Too Much Elbow Grease?

The Causes, Treatment, And Role Of MRI For Elbow Pain

by ​Dr. Thomas Pendergrast // July - August - September 2021

“Just give it a little more elbow grease!” We’ve all heard this expression before as a playful way to refer to hard work. But as we get older, many of us realize just how much sense it actually makes. We use our elbows for all sorts of activities, both work-related and recreational. Therefore, it’s no surprise that elbow pain is a common condition found in adults who are 30- to 40-plus years of age, due to repetitive overuse. Activities like golf, tennis, and other racquet sports, and occupations such as painting, carpentry, and plumbing are usually the culprits.

Elbow Pain and Epicondylitis

The common cause of elbow pain is medically referred to as epicondylitis, and there are two types that occur.

– Medial epicondylitis (or golfer’s elbow): Occurs on the inside of the elbow and affects the common flexor tendon and muscles in the forearm that contribute to moving the wrist and fingers.

– Lateral epicondylitis (or tennis elbow): Occurs in the outer elbow, where the common extensor tendon attaches the forearm muscle to the elbow bone.

Both types of epicondylitis develop gradually and create a dull and achy type of pain or soreness in the elbow. Dr. Thomas Pendergrast, a musculoskeletal radiologist with Raleigh Radiology, is well-acquainted with elbow pain, both as doctor and patient.

“I have golfer’s elbow myself … from playing tennis,” he shared. “Back in the 1800s (when they coined the phrase), different equipment was used for tennis which affected the lateral tendons and muscles. In today’s game, tennis is more stressful on the medial elbow.”

Conservative Measures Come First

in Treating Elbow Pain

Whether you are a tennis player suffering from golfer’s elbow, or a golfer suffering from tennis elbow, medical intervention is probably needed to relieve the pain, especially if your elbow is feeling tender to the touch.

A good first step is to visit your primary care physician or orthopaedist, where your condition can be evaluated based upon a physical exam and an understanding of your activities and history. Dr. Pendergrast explains that if the symptoms and exam fit epicondylitis, your doctor will likely first recommend three to six months of conservative measures for the cessation of pain.

Conservative measures include anti-inflammatory medications; icing after activity; corticosteroid injections in the elbow, given by an orthopaedist; activity modification; and physical therapy exercises, which can be done at home.

Using MRI to Evaluate Persistent Elbow Pain

If conservative treatment measures are not successful and the symptoms of elbow pain continue, an MRI is likely the next step. The elbow MRI is relatively simple and is a highly effective method for diagnosing elbow pain. The scan takes approximately 20 minutes and can be done without contrast fluid. After interpreting the images, a radiologist will report back to the patient’s referring physician.

“The sensitivity of MRI for detection of epicondylitis is nearly 100 percent,” explains Dr. Pendergrast. “With elbow pain, MRI findings and clinical findings tend to correlate nicely, making this condition readily identifiable – which is very helpful when it comes to determining the best treatment plan. I find it very satisfying to be able to use MRI to give patients a clear answer about their pain.”

MRI can determine the severity of epicondylitis – for example, whether the tendon is thickening or inflamed, or if there is a tear in the tendon. Tears can even be quantified using MRI to determine if surgical repair is needed. MRI can also identify other abnormalities associated with elbow pain, such as nerve entrapment syndrome (when the nerves around the elbow are being compressed or squeezed) and osteoarthritis. To an orthopaedic surgeon, a patient’s MRI results are often critical for surgical planning.

Does an MRI Always Mean Surgery?

Receiving an MRI for elbow pain does not always mean surgery is necessary. As Dr. Pendergrast also explains, “The severity of a tendon tear can be present on a spectrum, from low-grade to more severe. For example, I have tendinosis, a lower grade condition, and can keep it under control myself with the correct exercises.”

Tendinosis is a chronic, degenerative condition that can occur in the elbow tendons, typically due to overuse. This can increase the risk of a higher-grade tear, but can also be managed with conservative measures such as activity modification, wearing a brace, consistent and correct exercises, strength training, nutrition, and even massage.

However, high-grade tendon tears may require surgery, especially if there is associated ligamentous injury, which can also be seen on MRI. For this reason, it is important to see your doctor if you are experiencing elbow pain that is affecting daily activities. Proper treatment is needed to help resolve the pain and prevent further deterioration.

​Dr. Thomas Pendergrast

Raleigh Radiology offers top-of-the-line medical imaging services throughout Wake and Johnson Counties. To learn more about Raleigh Radiology, visit