Elbow Pain Treatment in Dallas, TX

Most elbow problems fall into a simple grid, and knowing which box you are in explains almost everything about treatment. There are two sides of the elbow, and on each side there is a tendon problem and a ligament problem.

Add one more that imitates the medial box and is regularly mistaken for it — the ulnar nerve — and you have covered the great majority of elbow pain.

Dr. Buford does not perform elbow surgery. What is offered here is assessment by a board-certified orthopedic surgeon and non-surgical treatment, including ultrasound-guided orthobiologics. Where an operation is the right answer you will be told plainly and referred, with your imaging and workup handed over — not treated with an injection because an injection was what was available.

Tennis elbow, and why the name is misleading

It goes by three names and they refer to the same problem: tennis elbow, lateral elbow tendinopathy, and lateral epicondylitis. Pain on the outer side, worse gripping, lifting a kettle, shaking hands, using a screwdriver.

In depth: tennis elbow and golfer’s elbow treatment in Dallas — what the corticosteroid trials actually show, why the PRP studies disagree with each other, and how the treatment decision gets made.

The oldest of those names is the least accurate in two ways. Most people who get it have never played tennis — it is far more often an occupational or DIY problem. And the “-itis” is wrong: when persistent tennis elbow is examined under the microscope, what is found is not an inflammatory infiltrate. It is a degenerative, disorganised tendon — collagen that has lost its tight parallel alignment, with an ingrowth of small vessels and nerve fibres that do not belong in healthy tendon. Tendinopathy is the accurate word, and it is why the modern literature has largely dropped epicondylitis.

Three consequences follow, and they explain most of the frustration people arrive with:

• Anti-inflammatories underperform, because there is not much inflammation to treat. They take the edge off. They do not change the tendon.
• Rest alone does not fix it. A degenerative tendon needs a stimulus to remodel. Complete rest removes it, the pain settles while you do nothing, and it returns the moment you grip something.
• Corticosteroid is the wrong tool. It relieves pain reliably in the short term and the medium-term results in tendinopathy are worse than far less aggressive treatment. The same trade-off described on the patellar tendinitis page. It is not offered here for this problem.

What works is progressive loading — graduated, measured, applied for long enough. Twelve weeks is a normal minimum for a tendon sore for a year, and programmes are routinely abandoned at week four, which is exactly when nothing should have changed yet.

Ligament injury on the outer side

Less familiar than tennis elbow, and worth knowing about because the two occupy the same corner of the elbow and get conflated.

The outer side is stabilised by the radial collateral ligament complex — which includes the radial collateral ligament itself and the lateral ulnar collateral ligament running from the outer bone of the upper arm around to the ulna. Injury usually follows a fall onto an outstretched hand, an elbow dislocation, or occasionally repeated corticosteroid injections into the area, which weaken the tissue the ligament attaches through.

The complaint is different from tendon pain: rather than pain on gripping, patients describe the elbow feeling unreliable — clunking, catching, or a sense of giving way pushing up out of a chair or off the floor with the palm down. That pattern is posterolateral rotatory instability, and it is a ligament problem, not a tendon one.

It matters practically: an unstable elbow treated as tennis elbow does not improve, and repeated steroid into it makes the underlying problem worse.

Golfer’s elbow — the medial tendon

The mirror image. Pain on the inner side, worse gripping and with the wrist bent forwards, formally medial epicondylitis and more accurately medial elbow tendinopathy. Same biology as the outer side, same treatment logic, same reason rest and anti-inflammatories disappoint.

It is less common than tennis elbow and, in throwers and racquet players, it frequently travels with UCL and ulnar nerve problems — which is why medial elbow pain in an athlete deserves a more careful look than medial elbow pain in a plumber.

The UCL, throwing athletes, and avoiding Tommy John surgery

The ulnar collateral ligament is the main restraint on the inner side of the elbow, and in throwing it takes an enormous load in the late cocking phase. It is the classic overhead-athlete injury — baseball pitchers above all, but also javelin, quarterbacks, volleyball and tennis.

In depth: UCL tear treatment and the alternative to Tommy John surgery — written for throwers, parents and trainers, with the published results and why platelet dose is the variable that separates the studies.

The history that matters is not simply pain. It is loss of velocity, loss of control, or pain arriving at a specific point in the throwing motion rather than generally after activity. Some describe a distinct pop and the end of that season.

Orthobiologics often make the operation unnecessary

This is one of the strongest indications in the whole field, and it is worth being specific about why.

