Last updated: 2026-08-11
How Is Pain on the Inside of the Elbow Different from Pain on the Outside?
If pain on the inside of the elbow worsens when you bend your wrist or rotate your forearm, start by reducing your working time and adjusting the angle of your movements. If you are forced to rest completely when you still need to use your arm, the pain may easily return with the same movements once you go back to work. Instead of stopping all activity without a plan, loosen your grip on tools, break continuous work into shorter intervals, and determine how much activity you can currently tolerate.
Medial epicondylitis develops when microdamage accumulates in the tendons on the inside of the elbow, where the wrist flexor muscles and pronator teres muscle that rotates the forearm attach. You may feel a sharp, tingling pain or a dull pulling sensation around the inner elbow bone when holding a heavy object with your palm facing upward.(Amin NH et al., 2015) You can also check whether pain radiates along the inner tendon when wringing out a wet towel.
Lateral epicondylitis, which causes pain on the outside of the elbow, involves a different tendon attachment site, so the movements that trigger symptoms also differ. If the outside of your elbow hurts when you lift an object with your wrist bent backward, the lateral tendon should be evaluated first. If the inside hurts when you bend your wrist and rotate your forearm inward, the origins of the wrist flexor muscles and pronator teres should be examined.(Ciccotti MC et al., 2004)
If your little finger and ring finger frequently become numb or tingle, the evaluation should not stop with the tendon. This is because the ulnar nerve, which passes along the inside of the elbow and continues toward the little finger, may also be compressed. We ask whether the numbness or tingling worsens when you rest your elbow on a desk for a long time or keep it bent, and whether your ability to pinch a piece of paper has also weakened.
Using musculoskeletal ultrasound, we move the wrist flexor attachment area and assess it from several angles. We check whether the tendon is swollen or thickened, whether it is partially torn, and also examine the thickness and movement of the ulnar nerve. Based on the examination results, we decide whether to begin with resistance exercises or add extracorporeal shock wave therapy or an image-guided injection.
How to Change Your Work Habits If You Cannot Take Time Off
If you need to keep working, rather than vaguely trying to reduce how much you use your arm each day, break down and modify the specific movements that cause pain. Reduce the angle at which your wrist bends and the force you use to grip tools, and shorten each period of continuous use. This is load management that varies your working posture so that strain does not concentrate on a single area of the tendon on the inner side of the elbow.
The thinner the handle, the more force you apply through your fingers and wrist to keep it from slipping. Wrap tape or padding around the handle to make it thicker, and alternate between both hands whenever possible to reduce grip fatigue. Adjust the height of the work surface or the position of your tools so that the back of your hand and forearm remain close to a straight line, and after using your arm for 20–30 minutes, open your hand and rest your elbow for 2–3 minutes.
If you stop using your arm entirely because it hurts, the tendon may also lose its ability to tolerate the demands of your work. Treating tendinopathy requires both a period of reducing excessive load and a period of gradually increasing the load again. Set an appropriate daily-use limit within a range where discomfort during work is tolerable and your symptoms and function are not noticeably worse the next day.(Millar NL et al., 2021)
Wear a counterforce brace around the muscle area two to three finger-widths below the painful bone, rather than directly over the bone. Its purpose is to reduce some of the tension transmitted to the tendon origin before it reaches that area when you grip a tool or lift a load. If wearing the brace makes the pain worse or causes new tingling that radiates into your little finger, readjust its position and tightness.
Begin rehabilitation with isometric exercises, such as resisting wrist flexion with your palm facing upward using your opposite hand or a light dumbbell. Hold each position for 20–30 seconds and repeat 4–5 times. If your symptoms have settled by the next day, progress to resistance exercises in which you slowly lower your wrist while resisting the movement. Because the stimulus placed on the tendon varies with the weight and frequency, reduce the amount of exercise on heavy workdays and increase it on days off.(Pavlova AV et al., 2023)
When Should Extracorporeal Shock Wave Therapy or Injections Be Added?
