It depends on the tissue that is painful; the two elbow braces people most often ask about do very different jobs. A counterforce strap is worn on the forearm below the elbow for lateral elbow (outer) tendon pain. A hinged brace controls the movement of the elbow joint itself, and is used for a recent medial elbow (inner) ligament injury. Neither is a treatment in itself.
Lateral elbow pain is typically due to tennis elbow, or lateral epicondylitis. The muscles that extend the wrist and fingers attach to the humerus via one common tendon at the outer elbow, and it wears down under repeated gripping and wrist extension. A counterforce strap transfers the tensile force to the muscles below, reducing the strain at the point of tendon attachment, which is why it is worn on the forearm, not over the painful area.
Medial elbow pain in the thrower is caused by damage to a different tissue. The ulnar collateral ligament sits on the inner side of the elbow and keeps the joint from being pried open as the arm accelerates, a stress doctors call valgus load, and that stress is exactly how the ligament gets hurt. A hinged brace restricts elbow movement to allow healing following a sudden injury, but is prescribed after medical examination, not selected from a shelf. It is of no benefit to gradual tendon wear, and cannot substitute for the throwing rest needed for a ligament injury.
Braces reduce the strain applied to injured tissues, so the diagnosis determines which one to select. Weak grip strength with outer elbow pain suggests a tendon problem, and pain on the inner elbow associated with throwing suggests a ligament problem. When the ligament is completely torn, Tommy John surgery is the reconstruction that rebuilds it.
In most cases, pain localized to the elbow points to one specific tissue being affected. Lifting and grasping put stress on one tissue, throwing stresses another tissue, and pulling while the elbow is flexed stresses a third tissue.
Gripping and lifting using pronation (palms facing downward) places strain on the common extensor tendon on the outside of the elbow. Treatment involves decreasing that strain: modify how you grasp and lift objects, apply ice to the area, and rest before stressing the tissue again. With honest load modification, most people recover without surgery; the modification is the part most people skip.
Throwing places stress on the inside of the elbow. The medial collateral ligament is placed under the greatest stress during cocking and acceleration phases of throwing. Tears of this structure can occur acutely, resulting in a popping sensation, bruising, loss of velocity and accuracy, or gradually through repeated microtears. The gradual version is the chronic injury most people call pitcher's elbow. Most of these also settle without surgery, on the tissue's schedule rather than a calendar, and when a complete tear needs rebuilding, Tommy John surgery is that reconstruction.
A tearing feeling and a bruise at the front after a heavy lift points to the biceps tendon. The biceps crosses over the shoulder too, so shoulder pain is often the other part of the story. Tingling or numbness extending down to the ring and little fingers isn't a tendon at all, but rather the ulnar nerve that travels just behind the attachment of the ligament and gets stretched along with it.
If it hurts when you wake up, the problem is almost always on the inside of the elbow. The reason is the ulnar nerve, the funny bone nerve, which passes through a narrow channel on the inner elbow and gets squeezed whenever the arm bends. A night spent with the arm folded is a night spent squeezing it.
You can tell the difference between joint pain and nerve pain by paying attention to where the numbness is. If the ring and little fingers go numb and straightening the arm is what wakes you, it is likely the nerve. If it happens after a long phone call, or after resting your elbow on a hard surface for a while, then it's also probably the nerve.
Splints help keep the elbow straight while you sleep. You can also wrap a pad over the inner elbow to protect the nerve during the day. Try not to lean on the arm, especially against hard surfaces.
Outer elbow pain at night follows a different logic: it is usually the extensor tendon aching after the day's load rather than anything being squeezed, so it eases with unloading rather than with straightening the arm.
If you have persistent numbness despite straightening the arm, weak grip strength, or difficulty holding objects, then you need to see a doctor. There's a limit to what splints can do and they won't fix nerve damage.
The goal with elbow exercises isn't to exercise the elbow joint, but instead to exercise the muscles that cross it.
The forearm muscles that move your wrist and fingers insert into your elbow. Building up the strength and length of these muscles will help decrease the stress that is being placed on your painful insertion.
The standard exercises for lateral elbow tendon pain include slow wrist curls with light resistance, the same motion but with the palm turned down, and a long hold stretch with the elbow locked straight. Physical therapy starts with these exact movements and progresses the resistance as the tendon tolerates it.
Flexor muscles attach to the same place on the inside of the elbow, and flex when you turn your palm up. Squeezing a stress ball works this area as well, since you're pressing harder on the inner muscles than on the outer muscles.
Ligaments are cords of connective tissue connecting two bones, and there is no known exercise that will thicken a ligament on demand.
Instead, what an injured ligament receives is strengthening in the supporting musculature and a splint or brace that restricts the amount of motion a joint can achieve during healing.
First motion returns, then strength, and this is also the sequence in rehabilitating an injured elbow. Don't push through a sharp pain; if the elbow is even more sore the next day, the program does not fit the problem. And when an elbow tendon is so sore that just doing strengthening exercises doesn't help it, regenerative medicine covers the non-surgical options worth bringing up.
Dr. Langer exceeded my expectations based on his stellar reputation. He was so thorough and spent an incredible amount of time breaking things down to a level I could understand. I was IMPRESSED!
