Golfer's Elbow (Medial Epicondylitis)

While golfer's elbow is one of the most common golf injuries, the name can be misleading as you do not need to play golf to develop this condition. It is common among beginners in golf, but it can result from any repetitive gripping or wrist flexion activities.

What is golfer’s elbow?

Golfer's elbow (medial epicondylitis) is an overuse injury involving the tendons that attach the muscles of the forearm to the bone on the inside the elbow joint. It is similar to tennis elbow (lateral epicondylitis), which involves the tendons of the outside of the elbow joint.

What causes golfer's elbow?

Medial epicondylitis (medial elbow tendinopathy) is caused by tendon overuse – repeated, strenuous arm movements, especially those involving repetitive wrist flexion, forearm pronation or gripping.

While inflammation may play a role very early in the process, examinations of chronically injured tendons under microscopes have not demonstrated there is actually significant inflammation. That is why you may receive a diagnosis of "tendinosis" or “tendinopathy” instead of tendonitis (where “-itis” means inflammation): When tendons are repetitively used with inadequate periods of rest, they do not have time to adapt and heal, and they become disorganized and degenerated. Chronic golfer’s elbow is thought to be due more to a failed healing response of the overloaded tendon, rather than an inflammatory process.

Why is medial epicondylitis called golfer’s elbow?

Medial epicondylitis is called golfer’s elbow because golf is an activity that can put repetitive load on the tendons of the inside of the elbow. It is most common in the right elbow of a novice right-handed golfer. Those who develop the condition often have an incorrect weight shift and tend to “throw the club down” at the ball. This is sometimes referred to as "hitting from the top." This can increase the stress on the muscles on the inside of the forearm. Specifically, there is increased muscle activation of the pronator teres, an inner forearm muscle, during the acceleration phase of the swing. Transferring your weight smoothly from your back to your front foot while keeping your shoulders level will ensure proper contact between the club face and the ball.

Golfer's elbow can also develop in the left arm of a right-handed golfer if their follow-through is generated by turning over the wrist. In these cases, there is increased strain on the inside of the left elbow as the golfer's wrist turns palm-up.

What are the symptoms of golfer’s elbow?

The most common symptom is inner elbow pain and/or pain in the inside of the forearm, but feelings of stiffness and/or weakness may also occur. Pain and tenderness are usually felt on the inner side of the elbow but may also spread to the forearm and wrist.

How do you prevent golfer’s elbow?

As golfer’s elbow is an overuse injury, the best way to prevent this injury is to minimize the amount of load/stress being placed on the area. If you are starting a new activity that will load the area, it is important to do this gradually, and allow adequate rest time for the tendon to recover. While symptoms occur more at the elbow, it is actually more important to evaluate the motion of your wrist during activities to ensure you are not flexing or pronating the area more than necessary.

For golfers, using proper equipment and maintaining proper swinging form will help prevent injury. New golfers should consider lessons and club fitting to avoid excessive strain. During the off-season, a balanced training program can be helpful to improve the mobility and strength necessary to complete the golf swing. Early in the golf season it is important to be mindful of a gradual progression of swing volume to avoid doing too much too quickly. Warm up and stretch appropriately before playing and listen to your body. Don’t make what could be a relatively minor condition into something more severe by playing through pain.

Grip size can have an impact on your elbow mechanics, especially for beginners who may not have developed proper form, and in older golfers. If you’re having elbow pain, try to increase the width of your grips or change your grip position. Oversized, soft grips can help to reduce compressive forces and pressure when holding a club, and this can help prevent golfer’s elbow. If you feel that you are really trying to hold your club tightly in your hands, you may be gripping too hard. Your club should lie in your fingers.

Exercises for golfer’s elbow

To warm up your elbows and forearms, do the following exercises on the course before you begin playing. They will prepare your muscles and promote ideal mechanics to help prevent injury and improve your performance.

Forearm rotation

1. Stand with your elbows bent at your sides. Keep your elbows close to your body.
2. Rotate your forearms, palms-up, then palms-down.
3. Perform 5 to 10 repetitions using slow, controlled movements.

Forearm stretch

1. Stand with one arm directly in front of you with your elbow straight and palm upward.
2. Bend your wrist so that your fingers point toward the ground.
3. Apply a stretch to your palm with your other hand. Stretch just until you feel a slight pull in your forearm but not pain.
4. Repeat with your palm facing down.
5. Hold each stretch for 15 seconds.
6. Perform on both sides.

What is the treatment for golfer’s elbow?

The first and most important treatment is to rest the arm. Stop doing the motion that caused the injury. Wearing a forearm band below the elbow (counterforce brace) or using a wrist splint to prevent repetitive wrist flexion can also reduce strain with activities. If tolerated, NSAID (nonsteroidal anti-inflammatory drug) pain medications such as ibuprofen can be tried for a brief period initially, but this does not cure the condition and should not be used long term. If pain continues for several weeks despite rest and a short course of pain relievers, consult a sports medicine physician, physiatrist, or an orthopedist specializing in upper extremity conditions.

The next most important part of treatment for medial epicondylitis is a physical therapy or exercise program to strengthen and rehabilitate the tendon. However, this can take weeks to months to see improvement. More severe cases, or cases that are not responding to the above-mentioned treatment methods, may benefit from an injection of cortisone or platelet-rich plasma (PRP) into the area.

Cortisone is a corticosteroid that helps reduce inflammation. Though it may help the symptoms, cortisone provides only a short-term benefit. In addition, a concern regarding cortisone use is that it can potentially weaken muscle and tendon tissue.

PRP, which involves isolating the growth factors from one’s own blood and injecting them into the tendon, is thought to be less damaging to the tendon than cortisone and has been shown to benefit some patients, but this is still being studied. Other investigational therapies that may provide benefit include nitroglycerin patches, tenotomy, or extracorporeal shock wave therapy.

When do you need medial epicondylitis surgery?

Most cases of golfer's elbow resolve with some combination of the conservative options described above, but in about 10% of cases, patients will require surgery. An HSS study found that, in cases where therapeutic injections did not provide sufficient relief, only about 3% end up needing surgery. However, in some people who smoked or had additional health issues such as diabetes or circulation problems, there was a higher risk for the need to have surgery later.

Surgery is usually considered if symptoms have not resolved after 6 to 12 months of conservative treatment. The surgery, known as medial epicondyle release, involves removing the degenerated area of the tendon and, if a tear is present, repairing it.

Golf-specific performance services at HSS

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Updated: 5/10/2024

Reviewed and updated by David A. Wang, MD