Golfer's Elbow (Medial Epicondylitis)

What golfer's elbow is

The muscles that bend your wrist and fingers and turn your palm down start from a shared tendon on the bony bump on the inside of the elbow, the medial epicondyle. Repeated loading causes small areas of tendon breakdown and disorganized healing, called tendinopathy. Despite the "-itis" name, there is little inflammation in established cases.

It is closely related to tennis elbow, which affects the outer elbow. For a comparison of both, see epicondylitis.

Symptoms

• Aching or burning pain on the inner elbow that may spread down the inside of the forearm.
• Pain when gripping, shaking hands, turning a doorknob, lifting with the palm up, or swinging a club or racquet.
• Tenderness over the bony bump on the inner elbow.
• Weak grip.
• Morning stiffness of the elbow.
• Numbness or tingling in the ring and little fingers if the nearby ulnar nerve is irritated (cubital tunnel syndrome).

Causes and risk factors

• Sports: golf (especially hitting the ground or poor technique), tennis forehands and serves, baseball pitching, javelin, bowling, rock climbing and weight training with heavy curls or pull-ups.
• Work: carpentry, plumbing, construction, assembly line work, typing with poor wrist position, and other repetitive gripping tasks.
• Age 40 to 60, when tendons are less able to adapt to load.
• Smoking, obesity and diabetes.
• Sudden increase in training volume or a change in equipment.

Diagnosis

A doctor or physical therapist examines the elbow. Typical findings are tenderness just in front of and below the medial epicondyle, and pain when you bend the wrist against resistance or turn the palm down against resistance. They also check:

• The ulnar nerve, by tapping behind the inner elbow and testing finger sensation and strength.
• Ligament stability, especially in throwers, to rule out an ulnar collateral ligament tear.
• The neck, since a pinched nerve can refer pain to the arm.

Imaging is not needed for typical cases. Ultrasound or MRI is used if the diagnosis is uncertain, symptoms do not improve after several months, or surgery is considered. X-rays can show arthritis, loose bodies or growth plate problems in young athletes.

Golfer's elbow treatment

Relative rest and load management

Reduce the activities that provoke pain, without immobilizing the arm. Lift with the palm facing down less, use both hands, and take regular breaks. Return to sport gradually.

Golfer's elbow exercises

Progressive loading is the core of treatment. Do these daily or every other day, with mild discomfort acceptable but no sharp pain:

1. Isometric wrist flexion: rest the forearm on a table, palm up. Press your palm upward against your other hand without moving, hold 30 to 45 seconds, repeat 5 times. Good for pain relief early on.
2. Eccentric wrist flexion: hold a light dumbbell palm up, use the other hand to lift the wrist up, then slowly lower it over 3 to 5 seconds. Do 3 sets of 10 to 15.
3. Pronation and supination: hold a hammer or light weight at one end and slowly turn the palm down and up.
4. Grip strengthening: squeeze a ball or putty.
5. Flexor stretch: arm straight, palm up, gently pull the fingers back with the other hand for 30 seconds.
6. Shoulder and upper back strengthening, which reduces load on the forearm.

Increase the weight gradually over 6 to 12 weeks.

Other measures

• Counterforce brace: a strap worn just below the elbow spreads the load on the tendon.
• Ice for 15 minutes after activity.
• Pain relief: topical NSAID gels are a good first option. Oral ibuprofen or acetaminophen (paracetamol) can help short term, following the label dose; avoid NSAIDs with kidney disease, stomach ulcers or blood thinners.
• Technique and equipment: a golf or tennis coach can correct swing faults; larger grips and lighter clubs or racquets reduce strain.
• Physical therapy with manual therapy and a supervised program.

Injections and procedures

• Steroid injections can ease pain for a few weeks but are linked to higher relapse rates and tendon weakening, so they are used sparingly. Care is needed near the ulnar nerve.
• Platelet-rich plasma (PRP) injections and shockwave therapy have mixed evidence.

Surgery

Surgery is considered after 6 to 12 months of failed treatment. It removes damaged tendon tissue and reattaches healthy tendon. The ulnar nerve may be released or moved if it is involved. Most people improve, but full recovery takes 3 to 6 months.

Recovery time

Most people improve over 6 to 12 weeks with exercise, and about 80 to 90 percent are better within a year. Mild cases may settle in weeks. Long-standing cases or those with ulnar nerve symptoms take longer.

Prevention

• Warm up before sport and build training gradually.
• Strengthen forearm, shoulder and core muscles.
• Use proper technique, and the right size grip and equipment.
• Take breaks from repetitive gripping at work and use tools with padded or larger handles.

Frequently asked questions

What does golfer's elbow feel like?

It feels like an ache or burning pain on the inner side of the elbow, which can spread down the forearm. It hurts when you grip, make a fist, shake hands, lift with your palm up or swing a club. The bony bump on the inside of the elbow is tender to press.

How long does golfer's elbow take to heal?

Most cases improve within 6 to 12 weeks of a consistent exercise program, and the vast majority are better within a year. Healing is slower if you keep doing the aggravating activity at the same level, or if the ulnar nerve is irritated.

What are the best exercises for golfer's elbow?

Start with isometric holds, pressing the palm against resistance without moving. Then add slow eccentric wrist curls with a light weight, forearm rotation exercises, grip strengthening and a gentle flexor stretch. Shoulder strengthening also helps. Progress the load gradually over several weeks.

Can you get golfer's elbow without playing golf?

Yes. Most people with golfer's elbow do not play golf. It is caused by any repeated gripping, wrist bending or forearm twisting, such as racquet sports, throwing, weight training, carpentry, plumbing or repetitive office and factory tasks.

Should I wear a brace for golfer's elbow?

A counterforce strap worn just below the elbow can reduce pain during activity by spreading force across the forearm muscles. It works best alongside an exercise program. Wrist splints at night may help some people. Braces do not cure the problem on their own.