Tendons and muscles at the elbow

Anatomy: Tendons and muscles around the elbow

Tendons connect muscles to bones. At the elbow, the muscle attachments of the forearm extensors extend beyond the lateral (outer) bony prominence, the lateral epicondyle, while the forearm flexors attach to the medial (inner) epicondyle. At the front, the distal biceps tendon runs to the radius (tuberositas radii); at the back, the triceps tendon attaches to the ulna (olecranon). These structures work together to allow flexion, extension, and rotational movements (pronation/supination).

• Forearm extensors (including the extensor carpi radialis brevis/longus muscle): Stabilize the wrist and fingers, often affected by “tennis elbow”.
• Forearm flexors (including the flexor carpi radialis/ulnaris and pronator teres muscles): gripping functions and pronation, often irritated in the “golfer's arm”.
• Distal biceps tendon: Responsible for powerful supination (outward rotation) and flexion.
• Triceps tendon: Main player in extension in the elbow.
• Entheses (tendon-bone junctions): Functionally critical zones in which overload can lead to irritation and degenerative changes.

Tendon gliding tissue, bursa and surrounding nerves (including radial nerve, ulnar nerve, median nerve) complete the system. Irritating conditions can be localized or can be caused by incorrect loading, technique errors, or a lack of trunk or shoulder muscles.

Common Complaints: What to Remember

• Pain on the outer or inner elbow, often as tenderness over the epicondyle.
• Stress-related pain when gripping, turning, lifting or typing; sometimes starting pain.
• Drawing or stabbing pain along the forearm, occasionally radiating.
• Loss of strength, tiring quickly, weak handshake.
• Morning stiffness, swelling, feeling of warmth in acute inflammation.
• Sudden “snap” moment, hematoma or palpable dent in tendon rupture (e.g. biceps/triceps).

Warning signs such as sudden onset of severe pain, bruising, change in shape of the upper or forearm or significant loss of function should be clarified by a doctor promptly.

Typical clinical pictures at a glance

The following illnesses and injuries primarily affect the tendon and muscle attachments to the elbow. On the linked subpages you will find detailed information about causes, diagnostics and therapy.

• Tennis elbow (lateral epicondylitis): Overuse-related irritation of the forearm extensors on the outer elbow - often during repetitive gripping and twisting movements.
• Golfer's elbow (medial epicondylitis): Irritation of the forearm flexors on the inner elbow - not only in golfers, but also during manual or office activities.
• Dumbbell arm – Inflammation of the distal biceps tendon: Front elbow pain, often after strength training or tensile stress.
• Distal biceps tendon rupture: Sudden pain with loss of strength during flexion/supination; rapid clarification recommended.
• Distal triceps tendon rupture: Pain and weakness during extension, often after sudden peak loading or a fall.
• Tendonitis of the forearm muscles: irritation of the flexor and extensor tendons, often due to overload, technical errors or monotonous work.

Further dysfunction may be associated with nerve compression (e.g. ulnar sulcus syndrome) or joint problems. A thorough examination helps to distinguish causes of pain.

Diagnostics: step by step to the cause

In our practice in Hamburg, we primarily rely on a thorough clinical examination and high-resolution ultrasound. Imaging is used specifically and according to indications.

Conservative therapy: evidence-based and relevant to everyday life

The aim is to gradually reduce pain, restore resilience and sustainably prevent recurrences. Most elbow tendon irritations respond to structured conservative treatment.

• Load control: Short-term relief from overloading activities, then gradually increasing the load.
• Physiotherapy: Eccentric and isometric training of the flexion/extension muscles, shoulder sling and trunk cooperation, manual therapy, transverse friction depending on the findings.
• Workplace and sports technology optimization: ergonomics, grip strengths, racket/mouse position, training periodization.
• Pain management: cooling in acute phases, heat in chronic tension; If necessary, time-limited anti-inflammatory medications or topical gels (if tolerated and after consultation).
• Orthosis, bandage, taping: Can provide short-term relief to painful roots.
• Shock wave therapy (ESWT): For chronic epicondylopathy as an option with moderate evidence; Number and intervals individually.
• Infiltrations: Local anesthetics and cortisone can relieve pain in the short term, but should be used cautiously and specifically because of possible tendon impairment.
• PRP/ACP (autologous blood plasma): Possible as a regenerative option in selected, chronic cases; The study situation is heterogeneous, benefit-risk assessment and information are a prerequisite.
• Occupational therapy/everyday training: gentle gripping techniques, aids, break management.

Treatment decisions are made individually. What is important is a clear definition of goals, regular follow-up checks and independent practice at home.

When does an operation make sense?

Surgical measures are usually only considered after conservative therapy has been exhausted - with the exception of recent, complete tendon tears, for which a timely approach is often discussed.

• Distal biceps tendon rupture: If there is a complete tear, surgery is often performed to restore flexion and, above all, supination strength. Decision based on functional requirements and findings.
• Distal triceps tendon rupture: In the case of a complete rupture, surgical reconstruction is usually required to regain extensor strength.
• Treatment-refractory epicondylopathies: After 6–12 months of structured conservative therapy, a surgical release/denervation procedure can be considered.

Any surgery carries risks such as infection, scarring or nerve irritation, and stiffness. Information and individual consideration are essential. The follow-up treatment includes immobilization, gradual mobilization and building up the tendon's resilience.

Prevention: What protects tendons

• Slow training build-up, sufficient breaks, variation instead of monotony.
• Train technique: grip width, racket stringing, ergonomic mouse/keyboard.
• Keep the load close to your body and avoid jerky tensile loads.
• Strength balance: forearm, shoulder blade fixators, core strength.
• Stretch and mobilize regularly, especially after long periods of work.
• React to warning signals early – adapt to the load instead of “pushing through”.

What you can do yourself

• Eccentric wrist extension training: Elbow slightly bent, support your forearm, slowly lower the dumbbell and lift it with the other hand.
• Isometric exercises with light resistance for flexors/extensors, hold for 5-10 seconds, several times a day.
• Pronation/supination with a light dumbbell or hammer handle in a neutral elbow position.
• Keep a stress diary to identify triggers and make adjustments.
• In case of acute irritation: cool briefly (e.g. 10 minutes, several times a day, pay attention to skin protection).

Exercises should be performed with little pain. If symptoms persist or you suspect a tear, please seek medical advice.

Course and prognosis

Many elbow tendon irritations improve within weeks to a few months with consistent conservative treatment. Chronic courses require patience and a combination of stress control, targeted training and, if necessary, additional measures such as shock waves or - in selected cases - PRP. Recurrences are possible, especially if the load or technique remains unchanged. After surgical treatment of tendon tears, rehabilitation extends over several months, depending on the procedure, before full sport or workload is realistic.

Your elbow treatment in Hamburg-Winterhude

In our orthopedic practice at Dorotheenstrasse 48, 22301 Hamburg, we look at tendon and muscle problems holistically: from the anamnesis to the clinical examination and high-resolution sonography to individual therapy planning. First conservative, structured and evidence-based - if necessary with coordinated network partners for further measures. We take the time to identify stress factors and define realistic goals together.

Other areas of the elbow

Elbow pain can also be caused by joint, ligament/capsule, or nerve problems. The following overview pages help with orientation and differentiation:

• Joint: Osteoarthritis, loose joint bodies and inflammation
• Ligaments and capsule: Instabilities and capsule irritations
• Bone injuries: fractures, bony avulsions
• Dislocations and blockages: dislocations, restricted movement
• Nerve compression and functional disorders: ulnar groove syndrome, radial tunnel, muscular imbalances