Golfer's Elbow (Medial Epicondylitis)
What Is Golfer's Elbow (Medial Epicondylitis)?
Golfer's elbow, known medically as medial epicondylitis, is damage to the wrist and finger flexor tendons where they attach to the bony bump on the inner side of the elbow. Despite its name, it is a degenerative tendon problem rather than a classic inflammation, and most people who have it do not play golf. The load carried by these tendons over time causes small tears and a failed healing response at the attachment site.
The condition is the inner-elbow counterpart of tennis elbow. Both involve overload where the tendon meets the bone; the difference is where the pain sits. In golfer's elbow the pain is on the inner side and worsens with bending the wrist down and gripping.
What Causes Golfer's Elbow? Risk Factors
Anyone can develop golfer's elbow, but people who use the hand, wrist and forearm repeatedly are affected more often. The risk rises with the total load placed on the flexor tendons rather than any single movement.
- Occupations with repeated gripping and wrist work: carpenters, plumbers, cooks, tailors and assembly-line workers.
- Sports that load the inner forearm: golf, throwing sports, racquet sports and weight training with heavy gripping.
- Poor technique, inadequate warm-up, a sudden increase in training load and equipment that is too heavy or wrongly sized.
- Age between 40 and 60, when tendons are less tolerant of repeated load, and previous elbow problems on the same side.
Symptoms of Golfer's Elbow
Symptoms usually build up gradually rather than after a single injury. The pain often starts as an ache that settles with rest and returns with activity.
- Pain and pinpoint tenderness over the bony bump on the inner side of the elbow.
- Pain that increases when bending the wrist down against resistance or gripping firmly.
- Pain that spreads along the inner side of the forearm and a weaker, less confident grip.
- Stiffness in the elbow, particularly in the morning or after a period of heavy use.
- In some patients, numbness or tingling in the ring and little fingers, which suggests the ulnar nerve is also involved.
Conditions That Can Mimic Golfer's Elbow
Pain on the inner side of the elbow has several possible sources, so the examination sets golfer's elbow apart from them. Irritation of the ulnar nerve as it passes behind the inner elbow produces numbness and tingling in the ring and little fingers rather than tendon pain with gripping. An injury to the ulnar (medial) collateral ligament, seen mainly in throwing athletes, causes instability and pain during the throwing motion.
Wear in the joint itself and stiffness point towards elbow osteoarthritis rather than a tendon problem, and referred pain from the neck travels down the arm with movement of the neck. Distinguishing these matters, because the treatment for each is different.
How Is Golfer's Elbow Diagnosed?
The diagnosis is usually made from the history and physical examination. The assessment covers when the pain began, which activities provoke it, the type of work and sport involved and whether there is any numbness in the hand.
- Pressing over the inner bony bump and the tendon origin to locate the point of maximum tenderness.
- Reproducing the pain by bending the wrist down against resistance with the elbow straight.
- Testing the stability of the inner ligament and checking the ulnar nerve, so that a ligament or nerve problem is not missed.
Imaging is not needed to confirm the diagnosis in most cases. X-rays may be requested to look for calcification or arthritis, and ultrasound or MRI are reserved for stubborn cases, when the diagnosis is uncertain, or when a ligament or nerve problem is suspected alongside the tendon.
Non-Surgical Treatment
The large majority of patients recover with non-surgical treatment. The aim is first to settle the pain and then to restore the load capacity of the tendon step by step, so that the same overload does not simply return.
- Activity and ergonomic modification: adjusting technique, tools and workload so the flexor tendons are not repeatedly overloaded, rather than stopping all activity.
- Pain management: short-term analgesic or anti-inflammatory medication and cold application during flare-ups.
- A counterforce brace or wrist splint in selected patients to reduce the strain on the tendon during aggravating tasks.
- Physiotherapy: this is the core of treatment, based on progressive loading of the flexor-pronator muscles rather than passive measures alone.
Exercise and Rehabilitation
Structured, progressive exercise gives the tendon a reason to remodel and rebuild its tolerance to load. The programme is advanced according to symptoms rather than a fixed timetable.
- Gentle stretching of the wrist flexors and pronators within a comfortable range to reduce tension at the tendon origin.
- Isometric holds in the early painful phase, where the muscle works without the joint moving, to load the tendon while keeping pain low.
- Progressive strengthening, including slow, controlled eccentric wrist-flexion exercises added as pain allows.
- Grip and forearm conditioning and, where relevant, correction of sporting or work technique before a full return to the aggravating activity.
A mild ache during and shortly after exercise is acceptable, but pain that worsens the next day means the load was too high and the programme is eased back. Consistency over weeks matters more than intensity in any single session.
Injections and Biologic Treatments
Injections are considered for patients whose pain does not settle with a well-followed exercise programme. Their role is to support rehabilitation, not to replace it, and the choice is discussed individually rather than applied routinely. Options such as platelet-rich plasma are used cautiously, since the evidence for degenerative tendon problems is mixed.
Corticosteroid injections can relieve pain in the short term but do not reliably improve the long-term outcome and are used sparingly at the inner elbow because the ulnar nerve lies close by. Biologic injections are discussed as one option among several, without any promise of a fixed result.
When Is Surgery Needed?
Surgery is relevant for only a small number of patients. It is generally considered when pain persists despite at least six months of a well-followed non-surgical programme and continues to limit work and daily life.
The procedure removes the degenerated part of the tendon and reattaches healthy tissue to the bone; where the ulnar nerve is also involved, it may be addressed at the same time. Surgery is followed by a structured rehabilitation programme, and the decision is individualised rather than offered as a routine step.
Recovery Time and Prevention
A clear reduction in symptoms usually takes several months, and full recovery can take between six months and a year. The process may be longer in people whose symptoms have been present for a long time or who use the arm heavily. The length of recovery does not mean treatment is failing; a degenerative tendon remodels slowly.
Once symptoms settle, the same measures that treat golfer's elbow help prevent it returning: warming up before activity, building load gradually, keeping good technique, using correctly sized equipment and maintaining forearm strength. Recurrent overload before the tendon has recovered is the most common reason symptoms come back.
When Should You See a Doctor?
Having inner-elbow pain assessed early makes it easier to treat and helps rule out ligament or nerve problems that need different management.
- Pain that does not settle within a few weeks or that affects daily activities and sleep.
- A grip that has become noticeably weaker, or difficulty holding and lifting objects.
- Numbness or tingling in the ring and little fingers, which suggests ulnar nerve involvement.
- A sense of instability or pain during throwing, which may point to a ligament problem rather than the tendon.
To have your elbow assessed you can contact Assoc. Prof. Serkan Sürücü, and you can also review the other conditions covered within elbow surgery.