Golfers Elbow: Causes, Diagnosis, and What the Evidence Actually Shows

Key Takeaways: Golfers Elbow

Golfers elbow (medial epicondylitis or medial epicondylalgia) affects the tendon origin of the wrist flexor and forearm pronator muscles at the inner elbow.
It is uncommon in the general population: a Finnish population study found definite medial epicondylitis in 0.4% of adults aged 30–64.
Despite the name, most cases are not linked to golf. Forceful and repetitive arm work, smoking and obesity have all been associated with it.
The tissue changes are described mainly as degenerative tendon change (tendinosis) rather than classic inflammation.
The diagnosis is usually clinical. Ultrasound performed well in a small diagnostic study, but it is operator-dependent.
Ulnar nerve symptoms and C6–C7 cervical radiculopathy are important overlapping or mimicking conditions.
The outlook is often favourable: in one occupational follow-up study, the three-year recovery rate among workers with medial epicondylitis was 81%.
In a randomised trial, corticosteroid injection reduced pain on one grading scale at 6 weeks, but not at 3 months or 1 year.
Exercise research specific to the medial elbow is thin, and surgery is reserved for cases that do not settle with nonoperative care.
In my clinical experience as an occupational health physician, golfers elbow often appears in people doing long-term repetitive manual work or desk work, and only rarely in golfers.
In my practice, active physiotherapy is the main approach, and I often see patients stop loading or quit physiotherapy when pain temporarily flares, and in my experience these patients often seem to recover more slowly.

Introduction: Golfers Elbow

Golfers elbow is one of those diagnoses whose name tells you less than you might think. The condition sits on the inner side of the elbow, where the muscles that bend the wrist and turn the forearm palm-down attach to a bony bump called the medial epicondyle. It is the less common sibling of tennis elbow, and most cases are not sport-related [1].

It is also relatively uncommon. In a representative Finnish population sample of 4,783 people aged 30–64, the prevalence of definite medial epicondylitis was 0.4%, compared with 1.3% for lateral epicondylitis [2].

As both a physician and a former competitive athlete, I find this condition a useful example of a broader principle in sports medicine: the label on a condition rarely tells the whole story, and the most important clinical step is often ruling out what else could be causing the pain.

Although golfers elbow is not especially common in the general population, it comes up fairly regularly in my own practice, largely because I also work as an occupational health physician. In many cases, the problem appears to start from work-related, repetitive use of the hands. A fairly typical patient is someone who has used their hands repeatedly and continuously in manual work for a long time, such as installation work or nursing, and I also see it in airline crew. In my clinical experience, golfers elbow also appears fairly often in people who do computer-based desk work, although the reason for this is not clear.

This article covers what golfers elbow is, who gets it, how it is diagnosed, which conditions can look similar, and what the research actually shows about injections, exercise, platelet-rich plasma (PRP) and surgery.

What Is Golfers Elbow? Anatomy and Tissue Changes

The medial epicondyle is the attachment site for five muscles that together form the common flexor tendon: pronator teres, flexor carpi radialis, palmaris longus, flexor digitorum superficialis and flexor carpi ulnaris [1]. These muscles flex the wrist and fingers and pronate the forearm, and the pain typically worsens with forearm pronation and gripping [1].

The traditional name, medial epicondylitis, suggests inflammation. A 2022 narrative review, however, describes the condition as resulting from microtrauma that accumulates over time under supraphysiological stress on the tendon, with proposed tissue changes including angiofibroblastic degradation, fibrosis and calcification at the medial epicondyle [1]. Some specialists therefore prefer terms such as tendinosis or tendinopathy, and the review suggests that medial epicondylalgia may be a more suitable name because it avoids the -itis suffix, which implies inflammation [1].

This matters practically. If the problem is a tendon that has lost some of its capacity to tolerate load, rather than a simple inflammation, that is the rationale behind loading-based rehabilitation, whose evidence for the medial elbow is discussed later in this article. The same principle is discussed in more detail in my article on eccentric training for tendinopathy.

