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Bethesda, MD(301) 530-1010
Dr. Marc GrunerSports & Regenerative Medicine
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Elbow Specialist

Elbow pain specialist — tennis & golfer's elbow

The short answer

Dr. Gruner treats tennis elbow, golfer's elbow, and other elbow tendon problems with activity modification, bracing, physical therapy, and advanced options like ultrasound-guided PRP and the Tenex procedure — helping you return to pain-free gripping and lifting without surgery.

Medically reviewed by Marc Gruner, DO, MBA, RMSK
Sports medicine physician, Mayo Clinic fellowship. Last reviewed June 2026

Elbow pain is often driven by overuse of the tendons that attach at the elbow — the extensor tendon on the outside (tennis elbow) or the flexor tendon on the inside (golfer's elbow). Because these are degenerative tendon injuries rather than simple inflammation, the right treatment restores healthy tendon loading.

Dr. Gruner develops a plan that may include activity modification, a counterforce brace, targeted physical therapy, and — for stubborn cases — ultrasound-guided PRP or percutaneous tenotomy (Tenex) to support tendon healing and get you back to pain-free movement.

What is elbow pain?

Most elbow pain in active adults comes from the tendons that attach around the elbow rather than the joint itself. On the outside of the elbow, the extensor tendon can degenerate from repetitive gripping and wrist extension (tennis elbow); on the inside, the flexor tendon can do the same from wrist flexion (golfer's elbow). Pain typically develops gradually and worsens with gripping, lifting, and repetitive tasks.

Less commonly, elbow pain arises from nerve irritation (cubital tunnel syndrome, causing pinky numbness), the biceps tendon, or ligament injury.

What causes tennis and golfer's elbow?

Both are overuse tendon injuries — the tendon accumulates micro-damage faster than the body repairs it, leading to degeneration. Despite the names, they affect far more office workers and tradespeople than athletes: anyone who repeatedly loads the wrist and forearm can develop them.

How is elbow pain treated without surgery?

First-line care is activity modification, a counterforce brace positioned just below the elbow, and a progressive loading program with physical therapy (often including massage and dry needling). When pain persists beyond a few months, Dr. Gruner offers ultrasound-guided PRP to stimulate tendon healing or the Tenex procedure to remove degenerated tissue — both office-based and far less invasive than open surgery.

Elbow conditions we treat

Tennis Elbow (Lateral Epicondylitis)Outer-elbow pain from overuse of the common extensor tendon.Golfer's Elbow (Medial Epicondylitis)Inner-elbow pain from overuse of the common flexor tendon.Cubital Tunnel SyndromeCompression of the ulnar nerve at the elbow causing numbness in the ring and little fingers.Distal Biceps TendinopathyPain at the front of the elbow where the biceps tendon attaches, worse with lifting and twisting.Little League Elbow (UCL Injuries)Throwing-overload injury of the inner elbow in young athletes, including UCL stress.

Treatments and procedures for the elbow

OrthobiologicsPRPConcentrated platelets from your own blood, injected under ultrasound guidance to support healing in joints and tendons.DiagnosticsMSK UltrasoundIn-office, real-time imaging of tendons, ligaments, nerves, and joints — no radiation — to pinpoint the source of pain.Office ProceduresTenexUltrasound-guided removal of damaged tendon tissue through a tiny opening — no open surgery.Office ProceduresTendon ScrapingA 2mm procedure that removes pain-causing tissue from the tendon's surface while preserving the tendon.

Rehabilitation protocol

What to expect week by week after your procedure. Your plan is individualized; follow these alongside your physical therapist.

Elbow — Ultrasound-Guided Tenotomy / PRP Protocol
Download full protocol (PDF)

  1. Week 0–1

    Protect, reduce pain and swelling

    • Sling for 3 days; no driving in sling
    • May lift up to 5 lbs; rest and elevate
    • Begin gentle active ROM 4×/day on day 3
    • Optional blood-flow-restriction (BFR) training 2×/week

  2. Weeks 1–2

    Restore full range of motion

    • May lift up to 10 lbs
    • Avoid repetitive elbow/hand activity and sustained gripping
    • Regain full ROM 3–5×/day

  3. Weeks 2–4

    Begin strengthening

    • May lift up to 20 lbs
    • Begin isometric wrist/elbow strengthening
    • Week 3: add light wrist flexion/extension weight (~2 lbs)

  4. Weeks 4–6

    Build strength and function

    • Progress isotonic strengthening
    • Integrated strengthening (chest press, rows, hammer curls)
    • Begin eccentric training

  5. Weeks 6+

    Return to sport

    • Continue strengthening
    • Sport-specific and progressive loading exercises

Do not use NSAIDs (ibuprofen, Aleve, aspirin) for 4 weeks, and avoid ice for the first week — both blunt the healing response. Acetaminophen (Tylenol) is fine for discomfort. Care is tailored to you; use these guidelines with your physical therapist.

Frequently asked questions

How long does tennis or golfer's elbow take to heal?
Many cases improve over 4–6 weeks with a structured loading program, bracing, and activity change. Cases that linger for months often respond to ultrasound-guided PRP or a Tenex procedure.
Should I stop using my arm if I have tennis elbow?
Complete rest usually isn't the answer — tendons need gradual, controlled loading to heal. Dr. Gruner guides you on modifying (not eliminating) activity while a progressive strengthening program rebuilds the tendon.

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Schedule a comprehensive evaluation to discuss your non-surgical treatment options.

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