ConditionBones, joints & muscles
Epicondylitis (Tennis Elbow and Golfer's Elbow)
Epicondylitis is pain from overloaded tendons where the forearm muscles attach to the bony bumps (epicondyles) of the elbow. Lateral epicondylitis, or tennis elbow, affects the outer elbow and hurts with gripping and lifting. Medial epicondylitis, or golfer's elbow, affects the inner elbow and hurts with bending the wrist and forearm. Despite the names, most cases come from work or everyday repetitive tasks, not sport. It usually improves within 6 to 12 months with load management and exercises.
Also called: Tennis elbow, golfer's elbow, lateral epicondylitis, medial epicondylitis, elbow tendinopathy, epicondylalgia
At a glance
- What it is
- Degenerative overload of the forearm tendons at the elbow (tendinopathy more than inflammation).
- Types
- Lateral (tennis elbow, much more common) and medial (golfer's elbow).
- Who gets it
- Usually adults aged 35 to 55, especially with repetitive gripping, lifting or tool use.
- Diagnosis
- Examination; imaging only if atypical or not improving.
- Treatment
- Activity changes, progressive strengthening, a forearm strap, pain relief; most recover within a year.
When to get help
See a doctor within a day or two
- Sudden elbow pain with a pop, bruising and weakness after lifting (possible tendon rupture)
- A hot, red, swollen elbow, especially with fever (possible infection or gout)
- Elbow pain after a fall with swelling or inability to straighten the arm (possible fracture)
Book a routine appointment
- Elbow pain lasting more than 6 weeks despite rest and exercises
- Numbness or tingling in the ring and little fingers, or a weak grip
- Elbow pain with neck pain or pain spreading down the arm
- Pain that wakes you at night or is present at rest
Usually safe to manage at home
- Outer or inner elbow pain that started after increased gripping, lifting or a new sport, with no swelling or numbness
Tennis elbow vs golfer's elbow
| Feature | Lateral epicondylitis (tennis elbow) | Medial epicondylitis (golfer's elbow) |
|---|---|---|
| Where it hurts | Outside of the elbow, may spread down the forearm | Inside of the elbow, may spread down the forearm |
| Tendon involved | Wrist extensors, mainly extensor carpi radialis brevis | Wrist flexors and pronators |
| Movements that hurt | Gripping, lifting with palm down, shaking hands, turning a doorknob | Bending the wrist, gripping, turning the palm down, throwing |
| How common | About 1 to 3% of adults each year | Several times less common |
| Associated problem | Radial tunnel syndrome can mimic it | Ulnar nerve irritation (cubital tunnel syndrome) in some |
See tennis elbow and golfer's elbow for each form in more detail.
What happens in the tendon
Epicondylitis was once thought to be inflammation (the "-itis"). Tissue studies show mainly tendinosis: disorganized collagen, new blood vessel growth and degeneration from repeated loading that outpaces repair. That is why anti-inflammatory treatments give only short-term relief and why progressive loading exercises are the mainstay.
Causes and risk factors
- repetitive gripping, twisting or lifting at work: plumbing, carpentry, painting, meat processing, assembly lines, computer mouse use
- racket sports with poor technique, heavy rackets or the wrong grip size (lateral)
- golf, throwing sports, weight training and bowling (medial)
- age 35 to 55
- smoking and obesity
- a sudden increase in activity
Symptoms
- pain and tenderness over the bony bump on the outer or inner elbow
- pain spreading into the forearm
- weak grip and pain when gripping, carrying bags or lifting a cup
- morning stiffness
- pain that builds gradually over weeks
Diagnosis
A doctor or physical therapist diagnoses epicondylitis by examination:
- tenderness just in front of or below the epicondyle
- pain with resisted wrist extension or middle finger extension (lateral)
- pain with resisted wrist flexion or forearm pronation (medial)
- checks of the neck, nerves and elbow joint to rule out other causes, such as cervical radiculopathy or elbow arthritis
Ultrasound or MRI is used if pain persists for months, if surgery is being considered, or if another diagnosis is suspected. X-rays exclude arthritis or calcification.
Treatment
Activity modification
Reduce, but do not completely stop, painful activities. Lift with the palm up, use two hands, and adjust tools, grips and workstation setup. In sport, have technique and equipment checked.
Exercise therapy
The most effective long-term treatment is progressive tendon loading:
- isometric holds: pressing against resistance without moving, to ease pain
- eccentric and slow resistance exercises: wrist extension (lateral) or flexion (medial) with a light dumbbell or band, gradually increasing load over 6 to 12 weeks
- grip strengthening and forearm rotation exercises
- shoulder and upper back strengthening
Some discomfort during exercise is acceptable if it settles within 24 hours.
Other measures
- Counterforce brace (forearm strap) worn just below the elbow during activity
- Wrist splint at night for some people
- Pain relief: topical NSAID gels or oral NSAIDs for short periods, following the label dose
- Ice after activity
Injections and procedures
- Steroid injections: relieve pain for a few weeks but are linked to worse results and more recurrence at 6 to 12 months than waiting, so they are used sparingly.
- Platelet-rich plasma (PRP): mixed evidence; may help some with chronic cases.
- Extracorporeal shockwave therapy: an option for persistent pain.
- Surgery: for the small number with severe symptoms after 6 to 12 months of good conservative care.
Outlook
Most people recover within 6 to 12 months, and about 80 to 90% improve without surgery. Recurrence is common if the triggering activity resumes without strength work and technique changes.
Frequently asked questions
What is the difference between lateral and medial epicondylitis?
Lateral epicondylitis (tennis elbow) causes pain on the outer elbow, worse with gripping and lifting with the palm down. Medial epicondylitis (golfer's elbow) causes pain on the inner elbow, worse with bending the wrist and gripping. Lateral is much more common.
What causes epicondylitis?
Epicondylitis is caused by repetitive overload of the forearm tendons where they attach to the elbow. Repetitive gripping, lifting and twisting at work, racket sports, golf and throwing are common causes. It is most frequent between ages 35 and 55.
How long does epicondylitis take to heal?
Most cases improve within 6 to 12 months. Progressive strengthening exercises and reducing aggravating activities speed recovery. Pain lasting more than 6 months despite good treatment may need specialist review.
Are steroid injections good for tennis elbow?
Steroid injections relieve pain quickly, but studies show worse outcomes and more recurrences at 6 to 12 months compared with exercise or waiting. They are best reserved for short-term relief when pain prevents rehabilitation.
Do braces help epicondylitis?
A forearm counterforce strap, worn just below the elbow during activity, can reduce pain for some people by changing how force passes through the tendon. It works best alongside exercises and activity changes.
Sources
This guide was written from current patient and clinical guidance, including:
- American Academy of Orthopaedic Surgeons: Tennis elbow (lateral epicondylitis); Golfer's elbow
- American Society for Surgery of the Hand: Tennis elbow
- NHS: Tennis elbow; Golfer's elbow
- British Journal of Sports Medicine: Lateral elbow tendinopathy consensus
- MedlinePlus: Tennis elbow