According to a 2022 narrative review, roughly 70% of cases have an insidious onset and about 30% are associated with an acute injury [1].

Who Gets It? Prevalence and Risk Factors

It is mostly not a golf injury

A 2022 narrative review reports that medial epicondylalgia is 7 to 10 times less prevalent than lateral epicondylalgia, accounting for at most 10–20% of all epicondylalgia cases, and that 90% of cases are not sport-related but occur in particular occupations [1]. These figures are drawn from earlier studies cited in the review rather than from new data, and estimates vary between populations: in the Finnish population study described above, the difference between medial and lateral epicondylitis was smaller [2]. The same review reports that the disorder predominantly occurs in the fourth and fifth decades of life and may affect up to 8% of people in certain occupations involving repetitive and forceful elbow use, such as meat cutters and butchers [1].

Sports that stress the wrist and elbow, such as golf, rowing, baseball, tennis and bowling, are also associated with the condition [1].

In my clinical experience, I rarely see golfers elbow in actual golfers, even though it occasionally appears true to its name. I see it now and then in athletes, and in otherwise fairly sedentary people who have been exercising more recreationally. It may become symptomatic especially with forceful pulling movements, such as pull-ups. I find that resistance training with weights is generally well tolerated, but very forceful pulling, such as weighted pull-ups, can sometimes be too much load, and the medial epicondyle may become painful. Even so, the background I see is often a chronic, low-level strain from work, such as desk work, and the patient then notices that the area becomes painful during training.

Risk factors in population data

In the Finnish population study, prevalence did not differ between men and women and was highest in people aged 45–54 [2]. Smoking, obesity, repetitive movements and forceful activities each showed significant associations with medial epicondylitis, independently of one another [2].

Two points are worth noting. First, these are associations from a prevalence study, not proof that each factor causes the condition. Second, smoking and obesity are not mechanical factors, which may suggest that systemic factors play a role alongside how the arm is used. This is an interpretation, not something the study tested.

Occupational cohorts and rising diagnosis rates

In a study of workers in repetitive jobs, 598 workers were re-examined after three years. The annual incidence of medial epicondylitis was estimated at 1.5%, and workers with medial epicondylitis had a significantly higher prevalence of other work-related upper-limb disorders [3]. In this cohort, medial epicondylitis was clearly associated with forceful work [3].

In the United States, an analysis of a national database identified 19,856 cases between 2007 and 2014. The annual incidence in the database increased significantly over the study period, and the proportion of diagnoses in patients aged 65 or older also increased [4].

Golfers Elbow Symptoms and Diagnosis

Typical symptoms

The main symptoms are pain and tenderness at the inner elbow, typically at the muscle–tendon junction or the wrist flexor insertion, sometimes radiating into the forearm [1]. Pain typically worsens with forearm pronation, gripping or throwing, and symptoms are often provoked by lifting heavy objects [1]. Reduced grip strength and joint stiffness can also occur [1].

Clinical examination

Diagnosis is primarily based on clinical signs and symptoms [1]. Tenderness at the flexor-pronator origin, about 0.5–1 cm distal to the medial epicondyle, is characteristic, and the review describes pain during resisted wrist flexion and pronation as the most sensitive test on physical examination [1].

In a surgical series of 30 elbows, resisted forearm pronation was positive in 28 elbows, while resisted wrist flexion was positive in 12, making resisted pronation the most sensitive provocative manoeuvre in that series [5].

From a clinical perspective, many patients do not describe pain that radiates outward, but the typical spot at the medial epicondyle is tender when I palpate it. A fairly typical finding in my practice is that pain appears at the medial epicondyle when the patient presses a fingertip down against a surface, such as a table. The skin is usually normal, and the epicondyle is not usually particularly swollen, although swelling can sometimes occur. In my experience, the pain is often located right at the tendon insertion rather than on the bone itself, and the medial joint line is usually not tender.

The role of imaging

Plain radiographs are usually normal, but they can help exclude other diagnoses such as a medial epicondyle fracture, elbow arthritis or deformity [1]. MRI is regarded as the gold standard for confirming the diagnosis [1].