If pain still causes you to drop tools or prevents you from increasing resistance even after adjusting your wrist angle and working hours and continuing resistance exercises, we discuss additional treatment options. The goal is to help you progress to the next stage of exercise while maintaining the adjusted workload.
Extracorporeal shock wave therapy delivers acoustic energy to the tendons on the inside of the elbow, mechanically stimulating the damaged tissue. At The Wells Nowon, treatment is performed once or twice a week using Lepton equipment. Ultrasound is used to locate the injury, and the shock wave energy is adjusted according to tendon thickness. In medial epicondylitis, the stimulation received by the tissue varies depending on the treatment area and shock wave schedule.(Schroeder AN et al., 2021)
Ultrasound-guided prolotherapy and ozone injections deliver medication around the injury while the needle tip and tendon origin are viewed in real time. Prolozone combines ozone with prolotherapy, which uses high-concentration glucose to target a local healing response.(Hsu C et al., 2023) At The Wells Nowon, a course consists of 4–6 sessions performed once every one to two weeks, with tendon thickness and the pain response reassessed by imaging at each session.
Extracorporeal shock wave therapy and prolotherapy both act directly on the damaged tendon to promote a tissue response, but they differ in how the stimulus is delivered and in the body of research accumulated to date. If pain and functional limitations persist despite sufficient load adjustment and rehabilitation, we assess the tendon’s current condition alongside the work movements you repeat each day. After reviewing the benefits and burdens of each treatment in the context of your daily life, we determine the treatment sequence individually.
If the pain is severe enough to make even light resistance at the wrist difficult, symptom control takes priority over rehabilitation initially. Once the discomfort subsides, resistance exercises that had been stopped are resumed within a comfortable range of motion. Repeating injections while leaving the causative work movements unchanged makes it difficult to sustain the recovery process through to completion.
Why Does It Hurt Again When It Seems Fully Healed?
If you return to your previous work pace as soon as your symptoms ease, the wrist flexor tendons may not yet be able to handle the former workload, causing pain to recur in the same area. The final stage of rehabilitation involves recreating in the clinic the actual grip strength and duration of continuous work required on the job.
If stiff elbow muscles prevent the wrist and forearm from moving smoothly, treatment begins by releasing adhesions in the forearm fascia. WINBACK and Lympha-T high-frequency therapy is applied at this stage to relax deep tissues and increase the restricted range of motion. Wrist flexor and pronator teres exercises are then added, and the degree of flexion is assessed to determine whether the newly gained range can be used actively.
Each person’s specific work tasks, such as turning a screwdriver or holding pliers for an extended period, are recreated in the rehabilitation room. If the job involves handling heavy materials, the patient practices holding the wrist in a neutral position, initially performing short repetitions with only a portion of the actual working weight and checking whether any lingering pain remains. If pain and grip strength remain stable the next morning, either the weight or the duration is increased.
The timing of a full return to work is not determined by the pain score alone. If the person previously had to put down a tool after 10 minutes, the endurance required for workplace tasks is assessed by checking whether the wrist maintains the same angle while repeating the movement for more than 20 minutes. The patient is also asked whether they are placing all the strain on one hand to avoid pain and whether any new numbness develops in the little finger after work.
Treatment for elbow tendinopathy does not end with reducing immediate pain; the next phase takes longer. The ability to tolerate the workload must also be restored so that the person can continue performing the same job months later.(Millar NL et al., 2021) Gradually increasing work speed and continuous use time in preparation for returning to work determines long-term arm function.
Could Numbness and Weakness in My Hand Be Caused by an Elbow Problem?
If your little finger and ring finger feel numb more often than usual or you have less strength when spreading your fingers, we also evaluate the ulnar nerve. We use ultrasound to examine whether the numbness worsens when you bend your elbow and whether the nerve catches or snaps as it passes behind the inner elbow bone. If we identify where the nerve is compressed, the first step is to avoid keeping the elbow bent for long periods or resting it against the edge of a desk, so we also determine whether your workplace allows you to make these changes.
