with a stiff elbow. An overview by site and trigger is on the page about elbow pain and how it is assessed.
Treatment: conservative first
I treat tennis elbow and golfer's elbow step by step. At the beginning stands the adjustment of the load: we look at which movement irritates the tendon attachment and change the grip, the technique, the workplace or the way training is built up. Physiotherapy starts in parallel, with tendon training that is increased slowly — physiotherapy and exercise therapy are in the same building at the Orthozentrum Döbling.
If that is not enough, further methods are available in the practice. Shockwave therapy, focused and radial, directs energy at the irritated tendon attachment. With PRP therapy I bring your body's own growth factors to the tendon under ultrasound guidance. An ultrasound-guided injection I use sparingly, when the state of irritation is pronounced. Magnetic field therapy can be added.
My practice is a private practice, in Austria a Wahlarztordination. I do not settle directly with any public health insurer; you receive an invoice and submit it to your insurer — on request I take care of the submission for you. More on the page about the private practice and reimbursement.
When an operation is necessary
If the symptoms persist despite consistent conservative treatment, a procedure at the tendon attachment is one option. The aim is to remove the remodelled tissue and to set healing in motion. That is possible through a small open incision or arthroscopically, through a keyhole examination of the elbow joint. The advantage of keyhole surgery: I assess the joint from the inside at the same time and treat accompanying findings such as loose bodies along with it.
In golfer's elbow the tendon attachment lies close to the ulnar nerve; before a procedure on the inner side I therefore check whether the nerve is involved. I carry out necessary procedures at the ATOMOS Klinik Währing, the Privatklinik Döbling or the Rudolfinerhaus, and I accompany you from planning through the procedure to aftercare.
Whether and when an operation takes place we decide together, as soon as all findings are available. Further conditions of this joint are in the overview for the elbow specialist in Vienna.
Frequently asked
Frequently asked questions about tennis elbow and golfer's elbow
Both describe an irritation of tendon attachments at the elbow, only in different places. In tennis elbow (epicondylitis lateralis) it is the attachment of the extensors at the outer bony prominence that is affected, in golfer's elbow (epicondylitis medialis) the attachment of the flexors on the inside. On the outside it is above all extending the wrist against resistance that hurts, on the inside flexing and gripping firmly.
Not necessarily. Treatment begins conservatively with an adjusted load, physiotherapy, shockwave therapy, an ultrasound-guided injection or PRP therapy. Only when the symptoms persist despite consistent conservative treatment and restrict work, sport or everyday life do I talk about a procedure. Whether an operation makes sense depends on the findings.
I use focused and radial shockwave therapy for irritated tendon attachments at the elbow. The energy is directed at the painful tendon attachment and is meant to influence the state of irritation and to stimulate the remodelling of the tissue. How well it responds in an individual case cannot be said in advance.
That cannot be answered across the board, and I deliberately do not name fixed periods. An irritated tendon attachment needs patience: the symptoms usually improve step by step, and setbacks after unaccustomed loading are possible. What matters is that the triggering load is adjusted and that the tendon training is continued.
The name is misleading. The tendon attachments at the elbow react to repeated, one-sided or unaccustomed loading: work at mouse and keyboard, manual trades, hairdressing and nursing, playing an instrument, gardening, strength and ball sports. A new training programme on its own can be enough. Tennis is only one trigger among many.
If the pain persists over a longer period, if it occurs at rest or at night, if grip strength clearly fades or if fingers go numb and tingle, you should have the elbow assessed. Numbness points to an irritation of the ulnar nerve rather than to an irritated tendon attachment. An examination also makes sense after a fall.
My practice is a private practice, in Austria a Wahlarztordination. I do not settle directly with any public health insurer; you receive an invoice and submit it to your insurer — on request I take care of the submission for you. For an operation, direct settlement with a supplementary private insurance is possible. You do not need a referral.
Dr. med. Martin Eigenschink
Specialist in Orthopaedics and Traumatology · Specialist in elbow, shoulder and hand surgery
Surgical and conservative treatment of the elbow, shoulder and hand, preferably minimally invasive. Practice at the Orthozentrum Döbling, 1190 Vienna. More about my background
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Medical notice: The contents of this page serve as general information. They do not replace a medical examination, diagnosis or individual advice. Medicine is a constantly evolving field — despite careful research, no guarantee can be given that the content is fully up to date.