Ultrasound is described as a practical and accessible alternative to MRI [1]. In a prospective, single-blind study of 21 elbows with clinical medial epicondylitis and 25 elbows without it, ultrasound showed a sensitivity of 95.2% and a specificity of 92% [6]. Tendinosis was seen in 15 elbows and a partial-thickness tear in 5 [6]. The study was small, and the diagnostic value of ultrasound depends heavily on the examiner’s experience [1].

Patients sometimes ask for imaging. In my experience, if imaging is needed, ultrasound is usually the option I would consider, but it is rarely necessary. In my view, the diagnosis itself is generally clear: in my clinical experience, when symptoms have developed through load, a tender tendon insertion at the medial epicondyle usually points fairly clearly to medial epicondylitis.

Conditions That Can Mimic or Accompany It

Inner elbow pain is not always golfers elbow. Several conditions overlap with it or imitate it.

Ulnar nerve problems

The ulnar nerve runs behind the medial epicondyle [1]. Medial epicondylitis is classified as type 1 (without ulnar nerve involvement) or type 2 (with ulnar nerve involvement) [1]. Numbness or tingling radiating into the ring and little fingers occurs mainly when ulnar neuropathy coexists [1]. In cubital tunnel syndrome, unlike medial epicondylitis, most patients report sensory loss first rather than activity-related pain [1].

In surgically treated patients, this distinction may have prognostic weight. In a retrospective series of 30 operated elbows followed for an average of seven years, 24 of 25 elbows with no or mild ulnar neuropathy had a good or excellent result, compared with 2 of 5 elbows with moderate or severe ulnar neuropathy (p = 0.009) [5]. A more recent systematic review, however, found that two studies reported minimal impact of preoperative ulnar neuritis on outcomes [7], so the picture is not fully consistent across studies.

Cervical radiculopathy (C6–C7)

It has been proposed that muscle weakness from C6 and C7 radiculopathy may predispose to medial epicondylitis [1], and it affects muscles that are also injured in medial epicondylitis [8]. In a study of 102 patients diagnosed with cervical radiculopathy, 55 were also diagnosed with medial epicondylitis [8]. The authors concluded that patients with medial epicondylitis should be examined for C6 and C7 radiculopathy [8].

It is important not to over-read this finding. The study measured how often medial epicondylitis occurred among people who already had a neck diagnosis — not how often neck problems are present in people with elbow tendon pain. It shows an association, not that the neck causes the elbow pain.

In practice, patients sometimes feel that their pain is somehow radiating. In my clinical experience, the background is usually that the whole chain is tight: the neck, shoulder and upper-arm muscles as well as the epicondyle, and when I palpate more carefully, there is tightness along the whole way. In this situation, the pain can usually be divided into medial epicondylitis and plain neck and shoulder muscle tension. There may also be shoulder impingement in the background, which may explain the shoulder pain and part of the neck and shoulder symptoms. Together, these may explain why the pain can feel as if it radiates through the whole upper limb. In my view, this picture often points more towards insertional tendinopathies at several joints along the arm, related to physically strenuous work, than towards true nerve root irritation. As I see it, however, radicular-type symptoms are not very often confused with medial epicondylitis. Neck- and shoulder-related muscle pain may be more easily confused with cervical radiculopathy, whereas medial epicondylitis is perhaps easier to separate clinically when radiculopathy needs to be excluded. I find key-muscle strength testing and the Spurling test to be useful parts of this overall clinical assessment.

Ulnar collateral ligament injury

Injury to the medial (ulnar) collateral ligament occurs mainly in overhead throwing athletes, because the anterior part of this ligament is the primary restraint against valgus stress during overhead throwing, and it can lead to valgus instability and a popping sensation at the inner elbow [1]. When examining overhead athletes, the same review stresses evaluating for ulnar neuritis and ulnar collateral ligament instability, which may coexist [1].

Other causes of medial elbow pain discussed in the same review include snapping triceps, ganglion cysts and degenerative joint changes [1].