The fastest way to get relief from an elbow that hurts right now is to take load off the elbow. A short time away from the activity or movement that causes it does more than anything else. An ice pack on the tender spot and an over-the-counter anti-inflammatory, if your stomach tolerates it, cover the rest, and the splint that fits the tissue keeps the load off during the day.
This will quiet a flare. What it doesn't do is fix the tissue below. A worn tendon, a loose ligament, a squeezed nerve, an irritated joint lining: none of these rest away or ice away, which is why the pain comes back once the arm goes back to work. Two signs say the problem has outgrown home care. If swelling continues to linger after a flare has quieted, that tells you the trouble lies in the capsule, not the tendon. If the relief wears off faster each time, that points the same way. For a stubborn tendon flare, shockwave therapy is offered as the next non-surgical step, and regenerative medicine lays out the rest of that menu.
The workup runs the same way every time, and imaging comes last.
We start by asking when your symptoms started, where the pain is located, what makes it worse, what you do for a living, and what your sport demands of the arm.
The exam itself does most of the work. It begins with watching how the arm moves. Pressing the bony bump on the outside of the elbow and then the one on the inside helps tell the two tendon issues apart. We also test your grip, how strong your wrist is, and how well you can feel sensations in your ring and little fingers. Putting your arm in the throwing position looks for that inner-elbow pain to come back. We'll also hook a finger underneath the biceps tendon in the front of your elbow to make sure it's properly connected.
We only use imaging if we think it will alter treatment plans. X-rays show bone, so they are the tool for spotting a fracture, arthritis, or loose fragments, but they carry no sign of a tendon injury. An MRI will reveal if there's a ligament or tendon tear. If your main symptoms are numbness and weakness, a nerve conduction study determines how fast the signal is traveling as it goes past the elbow. That test has limits too: a normal result does not prove the nerve is free.
Surgery is suggested when it has the best chance of significant, lasting relief, and the elbow surgery page covers what that entails.
Two credentials underpin the elbow work here. Active consultant to Major League Baseball on elbow injuries and performance-related surgical decision-making. Served as an orthopedic surgeon and team physician for the Miami Heat, Atlanta Thrashers, and Atlanta Falcons from 2007 to 2011.
Atlanta throwers, lifters, and typists all sit in the same chair. If your elbow has bothered you long enough to bring you here, request an appointment.
If pain is limiting the way you train, work, sleep, or move, an evaluation can turn uncertainty into a practical next-step plan.
Book an appointment →Explain what you want to return to, not only what hurts.
Look for the combination of findings that best explains the symptoms.
Understand the likely cause, whether imaging helps, and what comes next.
Atlanta Sports Medicine Institute helps active patients understand what may be driving their symptoms and compare appropriate treatment paths. The experience should be precise, understandable, and tied to the activities each patient wants to return to.
The most common culprit is the tendon on the outer part of the elbow. The muscles that raise the hand and fingers meet the arm at one shared tendon on the outer elbow, and when that tendon is strained, anything that loads it hurts. Straightening the arm while gripping is exactly that kind of load. Other symptoms include tenderness directly on the bony prominence, pain shooting down the forearm and a gradual loss of grip strength. If standard tennis elbow treatment isn't working, the radial nerve passes through a tunnel just past the elbow and presents with symptoms that are similar to tennis elbow.
Pain in both elbows usually points to a cause that reaches both arms rather than an injury to one. Tennis elbow most commonly occurs as a result of work rather than sport, and a job that requires repeating the same wrist motion throughout the day can place equal strain on both sides. This includes office work, factory work, playing instruments, and many of the manual trades. The other possibility to consider is the joint lining. Both inflammatory and crystal arthritis can inflame the elbow with no preceding injury, and these conditions usually affect both sides. Intermittent swelling and warmth in the elbow, but not necessarily pain with one specific motion, points more toward that process.
The injury is a tear of the ulnar collateral ligament on the inside of the elbow. If the injury occurs slowly rather than suddenly, it's more accurately called chronic overload, but most people refer to it as pitcher's elbow. In a young athlete with growing bones, the same stress leads to little leaguer's elbow. The operation that rebuilds a badly damaged ligament is named for the first pitcher to have it: everyone calls it Tommy John surgery.
Typically, yes. Elbow tendinitis usually settles when the tissue actually gets to rest, and the remedy that matters most is stopping the offending activity. Physical therapy, a counterforce brace, and a nonsteroidal anti-inflammatory are beneficial. How long it takes depends on how much wear the tendon carries and how honestly you unload it. You almost never need surgery for elbow tendinitis. If it's not getting better and it's making daily activities difficult, get it checked out.
The radial nerve runs along a narrow tunnel that passes behind the elbow crease. If it is compressed in this area, the pain occurs lower down in the forearm, is more diffuse, and shows up when actively turning the palm upward. Compression of the ulnar nerve can be confused with problems of the flexor tendons and adds numbness in the ring and little fingers. Both inflammatory and crystal arthritis can look similar as well. And a partial tear of the biceps tendon produces pain at the front of the elbow that gets mistaken for tendonitis. If the pain does not improve with tendon treatment, that diagnosis deserves a look.
Tell us what is bothering you and we will get you in front of the right person.
