Golfer’s Elbow: Causes and Treatment of Pain on the Inside of the Elbow

The wrist flexor muscles and pronator teres share an attachment to the medial epicondyle of the humerus. A clinical review from 2015 describes that degeneration of the flexor-pronator tendons occurs with repetitive, forced wrist extension and forearm supination during activities involving wrist flexion and pronation. The pathological process proceeds in stages: from irritation and microtrauma, through degenerative changes in the tendon, to its structural breakdown with possible fibrosis or calcification. In throwing athletes the pain may be most pronounced in the late cocking and early acceleration phases.

It is important to distinguish this from classic “inflammation”: histologically, chronic changes in the tendon resemble degeneration rather than an inflammatory state, so the terms “enthesopathy” or “tendinopathy” are closer to the truth than “epicondylitis”. In practice this matters for treatment — anti-inflammatory drugs and injections are less effective than the name suggests, and the key is to increase the tendon’s capacity to tolerate load. We discuss the same logic more broadly in the article on Achilles tendinopathy.

The data from Korea show that golfer’s elbow occurs roughly three times less often than tennis elbow, but it is not rare — on the contrary, it is diagnosed in hundreds of thousands of people. The proportion treated surgically is small (about 1%), which confirms that in the vast majority of cases the problem is resolved by conservative methods. It should be remembered, however, that this is an analysis of a claims database from a single country: the frequency of diagnoses may depend on coding and access to care, and the results do not necessarily translate 1:1 to other populations.

It is worth noting the finding that both conditions were more often diagnosed in women. This does not mean women are “weaker” — the mechanisms may relate to the type of work (repetitive manual tasks), age at peak incidence and the tendency to seek help. These are observational data and do not settle the causes.

Diagnosis is clinical. The typical picture is tenderness around the medial epicondyle and pain on resisted wrist flexion or forearm pronation, often with weakened grip. Imaging (ultrasound, MRI) is sometimes needed in an atypical course or when other causes are suspected, but tendon changes visible on imaging do not always correlate with pain.

The coexistence of golfer’s elbow and cubital tunnel syndrome is clinically important. In a small retrospective study of patients operated on simultaneously for medial epicondylitis and ulnar nerve compression (14 patients assessed after an average of 4.3 years), the results of the combined procedure were worse when the nerve was decompressed only “in situ” than when it was transposed; the authors note that the conclusions need confirmation. For the patient the practical conclusion is simple: tingling of the ring and little fingers with medial elbow pain is a reason for consultation, not for self-treatment.

This study is valuable for two reasons: it compares a steroid injection with placebo (saline), and it concerns golfer’s elbow specifically, on which randomised work is scarce. The result is consistent with the broader picture of tendinopathy. A systematic review of randomised trials of injections in tendinopathies (mainly covering tennis elbow) showed that corticosteroids reduce pain in the short term, but this effect reverses at intermediate and long term — in tennis elbow at 52 weeks no intervention was better than an injection. Of 991 participants in studies reporting adverse events after steroids, one (0.1%) had a serious complication in the form of tendon rupture.

For golfer’s elbow, particular caution is dictated by the proximity of the ulnar nerve, which runs in a groove just behind the medial epicondyle — an injection in this area should be performed by an experienced doctor. In the sources discussed we have no strong data that platelet-rich plasma (PRP) or other injections are effective in golfer’s elbow; for tennis elbow the results are ambiguous, and transferring them to golfer’s elbow would be speculation.

Since injections do not give lasting benefit and rest by itself weakens the tissue, training the tendon makes the most sense. For golfer’s elbow, however, the evidence is modest — weaker than for the Achilles or tennis elbow. A recently published systematic review assessed whether eccentric exercises help in medial epicondylitis.

The conclusion is honest but cautious: eccentric exercises may reduce pain and improve function, especially as part of a multimodal programme, but the certainty of evidence is low and larger trials are needed. For this reason in practice the principles developed for other tendinopathies are applied — gradually increasing load, often with an isometric phase at the start when pain is high, and moving on to movements with resistance — with the proviso that these are principles transferred from better-studied sites, not proven specifically for golfer’s elbow. We write about the logic of heavy, slow training in the article on the Achilles tendon.

An important element of treatment is establishing exactly what overloads the tendon. In a golfer it may be the technique of the stroke (excessive gripping of the club, hitting the ground), the thickness of the grip and the volume of play after a break; in a person who lifts weights — an overhand grip in heavy pulling exercises, fast addition of volume in pull-ups and curls; in an office worker — wrist position at the mouse and keyboard and lack of breaks. Analysis of technique with a coach or physiotherapist often gives more than any procedure.

Compression straps for the forearm (so-called counterforce braces) are widely used and may give temporary relief during activity, but in the sources of this article we have no solid randomised trials for golfer’s elbow — treat them as possible support in sport or work, not as treatment. As with other tendinopathies, it is not worth relying on a single method: a combination of load modification, strengthening and time usually brings the best results.

Golfer’s elbow is less “spectacular” than knee or Achilles injuries, but it can effectively get in the way of training and work. The most sensible approach combines three things: identifying and reducing the overloading factor, gradually increased loading of the forearm flexors, and patience measured in weeks and months. A steroid injection can give quick relief, but the randomised trial did not show an advantage over placebo at one year — so it should not replace an exercise programme.

If you also have numb fingers, if the pain appeared after an injury or does not go away despite honestly carried-out rehabilitation, do not wait it out — differential diagnosis has real significance here. The general importance of strength training and grip strength for joint health is described in our knowledge-base entries on strength training and on grip strength.