Golfers Elbow Treatment: What the Evidence Shows

The outlook is often favourable

In the occupational cohort described above, the three-year recovery rate for medial epicondylitis was 81% [3], and recovery was not associated with a change in working conditions [3]. This was an observational follow-up, not an untreated control group, so the figure does not show how many people would recover without any treatment.

It is still useful context for interpreting treatment studies: when many people improve over time, a treatment needs a control group to show that it adds anything beyond that improvement.

Corticosteroid injection: short-term benefit only

One randomised trial specific to golfers elbow was a prospective, double-blind study of 58 patients (60 elbows). Participants received a single injection of 1% lidocaine combined with either 40 mg methylprednisolone or saline, and both groups were also managed with physical therapy and non-steroidal anti-inflammatory drugs [9]. At six weeks, the steroid group had significantly less pain on a modified Nirschl–Pettrone grading (p < 0.03), but the groups did not differ in pain at three months or at one year [9]. On a visual analogue scale, pain intensity did not differ between the groups at either six weeks or one year [9]. The authors concluded that the improvement in both groups primarily reflected the natural history of the disorder and that steroid injection provides only short-term benefit [9].

A 2025 systematic review of surgical treatment identified four studies that examined whether preoperative injections were related to surgical outcomes [7]. Taken together, these studies do not establish that injections improve or worsen later surgical results.

In my practice, I am not particularly quick to recommend corticosteroid injections. Patients generally seem to understand that cortisone injections into tendons are something to be cautious about, as they are often worried that the injection may weaken the tendon. I am aware that corticosteroid injections are used in some parts of the world, but in my own work in Finland I do not recall ever seeing corticosteroid injected for medial epicondylitis.

Exercise and loading: plausible, but thinly studied for the medial elbow

Most of the exercise research on elbow tendinopathy comes from tennis elbow. A 2013 systematic review in the British Journal of Sports Medicine set out to assess exercise therapy and mobilisation for both medial and lateral epicondylitis, but all 12 randomised controlled trials it included studied lateral epicondylitis [10].

The evidence base has grown only modestly since then. A 2026 systematic review of eccentric exercise for medial epicondylitis included five studies with a total of 143 patients [11]. Eccentric exercise was associated with significant within-group reductions in pain and improvements in function, but superiority over a comparison group was demonstrated in only one randomised trial, in which a combined intervention was compared with ultrasound therapy, and the overall certainty of the evidence was rated low [11].

In other words, loading-based rehabilitation for golfers elbow is biologically plausible and consistent with the wider tendinopathy literature, but the medial-elbow-specific trial evidence remains limited. Short-term pain modulation with static contractions is discussed in my article on isometric exercise for pain.

In my practice, I generally refer patients with golfers elbow to active physiotherapy. Isometric and eccentric exercises are among the approaches that many of my patients seem to benefit from, and they tend to benefit more from active than from passive physiotherapy. Passive options for this area are fairly limited, mainly massage and stretching. Interestingly, my patients seem reluctant to have this condition massaged, even though they often readily seek massage for other painful conditions. Many patients have tried stretching, but in my experience it rarely produces a clear benefit.

A pattern I often see is that patients stop loading the arm when the pain returns, and they may hesitate to do resistance training or skip their usual sport. In my view, this is often unhelpful, because I have seen that avoiding all loading may make tendinopathy symptoms worse. The area may become sore during exercise, but over the long term, my impression is that loading such as resistance training may help keep symptoms at bay in many patients. Some patients are also alarmed when they start active physiotherapy, because the pain may temporarily worsen, and they may conclude that the condition is simply getting worse. Patients who stop at that point often seem to recover more slowly, although this is a clinical impression rather than a proven effect. For this reason, I tell my patients in advance that pain may increase at first with loading, and that it often eases over the longer term.

Platelet-rich plasma (PRP)

Among the sources reviewed here, the evidence for PRP in medial epicondylitis is observational. In a level 3 cohort study of recalcitrant type 1 medial epicondylitis, successful outcomes were reported in 80% of patients treated with PRP and 94% of those treated surgically (P = .37), with no significant difference in return-to-activity rates or elbow function scores [12]. The PRP group reached full range of motion and pain-free status earlier [12].

