Golfer Elbow
Golfer's Elbow: Inner Elbow Pain Explained
Pain on the inner side of the elbow — worse with gripping and wrist flexion — is medial epicondylitis, or golfer's elbow. Most patients are not golfers. Here is what is actually happening, the treatment that works, and the nerve problem that gets missed in 60% of cases.
What Is Golfer’s Elbow?
Golfer’s elbow — medial epicondylitis — is pain at the inner side of the elbow where the forearm flexor tendons attach to the bone. Despite the name, fewer than 10% of patients who develop it are golfers. It is far more common in manual workers, baseball players, rock climbers, and anyone who performs repetitive gripping and wrist flexion for hours at a time.
The underlying problem is not inflammation (despite the “-itis” suffix) but tendinosis — microscopic degenerative changes in the flexor-pronator tendon at its origin on the medial epicondyle. This distinction matters because anti-inflammatory treatments (NSAIDs, cortisone) have limited effect on a degenerative tendon and can actually impair healing with repeated use.
Golfer’s elbow: tender over the INNER bony bump. Pain with gripping, wrist flexion, forearm rotation. Worse on the follow-through of a golf swing or during a throwing motion.
Tennis elbow: tender over the OUTER bony bump. Pain with gripping, wrist extension, lifting palm-down. Worse with backhand strokes and repetitive gripping.
Both can coexist. If your symptoms don’t fit cleanly, you may have both — which changes the treatment plan.
Symptoms to Recognise
- Tenderness directly over the medial epicondyle (inner bony elbow bump) — often exquisitely point-tender
- Pain with resisted wrist flexion and forearm pronation (turning palm down)
- Weak grip — particularly when the elbow is straight
- Pain radiating down the inner forearm
- In up to 60% of cases: ring and little finger numbness from concurrent ulnar nerve compression — always check for this
Ring and little finger numbness with medial elbow pain suggests co-existing cubital tunnel syndrome (ulnar nerve compression at the elbow). This occurs in approximately 60% of medial epicondylitis cases. Treating the tendon without addressing the nerve is the most common reason golfer’s elbow treatment fails. Dr. Chambers always assesses both at your visit. See Cubital Tunnel Syndrome →
Treatment
Step 1 — Eccentric Physical Therapy (Cornerstone)
Eccentric exercises — where the muscle contracts while lengthening under load — are the single most evidence-based treatment for tendinosis. For golfer’s elbow, this means controlled wrist flexion exercises with a light weight, performed in a specific eccentric protocol. Unlike rest, eccentric loading stimulates tendon remodelling and drives healing in the degenerated tissue. A physiotherapist experienced in tendinopathy should supervise the programme. Duration: 12 weeks minimum.
Step 2 — Counterforce Bracing
A counterforce brace worn just below the medial elbow during activity reduces load on the tendon origin by changing the mechanical lever arm. Evidence supports its use as an adjunct to therapy — not as a sole treatment. Worn during golf, work, or any provocative activity.
Step 3 — PRP Injection (at 6–8 Weeks of Failed Conservative Rx)
Platelet-rich plasma (PRP) injection delivers a concentrated dose of growth factors into the degenerated tendon, stimulating repair. The evidence for PRP in medial epicondylitis is significantly stronger than for cortisone — which provides short-term pain relief but does not treat the underlying tendinosis and can weaken tendon collagen with repeated use. PRP requires ultrasound guidance for accurate delivery into the tendon.
At Raleigh Orthopaedic, Dr. Chambers performs PRP injections with ultrasound guidance to ensure accurate delivery. Most patients experience significant improvement within 6–8 weeks of injection. See PRP Injections →
Surgery — For Refractory Cases (<10%)
For the small number of patients who fail comprehensive conservative treatment (typically defined as 6+ months of eccentric therapy, bracing, and at least one PRP injection), surgical debridement of the degenerated tendon tissue produces excellent results. Performed as an outpatient procedure. Return to most activities: 3–4 months.
Returning to Golf or Sport
Return to full activity is guided by symptom resolution, not a fixed timeline. General principles:
- Short game first — chipping and putting place much less load on the medial elbow than a full swing
- Grip check — an excessively tight grip significantly increases tendon load. A lighter grip during rehabilitation is important.
- Counterforce brace during all play during the recovery period
- Full swing last — the wrist flexion moment through impact is the highest-load phase. Introduce gradually when short game is pain-free
See Tennis Elbow Treatment → and Do I Need Elbow Surgery? →
Frequently Asked Questions
Golfer’s elbow (medial epicondylitis) is degeneration of the common flexor-pronator tendon origin at the medial epicondyle — the bony bump on the inner elbow. Despite the name, most patients are not golfers. It is caused by repetitive wrist flexion and forearm pronation — common in golfers, baseball pitchers, rock climbers, construction workers, and heavy computer mouse users. The underlying pathology is tendinosis — degenerative changes in the tendon — not acute inflammation.
The location of tenderness distinguishes them: golfer’s elbow is tender over the medial epicondyle (the inner bony bump of the elbow), while tennis elbow is tender over the lateral epicondyle (the outer bony bump). Golfer’s elbow pain is reproduced by resisted wrist flexion and forearm pronation. Tennis elbow pain is reproduced by resisted wrist extension and gripping. Both can coexist in the same elbow, which is why symptoms sometimes do not fit a clean pattern.
Golfer’s elbow is notoriously slow to resolve because tendons have a poor blood supply and the underlying pathology is degenerative rather than inflammatory. With appropriate eccentric physical therapy and activity modification, 85–90% of cases resolve without surgery, but this typically takes 3–6 months. PRP injection at 6–8 weeks of failed conservative treatment significantly accelerates healing by introducing growth factors into the degenerated tendon. Surgery is reserved for the 10% that fail all conservative measures.
Continuing to play through significant tendon pain accelerates degeneration and prolongs recovery. A relative rest period (2–4 weeks of activity modification) combined with eccentric physical therapy is the recommended approach. Many patients can return to golf with a counterforce brace just above the medial elbow, grip modification, and technique adjustment (avoiding excessive wrist flexion through impact). Complete rest is not necessary — but playing at full intensity while in pain is counterproductive.
They are different conditions that frequently coexist. Golfer’s elbow is a tendon problem. Ulnar nerve compression at the elbow (cubital tunnel syndrome) produces ring and little finger numbness, inner elbow aching, and hand weakness. The two conditions share the same anatomical location and occur together in approximately 60% of medial elbow cases. Missing the ulnar nerve component is the most common reason golfer’s elbow treatment fails — treating the tendon while the nerve remains compressed does not fully resolve symptoms.
Inner Elbow Pain Affecting Your Game?
Golfer's elbow responds very well to the right treatment. No referral needed.
Stephen Chambers, M.D.
Dual Board-Certified Hand & Upper Extremity Surgeon · Raleigh Orthopaedic