Golfer’s elbow, medically known as medial epicondylitis, is a condition that causes pain and inflammation where the tendons of the forearm muscles attach to the bony bump on the inside of the elbow. Despite its name, golfer’s elbow is not exclusive to golfers, and can occur in anyone who repeatedly uses their wrist and fingers, doing activities that involve gripping or twisting movements.

Anatomy

The elbow is a complex hinge joint made up of three bones: the humerus (upper arm bone), and the radius and ulna (forearm bones). The medial epicondyle is a prominent part of the humerus where several forearm muscles and tendons attach, particularly those responsible for wrist flexion and forearm pronation. Overuse or strain on these muscles can lead to micro-tears in the tendon tissue, resulting in golfer’s elbow.

Causes

Golfer’s elbow typically results from overuse or repetitive stress. Common causes include:

• repetitive wrist flexion and forearm rotation (as seen in golf, throwing sports, or racquet sports)
• Activities such as weightlifting or manual work that involves typing, painting, hammering, carpentry,  and using other hand tools repeatedly.
• Poor technique in sports or heavy lifting
• Sudden increases in activity levels or training intensity
• It is less commonly associated with acute trauma or direct injury.

Symptoms

Patients with golfer’s elbow often experience one or more of the following symptoms:

• Pain and tenderness on the inner side of the elbow joint
• Stiffness in the elbow, with difficulty making a fist
• Pain that worsens with certain movements, particularly gripping or lifting
• Weakness in the hands and wrists
• Numbness or tingling, often radiating into the ring and little fingers

Symptoms typically develop gradually, and come and go for a few weeks/months, but can occasionally present more suddenly following very intensive activity.

Diagnosis

Diagnosis of golfer’s elbow is primarily clinical, based on a detailed history of activity, and symptoms, plus a physical examination to assess localised tenderness over the medial epicondyle and pain reproduced with resisted wrist flexion or pronation.

Further investigations may be considered if:

• Symptoms are persistent or atypical
• There is concern for alternative diagnoses

Imaging options include:

• Ultrasound scan: To assess tendon thickening, tears, or inflammation of the tendon
• RI: Provides detailed images of the tendons and nearby structures – this can be useful for more complex cases, to rule out other pathology that might be suspected.
• X-rays: Occasionally performed to rule out arthritis or other bony abnormalities

Differential Diagnosis

Several conditions can mimic golfer’s elbow and must be considered:

• Ulnar collateral ligament injury
• Cubital tunnel syndrome (ulnar nerve compression)
• Medial epicondyle fracture (particularly after trauma)
• Referred pain from the neck (cervical radiculopathy)
• Flexor-pronator strain

An accurate diagnosis ensures rapid, appropriate and effective treatment.

Treatment Options

Non-Surgical Management

Most cases of golfer’s elbow respond well to conservative treatment, including:

• Activity modification: Avoid aggravating activities and focus on trying to offload the tendon. Ensure that you are using good techniques when performing activities.
• Physiotherapy: This is the first line of treatment – targeted strength exercises and stretches to promote tendon healing, review techniques and ensure long-term recovery.
• Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) can be used to reduce pain and swelling – it’s important to discuss any medications with a professional before you start taking them.
• Bracing: Using an elbow or wrist brace to offload the tendon can be very effective.
• Shockwave therapy: This treatment helps promote tendon healing through soundwave stimulation.
• Corticosteroid injections: Injections can be seful for persistent pain, although repeated injections are not recommended due to potential tendon weakening. Following an injection it’s very important to follow an exercise programme to ensure the problem is fully resolved, otherwise your symptoms will return again quite quickly.
• Platelet-rich plasma (PRP) injections: This is an emerging option to help promote tendon healing – there are some good studies this is beneficial but must also be followed by a rehabilitation programme.

Surgical Treatment

Surgery is only considered for patients who do not respond to at least 6–12 months of conservative treatment.

Surgical options include:

• Open medial epicondyle debridement: Damaged tendon tissue is excised, and healthy tissue is repaired or reattached.
• Arthroscopic debridement: Minimally invasive keyhole surgery to remove and repair degenerative tendon tissue.
• Ulnar nerve decompression or transposition: Performed if there is associated nerve compression (cubital tunnel syndrome).

Outcomes:

• Surgical outcomes for golfer’s elbow are generally good, with success rates of 85–95% reported in a number of studies..
• Most patients experience significant pain relief and a return to full function within 3–6 months post-surgery.
• Rehabilitation with physiotherapy is very important postoperatively, to restore range of movement, strength and function, and ensure there is no recurrence of the problem.
• Risks, though low, include nerve injury, infection, or persistent symptoms.

Frequently Asked Questions

Can golfer’s elbow heal on its own?
Yes, many cases improve with rest, activity modification, and physiotherapy. However, recovery can take several weeks to months depending on severity.

Is surgery always necessary for golfer’s elbow?
No, surgery is reserved for cases that have not improved after prolonged non-surgical treatment (typically after 6–12 months).

How can I prevent golfer’s elbow from recurring?
Proper technique, gradual progression of activity, regular stretching, and strengthening exercises for the forearm muscles can help prevent recurrence.

What is the difference between golfer’s elbow and tennis elbow?
Golfer’s elbow affects the tendons on the inside (medial side) of the elbow, whereas tennis elbow affects the tendons on the outside (lateral side).

How soon can I return to sports after surgery for golfer’s elbow?
Most patients can return to sports between 3 and 6 months postoperatively, depending on healing and rehabilitation progress.