If numbness radiates from the elbow to the hand when you tilt your neck backward or turn it, we also assess the nerves extending from the neck. We compare sensation and differences in muscle strength between the left and right sides at the neck, shoulder, elbow, and fingers. If the compression originates in the neck, we do not repeatedly treat only the elbow tendon; instead, we expand the treatment area to include the site of nerve compression.(Ciccotti MC et al., 2004)
If pain wakes you every night or your elbow becomes swollen and hot, you should not dismiss it as simple work-related overuse. If your arm becomes weak immediately after an injury, causing you to drop an object you were holding, or if the muscles on the palm side of your hand become noticeably thinner, we determine whether the situation requires immediate medical attention. We decide on treatment after checking whether a tendon is torn, the joint is inflamed, or nerve compression is progressing.
The treatment approach and the workload permitted on the job vary depending on the extent of tendon damage, your occupational movements, and any accompanying neurological symptoms. You do not need to endure the pain or stop working altogether; we identify an amount of work you can continue without overstraining the elbow. We reduce movements that aggravate elbow pain at the workplace and then proceed with treatment to restore tendon and hand function within the remaining range of activity.
This content is provided for medical information purposes and may vary depending on individual circumstances. Please consult a specialist for an accurate diagnosis and treatment.
Park Sung-jin · Medical Director · The Wells Clinic, Nowon Branch
Related Articles
- Medial Epicondylitis — Causes, Symptoms, and Diagnosis of Inner Elbow Pain
- What Is Tennis Elbow? — Degenerative Changes in the Tendon, Not Inflammation
References
- Amin NH, Kumar NS, Schickendantz MS (2015). Medial epicondylitis: evaluation and management.. Journal of the American Academy of Orthopaedic Surgeons. PMID: 26001427
- Ciccotti MC, Schwartz MA, Ciccotti MG (2004). Diagnosis and treatment of medial epicondylitis of the elbow.. Clinics in Sports Medicine. PMID: 15474230
- Millar NL, Silbernagel KG, Thorborg K (2021). Tendinopathy.. Nature Reviews Disease Primers. PMID: 33414454
- Pavlova AV, Shim JSC, Moss R (2023). Effect of resistance exercise dose components for tendinopathy management: a systematic review with meta-analysis.. British Journal of Sports Medicine. PMID: 37169370
- Schroeder AN, Tenforde AS, Jelsing EJ (2021). Extracorporeal Shockwave Therapy in the Management of Sports Medicine Injuries.. Current Sports Medicine Reports. PMID: 34099607
- Hsu C, Vu K, Borg-Stein J (2023). Prolotherapy: A Narrative Review of Mechanisms, Techniques, and Protocols, and Evidence for Common Musculoskeletal Conditions.. Physical Medicine and Rehabilitation Clinics of North America. PMID: 36410881
Frequently Asked Questions
Q. Can I continue working if I have pain on the inside of my elbow?
You may continue working with modified duties as long as the pain does not worsen sharply during work or clearly persist into the next day. If the pain accumulates or your grip strength decreases, you should further reduce the workload and duration of continuous use.
Q. When should I wear a counterforce brace at work?
You can wear it over the forearm muscles while performing tasks that involve repetitive gripping and wrist flexion. If it is too tight and causes numbness or changes in hand color, loosen it immediately. You do not need to keep wearing it while resting.
Q. What criteria are used to choose between extracorporeal shock wave therapy and prolotherapy injections?
The choice is based on the location and extent of the tendon injury, pain sensitivity, work schedule, and response to previous treatments. Rather than routinely using one method first, the order is determined based on ultrasound findings and factors that interfere with rehabilitation progress.
Q. Can I use my arm immediately after injection treatment?
Light everyday movements may be possible, but it is safer to limit forceful gripping and repetitive wrist use on the day of the injection. Afterward, you should gradually increase use based on the type of injection and your pain response.
Q. If My Little Finger and Ring Finger Feel Numb, Is This a Different Problem From Medial Epicondylitis?
Numbness in these fingers may be related to irritation of the ulnar nerve, which passes along the inside of the elbow, and may occur together with tendon pain. If the strength used to spread the fingers decreases or the numbness persists, the location of nerve compression and nerve function should be evaluated separately.