Direct answer: Tennis elbow (lateral epicondylitis) and golfer's elbow (medial epicondylitis) are both overuse injuries at the forearm tendon origin, and when the pain outlasts rest, bracing, and a course of physical therapy, fibrous adhesion at that tendon origin is frequently the reason. The disorganized collagen that forms there restricts the tendon's normal glide and keeps it irritated under load. At Novo Soft Tissue in the Denver Tech Center, an exam determines whether adhesion is present and whether radial ESWT, manual release, or both fits the case — and for golfers, whether a swing fault is driving the repeated strain in the first place.
Most people reach out after months of rest, a forearm brace or strap, stretching and eccentric loading exercises, and sometimes a cortisone injection that helped briefly before symptoms returned. These approaches can calm inflammation temporarily but don't directly address tendon tissue that has already become adhered and disorganized.
The common extensor tendon origin at the lateral epicondyle (tennis elbow) and the common flexor tendon origin at the medial epicondyle (golfer's elbow) are both small, concentrated sites where repetitive gripping and wrist motion causes the tendon fibers to thicken and lose their normal parallel alignment. On exam, this shows up as point tenderness sharply localized to the epicondyle itself, with pain reproduced by resisted wrist extension (tennis elbow) or flexion (golfer's elbow) rather than by the whole forearm.
Because this is a small, relatively superficial tendon origin, radial ESWT is the modality most often used here, paired with manual adhesion release to help restore normal tendon glide once the shockwave work has been done.
A network meta-analysis spanning 23 trials and 1,484 patients on tennis elbow (lateral epicondylitis) found radial ESWT ranked far above focused ESWT for long-term disability scores and for pain at rest at long-term follow-up. Research specific to golfer's elbow is less extensive, but the tendon-adhesion mechanism at the medial epicondyle mirrors the lateral side closely enough that the same radial-ESWT-first approach is used there as well, confirmed or adjusted based on what the exam finds.
A new-patient comprehensive exam is $270 and includes a full history, physical examination, and an explanation of the diagnosis; no treatment is performed on the first visit. Follow-up visits are $90 for a single-region treatment. $180 for focused shockwave treatment. Novo Soft Tissue does not bill insurance directly, but accepts cash, check, major credit cards, HSA, and FSA, and provides documentation you can submit for possible reimbursement.
Request an appointment to have chronic elbow pain evaluated for adhesion, or read more about how focused and radial shockwave differ and how manual adhesion release works. Golfers: if a swing fault is contributing, see our TPI golf performance page.
Last reviewed: September 2026