Golfers elbow is the most common cause of pain on the inner side of the elbow.
Also known as medial epicondylitis, it is caused by damage to the tendons that bend and twist the forearm and hand.
Golfers elbow symptoms typically develop gradually from overuse, although it can occur more rapidly after an elbow injury.
Despite the name, it doesn’t just affect golf players. Medial epicondylitis is common in manual workers, athletes who play racket sports and weightlifters.
Golfers elbow is a type of forearm tendonitis that occurs on the inner side of the elbow at the medial epicondyle, a bony lump that protrudes from the lower end of the humerus (upper arm bone).
A number of the forearm muscles join together at the elbow to form the common flexor tendon:
Tendons are thick, cord like structures that connect muscles to bone.
The common flexor tendon is approximately 3cm long and attaches these muscles to the medial epicondyle. Damage to the common flexor tendon from overloading, overstretching or occasionally a one-off injury leads to inflammation of the tendon which results in golfers elbow.
There are lots of other names for golfers elbow including baseball elbow, suitcase elbow, forehand tennis elbow, pitchers elbow, throwers elbow, climbers elbow and medial elbow tendonitis, but they all refer to the same thing.
Golfers elbow is the most common cause of inner elbow pain. A similar condition occurs on the outer elbow where overuse causes irritation and damage at the common extensor tendon, known as Lateral Epicondylitis aka golfers elbow.
Golfers elbow is usually caused by repetitive overuse of the forearm muscles which places strain through the common flexor tendon. The forearm muscles let you grip things, rotate your arm and bend your wrist and fingers.
Repetitive overuse of these muscles can lead to overloading and microtearing of the tendon fibres. This damage leads to inflammation of the common flexor tendon and over time may result in degeneration and wear and tear with calcification, scar formation and thickening in the tendon and decreased collagen strength.
Common causes of medial epicondylitis are:
Golfers elbow is typically caused by repetitive use rather than one-off overloading and usually only develops when aggravating activities are carried out for at least an hour a day on a number of consecutive days.
Medial epicondylitis can affect people at any age but is most common between the ages of 45-65. It is more common in women than men and in approximately 75% of cases affects the dominant arm.
Common symptoms of golfers elbow are:
The symptoms of golfers elbow tend to develop gradually over time and get progressively worse without treatment.
Your doctor or physical therapist can usually diagnose golfers elbow. They will take a full history asking lots of questions about your symptoms, how and when they started, what aggravates and eases your symptoms and your hobbies and daily activities.
They will then carry out a physical examination looking at your neck and upper limb movements and muscle strength. They will also carry out some simple diagnostic tests for medial epicondylitis.
Common diagnostic tests for golfers elbow are:
These tests are usually sufficient for accurately diagnosing golfers elbow but in some cases your doctor may send you for further tests/scans e.g. ultrasound or MRI, to rule out other pathologies.
Most cases of medial epicondylitis will respond well to conservative treatment that focusses on reducing pain and inflammation.
Golfers elbow treatment usually involves:
As golfers elbow is an overuse injury, it is really important to rest from aggravating activities as much as possible to allow the tendon time to heal. Failure to do so will keep aggravating the condition and slow the healing process – think of it like picking at a scab.
However, complete rest may not always be possible e.g. if the tendonitis is linked to employment, in which case activity modification will be crucial.
Regularly applying ice to the inner elbow for 10 minutes every few hours can help to reduce the pain and inflammation associated with medial epicondylitis.
Ice should be wrapped up in dish cloth or towel rather than placed directly on the skin. Find out how to use ice treatment safely and effectively.
Cver-the-counter painkillers and anti-inflammatories such as paracetamol and ibuprofen can help to reduce golfers elbow pain and inflammation. Talk to your pharmacist or doctor for advice.
Exercises are an important part in golfers elbow rehab. It is important to get the right balance between resting to allow the tendon to heal, but maintaining and increase arm mobility and strength.
Strengthening Exercises: Strengthening the shoulder, elbow and wrist muscles can help reduce the strain through the common flexor tendon. You will normally start with isometric exercises (where you load the muscle without it changing length) and then progress on to eccentric exercises (where you load the muscle as it lengthens).
Golfers Elbow Stretches: It can really help to stretch out the muscles that attach through the common flexor tendon to reduce the strain through it.
You can find a whole selection of strengthening and stretching exercises in the Golfers Elbow Exercises section.
If your golfers elbow is linked to your job or a specific sport, it can help to change work tools or sports rackets. For example, using a larger grip size or lighter-weight item can help to reduce the strain through the common flexor tendon.
Corticosteroid injections can be used as part of golfers elbow treatment. A combination of corticosteroid and local anesthetic is injected into the common flexor tendon to reduce pain and inflammation.
Symptoms will usually improve around 5-7 days after the injection but some people do notice an increase in symptoms for the first 1-2 days. Steroid injections can temporarily weaken the tendon so it is important to take it easy and avoid any heavy lifting for a few days.
The benefits of corticosteroid injections for golfers elbow are usually temporary so they should not be given in isolation but combined with other treatments.
Wearing a counterforce brace/strap on the forearm, just below the elbow, helps to direct strain away from the common flexor tendon.
A counterforce golfers elbow brace applies pressure over the forearm flexors. This biomechanically reduces the forces pulling through the attachment site of the common extensor tendon at the medial epicondyle. This helps to reduce pain and protect against further damage.
Your physical therapist may recommend a course of ultrasound, laser treatment or shockwave therapy to help reduce pain and inflammation, although these are becoming less popular treatment options for tendon injuries.
Acupuncture can be used to help reduce pain and inflammation with medial epicondylitis. The evidence to support the use of acupuncture in tendonitis is somewhat lacking at present but some people do find it beneficial in the short term.
Once the medial tendonitis pain has settled down, you can start returning to your normal activities, but you will probably need to reduce the volume, intensity, frequency and duration initially to reduce the risk of golfers elbow symptoms returning. Be guided by pain – if you notice your symptoms returning, ease off.
The sooner treatment for golfers elbow begins, the quicker it is likely to settle down. The more chronic medial epicondylitis becomes, the greater the degree of inflammation and scarring, which will result in slower healing and increase the risk of future episodes.
If after 6-12 months of these conservative treatments there is no improvement in your golfers elbow symptoms, which is rare (less than 3% of case), then surgery may be advised.
There a various different procedures but they generally involve releasing the common flexor tendon at its attachment to the medial epicondyle and debriding (removing) any scar tissue. Golfers elbow surgery has a 60-70% success rate.
Page Last Updated: 01/11/2022
Next Review Due: 01/11/2024