Epitrocleitis – commonly known as medial epicondylitis or “golfer’s elbow” – is a painful condition affecting the inner side of the elbow. It develops when the common flexor tendon at the medial epicondyle of the humerus becomes chronically degenerated, typically from repetitive gripping, wrist flexion, or forearm rotation. The result is persistent pain, weakness, and difficulty with everyday activities like carrying objects or shaking hands.
Despite its name, epitrocleitis affects far more people than golfers. It is common in manual workers, tennis players, office workers, and anyone who performs repetitive arm motions. And for many patients, conventional treatments provide only temporary relief without addressing the underlying tendon damage.
Stem cell therapy for epitrocleitis is an emerging regenerative approach that may offer a meaningful option for patients who have not found lasting relief through rest, physical therapy, or cortisone injections.
Why Epitrocleitis Becomes Chronic
Tendons have a limited blood supply, which means they heal slowly. In epitrocleitis, the repeated microtrauma to the flexor tendon at the medial epicondyle creates a cycle of degeneration rather than true healing. The tissue undergoes changes called angiofibroblastic tendinosis – a process where normal tendon tissue is replaced with disorganized, less functional tissue that is more prone to further injury.
This is why corticosteroid injections, which reduce acute inflammation, often provide only short-term relief. They do not address the structural degeneration of the tendon, and repeated injections may actually weaken tendon tissue over time.
What Conventional Treatment Offers
Standard treatments for epitrocleitis typically include:
- Rest and activity modification
- Non-steroidal anti-inflammatory drugs (NSAIDs) for pain management
- Physical therapy and eccentric loading exercises
- Bracing or counterforce straps
- Corticosteroid injections for short-term pain relief
- Extracorporeal shockwave therapy (ESWT)
These approaches are often the appropriate first line of care, and many patients improve with them – particularly if the condition is caught early. However, a significant proportion of patients develop chronic epitrocleitis that does not resolve with conservative management alone, and for these individuals, more targeted interventions may be warranted.
How Stem Cell Therapy for Epitrocleitis Works
Stem cell therapy for epitrocleitis centers on the use of mesenchymal stem cells (MSCs) – cells with the ability to modulate inflammation, release growth factors, and potentially support tissue repair. MSCs can be obtained from bone marrow (BMAC – bone marrow aspirate concentrate) or from adipose (fat) tissue.
When injected precisely into the degenerated tendon under ultrasound guidance, MSCs are thought to work through several mechanisms:
- Paracrine signaling: MSCs release growth factors and cytokines that reduce local inflammation and attract the body’s own repair cells
- Immunomodulation: MSCs help shift the tendon environment from a degenerative, pro-inflammatory state toward a more regenerative one
- Trophic support: MSCs may help support the survival and function of existing tendon cells (tenocytes)
Research on MSC behavior supports their role as what has been described as an “injury drugstore” – cells that respond to local damage signals by releasing a range of bioactive molecules that promote healing (Caplan & Correa, Cell Stem Cell, 2011).
What the Evidence Suggests
The use of stem cell therapy for tendinopathy, including conditions like epitrocleitis, is an active area of research. A systematic review examining stem cell therapy for tendon disorders found that while high-quality randomized controlled trial data remains limited, preclinical and early clinical studies suggested potential for MSC-based approaches in tendon repair (Pas et al., Br J Sports Med., 2017). The authors noted that robust clinical evidence was still needed, and that the field was evolving.
Animal and early human studies on adipose-derived MSCs for tendon healing have shown that these cells can improve tendon structure and reduce pain-related behavior, supporting the biological plausibility of the approach (Lee et al., Am J Sports Med., 2017).
For related elbow conditions, research has also shown that biologic injections into degenerative tendons can outperform cortisone over longer follow-up periods, suggesting that regenerative approaches may provide more durable outcomes than purely anti-inflammatory ones (Behera et al., J Clin Orthop Trauma, 2020).
What Stem Cell Treatment Involves
For patients exploring stem cell therapy for epitrocleitis, the process typically includes:
Evaluation: A clinical assessment and diagnostic imaging (ultrasound or MRI) to confirm the diagnosis and assess the degree of tendon degeneration.
Harvest: MSCs are collected from bone marrow (iliac crest) or adipose tissue under sterile conditions. The sample is then processed to concentrate the cells.
Injection: The MSC preparation is injected directly into the degenerated tendon under ultrasound guidance for precise placement.
Recovery: Patients are typically advised to reduce loading on the elbow for a period of days to weeks while the tendon begins its regenerative response.
Most patients who proceed with this approach have already tried conservative treatments without adequate relief and are seeking an option that addresses the structural basis of their pain rather than masking symptoms.
Frequently Asked Questions
Is stem cell therapy painful for epitrocleitis?
The injection itself is typically performed with local anesthesia to minimize discomfort. Mild soreness at the injection site in the days following treatment is common and expected.
How many stem cell injections are needed for epitrocleitis?
In most cases, a single injection session is performed, with a follow-up evaluation at 4–6 weeks. Some patients may require a second treatment depending on clinical response and imaging findings.
How long does recovery take after stem cell therapy for golfer’s elbow?
Early recovery – with reduced loading and modified activity – typically spans two to four weeks. Full functional improvement may continue developing over three to six months as the tendon remodels.
Does stem cell therapy work better than cortisone for epitrocleitis?
These are fundamentally different approaches. Cortisone addresses acute inflammation and provides faster short-term relief but does not repair tendon structure. Stem cell therapy aims to support tissue regeneration over a longer timeline. For chronic, refractory epitrocleitis, regenerative approaches may offer more durable benefits.
Key Takeaways
- This condition involves chronic degeneration of the flexor tendon at the medial epicondyle, not simply inflammation
- Conventional treatments often provide temporary relief without addressing tendon structure
- Stem cell therapy using MSCs may offer a regenerative option for patients with chronic or refractory medial epicondylitis
- MSCs work through paracrine signaling, immunomodulation, and trophic support of the local tendon environment
- Evidence is emerging and promising, though large randomized trials in this specific condition are still underway
- A thorough evaluation and imaging assessment are essential before considering this treatment
To explore whether stem cell therapy at Ways2Well may be appropriate for your elbow condition, schedule a stem cell therapy consultation or schedule a consultation with our medical team to discuss your options.
References
- Caplan AI, Correa D. “The MSC: An injury drugstore.” Cell Stem Cell. 2011;9(1):11–15. DOI: https://doi.org/10.1016/j.stem.2011.06.008
- Pas HI, Moen MH, Haisma HJ, Winters M. “No evidence for the use of stem cell therapy for tendon disorders: a systematic review.” Br J Sports Med. 2017;51(13):996–1002. DOI: https://doi.org/10.1136/bjsports-2016-096794
- Lee SY, Kwon B, Lee K, Son YH, Chung SG. “Therapeutic mechanisms of human adipose-derived mesenchymal stem cells in a rat tendon injury model.” Am J Sports Med. 2017;45(6):1429–1439. DOI: https://doi.org/10.1177/0363546517689874
- Behera P, Dhillon MS, Aggarwal S, Marwaha N. “Leukocyte-poor platelet-rich plasma versus leukocyte-rich platelet-rich plasma in lateral epicondylitis: a systematic review.” J Clin Orthop Trauma. 2020;11(Suppl 4):S535–S542. DOI: https://doi.org/10.1016/j.jcot.2020.05.028
Author: Ways2Well Editorial Team
Reviewed by: Scientific Advisory Board member