Golfers elbow
Content reviewed by✓Mr Andrew Davies, PhD FRCS (Tr & Orth)· Reviewed June 2026Golfers elbow (medial epicondylitis or medial epicondylalgia) is a tendinopathy of the common flexor-pronator origin at the medial epicondyle of the humerus, causing pain on the inner side of the elbow.
📊 Golfers elbow affects approximately 0.4-1% of the adult population. Despite the name, the condition is more commonly associated with manual occupations than with golf.
What is golfers elbow?
Golfers elbow is pain on the inner side of the elbow, where the tendons of the forearm muscles attach to the bone. Despite the name, the majority of people who develop it have never played golf, it can be caused by any repetitive gripping, twisting, or wrist-bending activity. Gardening, painting, using a screwdriver, heavy lifting, and computer work are all common triggers.
The underlying problem is not true inflammation but a degenerative change in the tendon, the normal collagen fibres become disorganised and unhealthy. This is why anti-inflammatory medication and steroid injections, while sometimes helpful in the short term, do not address the underlying cause and can actually worsen the tendon over time. The most effective long-term treatment is a carefully graded loading programme that stimulates the tendon to repair itself.
It is important to check whether the ulnar nerve (which runs close by on the inner side of the elbow) is also involved, around 60% of throwing athletes with golfers elbow have some degree of nerve irritation causing tingling in the ring and little fingers. This needs to be assessed and treated alongside the tendon problem.
Common causes
- Repetitive wrist flexion and forearm pronation
- Heavy manual labour involving gripping and forearm rotation
- Throwing sports - valgus stress at the medial elbow
- Racket sports
- Golf (take-away and impact phases)
- Sudden increase in training load or change in technique
Who is at risk? Age 35-55, manual occupations, throwing athletes, and dominant arm use are the main risk factors. Coexisting ulnar nerve irritation is common, particularly in overhead athletes.
Symptoms
Symptoms vary depending on the severity and duration of the condition. Common symptoms include:
- Pain and tenderness directly over the medial epicondyle
- Pain reproduced by resisted wrist flexion and forearm pronation with the elbow extended
- Aching discomfort radiating down the medial forearm
- Weakness of grip strength
- In athletes: pain during the throwing motion, particularly at ball release
- In coexisting cubital tunnel syndrome: numbness and tingling in the ring and little fingers
When to seek help: See your GP or physiotherapist if medial elbow pain is limiting work or sport and has not improved after 6-8 weeks of self-management. Ask about associated tingling in the fingers, which may indicate co-existing ulnar nerve involvement.
How is it diagnosed?
Your surgeon will take a detailed history and examine the joint. The following investigations may be arranged to confirm the diagnosis:
- Clinical examination - tenderness at the medial epicondyle, pain with resisted wrist flexion
- Evaluation of the ulnar nerve - Tinel sign at cubital tunnel, elbow flexion test
- Nerve conduction studies - essential if numbness or tingling is present
- Ultrasound - confirms tendon degeneration and guides injection if planned
- MRI - for atypical cases, to assess the ulnar collateral ligament in athletes, and before surgery
Always assess for coexisting ulnar nerve involvement. Nerve conduction studies are recommended if any neurological symptoms are present. In throwing athletes, MRI assessment of the ulnar collateral ligament is important as UCL injury may present identically to medial epicondylalgia.
Treatment pathway
Treatment is tailored to the severity of the condition, your age, activity level, and overall health. Most conditions are treated in a stepwise fashion, starting with the least invasive options.
Physiotherapy and load management
Eccentric and isometric strengthening of the wrist flexors and forearm pronators under physiotherapist guidance. Activity modification to reduce provocative loading. A medial elbow counterforce brace may reduce strain on the common flexor origin. Technique assessment in athletes to identify and correct contributing biomechanical faults.
Extracorporeal shockwave therapy (ESWT)
Shockwave therapy stimulates healing in degenerative tendons. Preferred over corticosteroid injection due to superior long-term outcomes. Typically 3-6 sessions. The proximity of the ulnar nerve to the medial epicondyle requires careful delivery to avoid nerve irritation.
Surgical debridement and release
Excision of degenerative tissue from the common flexor-pronator origin, with or without medial epicondyle drilling. Reserved for refractory cases after 6-12 months of structured non-operative management. Ulnar nerve decompression may be performed simultaneously if cubital tunnel syndrome coexists.
