Golfer's Elbow

Medial epicondylitis, commonly known as golfer’s elbow, is a condition that causes pain and tenderness on the inside of the elbow where the forearm flexor muscles attach to the medial epicondyle. It is the inside-of-elbow counterpart to tennis elbow (lateral epicondylitis), which affects the outside. Despite the name, golfer’s elbow is not limited to golfers: it affects climbers, throwing athletes, manual labourers, and anyone whose activities involve repeated gripping, flexing, or rotating of the forearm.

Causes of Golfer’s Elbow

Golfer’s elbow develops from repetitive strain and overuse of the forearm flexor and pronator muscles, which attach at the medial epicondyle of the humerus. Like its lateral counterpart, tennis elbow, research has shown that medial epicondylitis is not a true inflammatory condition despite carrying the “-itis” suffix. Histological studies of affected tendons reveal degenerative changes (a process called angiofibroblastic tendinopathy) characterized by disorganized collagen, poor vascularity, and the absence of the inflammatory cells one would expect in a true “-itis”¹. This distinction matters because it shapes which treatments are likely to support genuine tissue repair versus those that simply mask symptoms.

Risk Factors

Risk factors that increase the likelihood of developing golfer’s elbow include:

• Golf (particularly with poor swing mechanics or overtraining)
• Rock climbing and bouldering
• Throwing sports such as baseball, javelin, and football
• Racquet sports (golfer’s elbow can co-exist with tennis elbow in the same individual)
• Occupations involving repetitive gripping, hammering, or tool use
• Weightlifting and gym training, particularly with high-volume pulling exercises
• Age between 40 and 60 years

Symptoms of Golfer’s Elbow

The defining symptom of golfer’s elbow is pain and tenderness on the medial (inside) aspect of the elbow, which distinguishes it clearly from tennis elbow, where pain is felt on the lateral (outside) aspect. Symptoms may include:

• Aching or sharp pain at the inner elbow, sometimes radiating down the forearm
• Weakness in grip strength
• Stiffness of the elbow, particularly in the morning
• Pain that worsens with wrist flexion, forearm pronation, or gripping activities
• Occasional numbness or tingling into the ring and little fingers if the nearby ulnar nerve is irritated

Symptoms can develop gradually through repeated low-grade loading of the flexor-pronator tendon, or more acutely following an unusually intense bout of activity.

Diagnosis

Golfer’s elbow is primarily diagnosed through a thorough health history and physical examination. Tenderness to palpation directly over the medial epicondyle, combined with pain reproduction during resisted wrist flexion or forearm pronation, is characteristic. Imaging is not always required, but ultrasound or MRI may be ordered to assess tendon integrity, rule out partial or complete tears, or exclude other causes of medial elbow pain such as ulnar collateral ligament injury or ulnar nerve entrapment.

Conventional Treatment

Initial management of medial epicondylitis typically involves activity modification, a counterforce brace, and oral anti-inflammatory medications for pain control. Physiotherapy with specific eccentric and progressive loading exercises is an important part of rehabilitation. When conservative measures are insufficient, corticosteroid injections are sometimes used. While cortisone can reduce pain in the short term, research has raised concerns that repeated injections may impair tendon healing and increase the risk of longer-term tissue damage². Surgical release of the flexor-pronator origin is reserved for refractory cases and carries its own risks and recovery demands.

Regenerative Treatment Options

Because medial epicondylitis is fundamentally a degenerative tendinopathy rather than an inflammatory condition, treatments that stimulate tissue repair rather than suppress inflammation offer a logical and evidence-supported approach.

Platelet-Rich Plasma (PRP) involves concentrating the growth-factor-rich platelet fraction from a patient’s own blood and injecting it at the site of tendon degeneration. PRP has been studied specifically for medial epicondylitis and has shown promising results in promoting tendon healing and providing durable pain relief³. Because PRP is derived from the patient’s own blood, its safety profile is excellent.

Prolotherapy and Prolozone therapy are injection-based regenerative treatments that use a proliferant solution (prolotherapy) or ozone combined with nutrients (prolozone) to stimulate the body’s natural healing response in chronically degenerated tendons and ligaments. Both approaches have been used in the treatment of elbow tendinopathies and form part of an integrated sports medicine approach at the clinic. More information on prolotherapy and prolozone can be found on the prolotherapy and prolozone pages.

Patients with lateral elbow pain may also be interested in the related page on tennis elbow.

References

1. Nirschl RP, Pettrone FA. Tennis elbow: the surgical treatment of lateral epicondylitis. J Bone Joint Surg Am. 1979;61(6A):832-839.
2. Coombes BK, Bisset L, Vicenzino B. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Lancet. 2010;376(9754):1751-1767.
3. Palacio EP, Schiavetti RR, Kanunfre M, Ikeda TM, Mizobuchi RR, Galbiatti JA. Effects of platelet-rich plasma on lateral epicondylitis of the elbow: prospective randomized controlled trial. Rev Bras Ortop. 2016;51(1):90-95.
4. Carayannopoulos A, Borg-Stein J, Vad V. Medial epicondylitis and the role of regenerative injection therapy. Curr Rev Musculoskelet Med. 2012;5(2):101-106.