For partial UCL tears in throwers, orthobiologic treatment is an established option that frequently returns athletes to competition without surgery. Ultrasound-guided PRP into the injured portion of the ligament, combined with a properly structured throwing progression, has a real and published track record in this exact injury. It is not a fringe use; it is one of the places where the evidence for biologic treatment of a ligament is at its strongest.

Dr. Buford’s own assessment, offered as clinical opinion rather than as a published figure: in his practice the availability of orthobiologic treatment has reduced the need for elbow ligament surgery in these injuries by as much as 75%. That is a judgment formed from treating them over many years, not a number from a trial — but it reflects how substantially the non-surgical option has changed the conversation for a partial tear. Every individual case still turns on the examination and the imaging.

A patient in his own words: three months after a right elbow ulnar collateral ligament injection — a short video check-in.

The alternative is UCL reconstruction — “Tommy John” surgery, named after the pitcher who was the first to undergo it in 1974 and went on to win well over a hundred more games afterwards. It is a genuinely good operation with a high return-to-play rate, and it is sometimes the right answer.

But the recovery is long. A return to competitive pitching is generally measured in the range of a year to eighteen months, with a graduated throwing programme occupying much of it. Set against a biologic injection with a rehabilitation window measured in months, that difference is the entire argument for trying the non-surgical route first in a suitable partial tear — particularly since surgery remains available afterwards if it does not work.

Where honesty is required: a complete UCL tear in someone who intends to keep throwing competitively is usually a surgical conversation. Reconstruction is not performed here — you would be referred to a surgeon who does it, promptly and with your workup. Which category you are in is decided by examination and imaging, not by preference.

The one that gets missed: the ulnar nerve

Pain on the inner elbow with tingling or numbness in the ring and little fingers is usually not golfer’s elbow. It is the ulnar nerve being compressed where it passes behind the elbow — cubital tunnel syndrome.

Symptoms brought on by holding the elbow bent — phone calls, sleeping with the arm curled — point to the nerve. So does any weakness of grip or difficulty with fine finger movements, which is a reason to be assessed sooner rather than later; nerve problems left long enough do not fully recover.

Where PRP fits, and why the elbow suits it

The elbow tendons and ligaments are superficial, small, and easy to see. That makes this one of the better targets for an image-guided injection anywhere in the body: the abnormal tissue is identified on ultrasound and treated directly, rather than injecting the general area by feel.

For tendinopathy the sequence matters — PRP is for the tendon that has had a properly executed loading programme and has not responded, not a shortcut around the rehabilitation. For a partial UCL injury in a thrower it sits earlier in the plan, as the primary non-surgical treatment alongside a structured throwing progression.

Two things about how it is done here: the injection is ultrasound-guided into the abnormal tissue itself, and the platelet dose delivered is measured and recorded. Two syringes both labelled PRP can differ tenfold in what they actually deliver, and Dr. Buford’s published research is specifically on that question.

Detail and cost are on PRP and orthobiologics for the elbow.

Do not wait on these

• A sudden pop in the front of the elbow while lifting, with bruising and weakness turning a doorknob or a screwdriver. A distal biceps tendon rupture is best repaired within a few weeks — the window genuinely matters, and it is frequently dismissed as a strain. It is a surgical repair and is not performed here, so the value of being seen quickly is getting the diagnosis made and the referral moving.
• Progressive numbness or weakness in the hand.
• A hot, swollen elbow with fever.
• An elbow that feels like it is giving way or dislocating.

What is offered here

• Assessment by a board-certified orthopedic surgeon, with ultrasound in the room — tendons and ligaments examined in motion and under load, which a static scan cannot do.
• A loading programme that is specific and progressed, because for tendinopathy it is the treatment rather than the filler before one.
• Ultrasound-guided PRP, with the platelet dose measured.
• A straight answer about surgery where that is the right route, and a referral with your imaging and workup handed over.

What is not offered

• Elbow surgery of any kind — including UCL reconstruction, tennis elbow release, ulnar nerve procedures and distal biceps repair. Not performed here; you will be referred.
• Corticosteroid injection into a degenerative elbow tendon. Short-term relief, worse medium-term outcomes, and on the outer side it weakens the tissue the lateral ligament complex attaches through.
• Any injectable stem cell product sourced from a donor — amniotic, umbilical cord, placental and “exosome” products are not legal for this use in the United States and are not offered here at any price.

Common questions

Why hasn't my tennis elbow got better with rest?

