Golfer's Elbow

Golfer's elbow is a tendinopathy of the common flexor-pronator tendon origin at the medial epicondyle, the bony prominence on the inner side of the elbow. Like tennis elbow, the name is misleading: most cases are unrelated to golf. It is five to ten times less common than tennis elbow but often more complex due to the proximity of the ulnar nerve.

(Medial Epicondylitis)

Key Distinction From Tennis Elbow

Golfer's elbow - medial

Pain on the inner side of the elbow. Affects the flexor-pronator tendon origin. Worsened by gripping, wrist flexion, and pronation. Ulnar nerve involved in up to 30% of cases.

Tennis elbow - lateral

Pain on the outer side of the elbow. Affects the extensor tendon origin (ECRB). Worsened by gripping and wrist extension. Five to ten times more common than golfer's elbow.

Symptoms

  • Tenderness directly over the medial epicondyle, often radiating down the inner forearm toward the wrist

  • Pain worsened by shaking hands, carrying bags, throwing, or swinging a golf club

  • Tingling in the ring and little fingers if the nearby ulnar nerve is also irritated

  • Reduced grip strength, particularly when the wrist is flexed

⚠ Ulnar collateral ligament (UCL) injury, common in throwing athletes, can closely mimic golfer's elbow. Your surgeon will assess for medial instability; if suspected, an MRI arthrogram will be arranged to assess the UCL before diagnosing simple tendinopathy.

Treatment

Activity modification and load management

Reduce the aggravating activity. For golfers, a swing analysis and coaching review can identify over-gripping and excessive wrist snap, both common contributors to medial overload.

1

Physiotherapy - eccentric and isometric loading

A progressive loading programme targeting the flexor-pronator group. Isometric in the early painful phase, transitioning to eccentric and heavy slow resistance over 8-12 weeks.

2

Corticosteroid injection

Injected around, not into, the medial epicondyle. Extra care is taken to avoid the nearby ulnar nerve. Best used to enable physiotherapy engagement.

3

PRP injection

Evidence mirrors that for tennis elbow, potentially superior to steroid at 6-12 months. A reasonable option for persistent cases before considering surgery.

4

Surgery

Debridement of the degenerated flexor-pronator origin, with or without ulnar nerve decompression if nerve involvement is confirmed. Reserved for those failing 6-12 months conservative management. Around 80-85% achieve significant improvement.

5

Fewer than 10% of golfer's elbow cases require surgery. Always screen for concurrent ulnar nerve irritation - treating the tendon alone when the nerve is involved will produce incomplete results.

RECOVERY AFTER SURGERY

  • Wrist flexor stretch: arm flexed, palm up, gently bend wrist upward. Hold 30 sec, 3 reps, 2-3x daily.

  • Isometric wrist flexion: press back of hand downward against resistance, no movement. Hold 30-45 sec, 5 reps. Pain 3-4/10 is acceptable.

  • Eccentric wrist flexion with weight: flex wrist downwards with good hand, then lift slowly over 3-5 seconds. 3 x 15 reps daily. The slow lifting phase is therapeutic.

  • Heavy slow resistance, wrist flexions and curls at 3 sec up / 3 sec down tempo. 3 sets, 3x per week. Progress load by 10% when 15 reps become easy.

FREQUENTLY ASKED QUESTIONS

  • If you have tingling or numbness in your ring and little fingers alongside inner elbow pain, concurrent cubital tunnel syndrome is likely. Tell your surgeon about any hand or finger symptoms, this changes the treatment approach.

  • Modified activity is preferable to complete rest. Reducing volume, correcting technique, and using a counterforce brace allow many patients to continue some sport during recovery.

  • A UCL tear causes medial elbow instability, a valgus stress test reveals abnormal joint opening and MRI arthrogram shows ligament disruption. UCL tears in throwing athletes may require surgical repair or reconstruction, which is distinct from tendinopathy treatment.

This guide is intended for patient education purposes and does not replace a formal surgical consultation. Treatment decisions are always individualised based on your specific history, examination findings, and imaging. Please discuss your symptoms and management plan directly with your orthopaedic surgeon.