Recovery
The majority of patients recover with non-operative treatment within 12-18 months. Corticosteroid injections are not recommended due to evidence of worse long-term outcomes. Coexisting ulnar nerve involvement should be addressed concurrently to optimise recovery.
- Physiotherapy programme: 3-6 months
- Shockwave therapy: 3-6 sessions over 6-12 weeks
- Natural history: 80-90% resolve within 12-18 months
- After surgery: 3-6 months rehabilitation
What results can I expect?
Over 80% of patients with golfers elbow resolve with appropriate conservative management. Surgical outcomes are good in carefully selected patients. Prognosis is less favourable when significant ulnar nerve involvement is present.
Golfers elbow - medial elbow tendinopathy explained
Common activity questions for this condition. Timelines are approximate, always follow the specific guidance given by your surgeon and physiotherapist.
| Activity | Typical timeline | Notes |
|---|---|---|
| Drive | When comfortable | When gripping the wheel is pain-free. May be days to weeks. |
| Return to desk work | Immediately | Ergonomic review important, keyboard, mouse, chair position. Avoid forearm resting on hard surfaces. |
| Manual work | Months 2–6 | Gradual return with load management. Sudden increase in gripping is the main trigger for flare-ups. |
| Golf | Months 3–6 | With technique review and medial elbow brace. Gradual return, 9 holes before 18. |
| Throwing sport | Months 3–6 | Volume before intensity. Assess for ulnar nerve coexistence. |
| Full recovery | Months 6–18 | 80–90% recover fully within 12–18 months with correct loading programme. |
Common concerns during recovery, and whether they are expected.
Your questions, answered
Plain-English answers to the things people most often ask, drawn from real patient questions and grounded in published guidance. Tap a question to open it.
About thisWhat is golfer’s elbow?
It is pain on the inner side of the elbow from overload of the tendons that bend the wrist and fingers. Despite the name, most cases are not caused by golf, but by repetitive gripping or lifting.
Your choiceHow is it treated?
Most cases settle with time, adjusting the activities that aggravate it, and a progressive tendon-loading exercise programme. Surgery is rarely needed and is only considered after long-lasting symptoms despite good non-surgical care.
InjectionsDo steroid injections help?
A steroid injection may ease pain in the short term, but the evidence suggests it does not improve longer-term outcomes and may be no better than exercise over time. Many clinicians favour an exercise-based approach first.
Self-careWhat can I do day to day?
Adjust the activities that flare it, check your technique and grip on tools or clubs, and follow a graded strengthening programme. Simple pain relief can help while the tendon settles.
Getting backHow long does it take?
It can be slow, often improving over months. Staying gently active within comfort, rather than resting completely, usually recovers better.
UrgentWhen should I seek review?
Numbness or tingling spreading into the little and ring fingers (which can suggest nerve involvement), significant weakness, or pain that followed a clear injury rather than gradual overuse.
WellbeingIt is frustrating how slow this is.
Tendon problems are often slow to settle, which is normal. Consistency with the exercises and realistic timelines make a real difference.
- Versus Arthritis: Elbow pain
- British Elbow & Shoulder Society: Exercises for elbow stiffness
- British Elbow & Shoulder Society: Patient information
These links are to UK clinical guidance and patient information from recognised organisations. This page is for general information and does not replace personalised advice from your own clinical team.
Preparing for surgery?
Read our step-by-step guide - what to expect before, during, and after your procedure.
How is it diagnosed?
- ✓Clinical examination - tenderness at the medial epicondyle, pain with resisted wrist flexion
- ✓Evaluation of the ulnar nerve - Tinel sign at cubital tunnel, elbow flexion test
- ✓Nerve conduction studies - essential if numbness or tingling is present
- ✓Ultrasound - confirms tendon degeneration and guides injection if planned
- ✓MRI - for atypical cases, to assess the ulnar collateral ligament in athletes, and before surgery
Recovery milestones
- ●Physiotherapy programme: 3-6 months
- ●Shockwave therapy: 3-6 sessions over 6-12 weeks
- ●Natural history: 80-90% resolve within 12-18 months
- ●After surgery: 3-6 months rehabilitation