Because rest removes the symptom without changing the tendon. Persistent tennis elbow is degenerative rather than inflammatory — disorganised collagen with abnormal vessel and nerve ingrowth — and a degenerative tendon needs graduated loading to remodel. Complete rest deconditions it further, so the pain returns at the first real grip. Better with rest, worse on return, repeatedly, is the classic history and the strongest argument for a properly progressed loading programme.

Should I have a cortisone shot for tennis elbow?

It is not offered here for this problem. Corticosteroid relieves tendon pain reliably in the short term, but medium-term outcomes in tendinopathy are worse than with far less aggressive treatment. If something is going to be injected into that tendon, PRP is the better-reasoned choice — and it belongs after a loading programme, not instead of one.

Does PRP work for tennis elbow?

It is one of the better-supported indications for PRP, and the elbow is an unusually good target because the tendons are superficial and easy to see on ultrasound — the abnormal tissue can be treated directly rather than by feel. The sequence matters: PRP is for the tendon that has completed a proper loading programme without responding. Here the injection is ultrasound-guided and the platelet dose delivered is measured and recorded.

I have inner elbow pain and tingling in my fingers. Is that golfer's elbow?

Probably not. Tingling or numbness in the ring and little fingers points to the ulnar nerve where it passes behind the elbow — cubital tunnel syndrome — rather than to the tendon. Symptoms that come on with the elbow held bent, and any weakness of grip or fine finger movement, make the nerve more likely still. Worth being assessed sooner rather than later, because nerve problems left long enough do not fully recover.

I felt a pop in my elbow lifting something. Can I wait and see?

Not if it was in the front of the elbow with bruising and weakness turning a doorknob or screwdriver. That pattern suggests a distal biceps tendon rupture, which is best repaired within a few weeks — the window genuinely matters and the injury is frequently dismissed as a strain. Get it looked at promptly.

Can a UCL tear be treated without surgery?

Often, yes — for a partial tear. Ultrasound-guided PRP into the injured part of the ligament, combined with a properly structured throwing progression, is an established option that frequently returns throwers to competition without an operation, and it is one of the strongest indications for biologic treatment of a ligament anywhere in the body. The comparison that drives the decision is recovery time: UCL reconstruction — Tommy John surgery — generally means a year to eighteen months before competitive pitching, where the non-surgical route is measured in months, and surgery stays available if it does not work. Dr. Buford's own view, as clinical opinion rather than a published figure, is that orthobiologic treatment has reduced the need for surgery in these injuries by as much as 75% in his practice. A complete tear in someone intending to keep throwing competitively is usually surgical, and you will be told that plainly and referred.

Do you perform elbow surgery?

No. Elbow surgery is not performed at this practice — that includes UCL reconstruction, tennis elbow release, ulnar nerve procedures and distal biceps repair. What is offered is assessment by a board-certified orthopedic surgeon and non-surgical treatment, including ultrasound-guided orthobiologics. If your problem needs an operation you will be told and referred with your imaging and workup, rather than treated with an injection because an injection was available.

Why is it called Tommy John surgery?

After the Los Angeles Dodgers pitcher who was the first to undergo the operation in 1974. He returned and won well over a hundred more games, which is why his name stuck to the procedure. Formally it is ulnar collateral ligament reconstruction. It is a genuinely good operation with a high return-to-play rate — the drawback is the length of the recovery, which is what makes trying a biologic first worthwhile in a suitable partial tear.

Is tennis elbow the same as lateral epicondylitis?

Yes — tennis elbow, lateral elbow tendinopathy and lateral epicondylitis all describe the same problem on the outer side of the elbow. Tendinopathy is the most accurate of the three, because what is actually found in a persistent case is tendon degeneration rather than inflammation, and most people who get it have never played tennis.

How long does treatment take to work?

Longer than most people are told. Twelve weeks of progressive loading is a normal minimum for a tendon that has been sore for a year, and improvement is judged on how the elbow feels the morning after loading rather than during it. Where PRP is added, expect a few days of increased soreness first — the treatment works by provoking a repair response — and avoid anti-inflammatory medication during that window.

More reading

Dr. Buford writes regularly about orthobiologic treatment of the upper limb — what the published trials actually measured, and where the results land in practice: hand, wrist and elbow orthobiologics.

Related

• Tennis elbow and golfer’s elbow — treatment in Dallas
• UCL tears — the Tommy John surgery alternative
• Patient story and video — UCL injection, three-month result
• PRP and orthobiologics for the elbow — procedures and investment
• Platelet-rich plasma (PRP) injections
• Patellar tendinitis — the same tendon argument, different joint
• Research and publications
• Don Buford, MD — board-certified orthopedic surgeon