A non-significant difference in a non-randomised cohort does not prove that the two treatments are equivalent, and there is no placebo-controlled randomised trial of PRP specifically for medial epicondylitis among the sources reviewed here.

Surgery for persistent cases

Surgery is indicated when conservative management fails [7]. The same 2025 systematic review reported a median time to surgery of six months of failed nonoperative treatment [7].

A 2023 systematic review in the American Journal of Sports Medicine included 16 studies: 13 on open techniques, two arthroscopic and one percutaneous [13]. Return-to-sport rates ranged from 81% to 100% and return-to-work rates from 66.7% to 100%, and the authors concluded that further research is needed to determine whether any technique is superior [13]. The 2025 review likewise highlighted a scarcity of high-quality research on surgical management [7].

Recovery after surgery is not always quick: in the long-term surgical series, nine elbows needed more than six months to reach maximum improvement [5].

In the United States data, the annual number of operations increased between 2007 and 2014, but the annual proportion of diagnosed cases that proceeded to surgery remained constant [4].

What This Means in Practice

Taken together, the research describes golfers elbow as a condition that:

Is uncommon in the general population and is linked more to forceful and repetitive arm use than to golf [2][1]
Is usually diagnosed clinically, with imaging used mainly in unclear cases or to exclude other conditions [1]
Can overlap with ulnar nerve problems and C6–C7 radiculopathy, which may change the assessment; in one surgical series, moderate or severe ulnar neuropathy was linked to poorer results [8][5]
Often improves during follow-up, which makes that improvement an important comparison for any treatment [3]
Has trial evidence for only short-term benefit from corticosteroid injection [9]
Has low-certainty, medial-elbow-specific evidence for eccentric exercise [11]
Is treated surgically mainly when symptoms persist despite nonoperative care [13][7]

If symptoms are severe, I sometimes prescribe a rest splint, and some patients use an epicondylitis strap, although in my experience such straps are more widely used for lateral epicondylitis, or tennis elbow. A rest splint may ease symptoms in many patients, but it does not usually solve the problem on its own, and in my practice active physiotherapy remains the main approach.

For elbow supports, see my separate article on best tennis elbow braces.

In my practice, I often tell patients that very forceful, jerking movements, such as weighted pull-ups or the golf swing, may aggravate this condition, and that limiting them for a while may be worth considering. Golf itself is not necessarily very strenuous, but in my experience some of its abrupt movements may provoke symptoms.

Conclusion: Golfers Elbow

Golfers elbow is generally described as a degenerative tendon problem at the inner elbow that is far more often linked to work and everyday loading than to golf. It affects a small proportion of the adult population, peaks in middle age, and has been associated with smoking, obesity and forceful, repetitive arm use.

The diagnosis is mostly clinical, but careful assessment matters because the ulnar nerve, the cervical spine and, in throwing athletes, the ulnar collateral ligament can all produce similar symptoms. The outlook is often favourable, with a three-year recovery rate of 81% among affected workers in one occupational follow-up study. Corticosteroid injection has trial evidence for short-term benefit only, exercise research specific to the medial elbow remains thin, and surgery is reserved for persistent cases, with generally good but heterogeneous results.

From my own clinical perspective, golfers elbow is mostly a work-related problem that I rarely see in golfers. I find the diagnosis is usually clear from the history and examination, and imaging is rarely necessary. In my own work in Finland, I do not recall seeing corticosteroid injections used for it; in my practice, active physiotherapy is the main approach, and a temporary increase in pain when loading begins does not necessarily mean that the condition is getting worse.

The most honest summary is that the outlook in follow-up data is often favourable, but recovery can take time, and much of the treatment evidence remains limited.

Golfers Elbow: Causes, Diagnosis, and What the Evidence Actually Shows

Table of Contents

Key Takeaways: Golfers Elbow

Introduction: Golfers Elbow

What Is Golfers Elbow? Anatomy and Tissue Changes