Golfer's Elbow (Epicondylitis humeri ulnaris): Symptoms and Treatment for Golfer's Elbow

Golfer's elbow is an overuse injury of the elbow, medically known as epicondylitis humeri, epicondylitis humeri ulnaris, or epicondylitis humeri medialis. Internationally, the term "medial epicondylitis" is also commonly used.

The condition affects the tendon attachment of the flexor muscles at the medial epicondyle of the humerus in the elbow region. These muscles control the movements of the forearm and wrist. Repetitive strain leads to minor injuries in the transition area between the bone and the tendon. Regeneration is delayed by reduced blood flow, which prolongs the healing process.

The humerus, together with the ulna and radius, forms the bony framework of the joint. In addition to local irritation, the quality of the tendon structure and the resilience of the tendon insertions also play a role.

Golfer’s elbow must be distinguished from tennis elbow (med. Epicondylitis humeri radialis), which affects the extensor muscles on the outer side of the arm. 

The development of golfer’s elbow is usually due to repeated and excessive strain on the flexor muscles. People who consistently use one side of their arm and frequently perform gripping, twisting, and bending movements are particularly at risk.

Typical triggers include:

• Sports involving hitting and throwing, such as tennis, golf, and baseball
• Strength training
• manual labor (tile setters, 
• working with a computer mouse or tools

Chronic overuse leads to structural changes at the tendon insertion on the inner side of the elbow. These primarily affect the forearm muscles and individual muscles. The result is local inflammation that develops into epicondylitis.

Other risk factors include:

• weak or shortened muscles
• lack of stretching
• insufficient rest or relief
• incorrect movement technique
• previous injuries

The ulnar nerve may also play a role, as irritation of this nerve exacerbates the symptoms. 

The goal is to relieve mechanical irritation early on and reduce it permanently. This connection is frequently discussed in the context of causes and treatment; those who would like to learn more about the causes can find sports medicine guidelines on the subject.

Golfer's elbow @ bilderzwerg /AdobeStock 

The doctor performs a thorough physical examination and specific tests. During the examination, the doctor checks whether pain occurs during certain movements or if there is tenderness on the inner side of the elbow.

They will also check:

• whether there is swelling
• whether you can move your forearm, hand, and fingers freely
• whether you can apply the same amount of force with both hands

Although the main focus is on examining the affected arm, the spine can also be a trigger for such symptoms. Therefore, the physical examination extends to other areas of the body as well.

Information about sports and occupational activities, the circumstances of the injury (medical history), and the physical examination make it possible to diagnose golfer’s elbow.

If there is any doubt regarding the cause of your symptoms, imaging tests can provide further insight.

An X-ray is appropriate to rule out tendon calcifications as the cause.

An ultrasound examination can detect fluid in the area where the tendon originates.

Magnetic resonance imaging (MRI), in particular, plays an important role in diagnosing golfer’s elbow.

An MRI, possibly with contrast dye, can reveal the following changes:

• Tendon thickening
• Tendon changes and
• Other changes in the soft tissues (such as the muscles)

Golfer’s elbow can occur not only while playing golf @ EpicStockMedia /AdobeStock

• Nerve compression syndrome (pain caused by pressure on a nerve)
• Cervical spine syndrome (cervical syndrome)
• Plica syndrome (pain caused by a trapped or inflamed synovial fold in the joint)
• Arthritis (inflammation) in the elbow joint
• Osteoarthritis (wear and tear) in the elbow joint

Specialists in the diagnosis and treatment of golfer’s elbow are:

• Orthopedic surgeons
• Traumatologists
• Orthopedic surgeons
• Specialists in physical medicine and, if necessary,
• General practitioners

Specialists in the diagnosis and treatment of golfer’s elbow are:

• Orthopedic surgeons
• Traumatologists
• Orthopedic surgeons
• Specialists in physical medicine and, if necessary,
• General practitioners

They can distinguish golfer’s elbow from other possible causes and provide an overview of the treatment options.

As a first step, you should stop doing the activities that triggered your symptoms.

You’ll need to avoid sports and other strenuous activities for about six to twelve weeks.

The primary goal of treatment is to reduce pain and prevent recurrence.

For pain during the acute phase, it helps to rest the arm for a few days or wear a splint.

Nonsteroidal anti-inflammatory drugs (NSAIDs), a group of pain-relieving medications, can be taken for up to about six weeks.

Applying cold to the painful area can also provide relief during the acute phase. In cases of chronic pain, however, heat therapy is more effective.

Once the pain subsides, patients should stretch and strengthen the muscles of the elbow and forearm. This can help prevent the symptoms from recurring.

Various techniques are available for this purpose and for treating chronic symptoms, such as:

• Physical therapy
• Manual therapies
• Physical therapies such as therapeutic ultrasound/sonophoresis, shock wave therapy, laser therapy, or radiotherapy (radiation therapy)
• Acupuncture
• Kinesio tape (physio tape, muscle tape): highly elastic adhesive tape for taping the forearm

In cases of chronic conditions, a cortisone injection into the area around the inflamed tendon insertions can provide short-term relief.

Over a longer period, however, cortisone tends to have the opposite effect. Injections of platelet-rich plasma or autologous blood may also be beneficial.

In most cases, golfer’s elbow can be treated using these conservative methods. If no improvement has occurred after six months of conservative therapy, surgical treatment may be an option.

During surgery, doctors remove diseased tissue in the area where the tendon originates. Or they release adhesions in the affected muscles.

The patient then keeps the arm immobilized for one to two weeks. After that, they begin mobilization exercises. Sports are usually possible again after three to six months.

In most cases, conservative treatment of golfer’s elbow is sufficient @ Racle Fotodesign /AdobeStock

Treatment for golfer’s elbow depends on the duration and intensity of the symptoms. In most cases, conservative treatment is sufficient.

The goal of any treatment is to relieve pain, reduce inflammation, stabilize the area, and prevent relapses.

Treatment should begin early. Strenuous activities are reduced, the arm is temporarily immobilized, and anti-inflammatory medications are administered.

Physical therapy includes, among other things, cold and heat applications, ultrasound, electrotherapy, shock wave therapy, or extracorporeal shock wave therapy. The latter promotes blood flow and tendon regeneration. International publications also refer to this as treatment for medial epicondylitis. 

Wearing a bandage or epicondylitis brace relieves pressure on the tendons.

Physical therapy includes strengthening exercises, mobilization, and targeted stretching. Many professional associations also recommend structured programs featuring the most effective exercises, summarized as “Exercises and Tips.”

Treatment is part of a conservative therapy regimen that combines medication, exercise, and physical interventions. If there is no improvement after several months, surgery may be considered. During surgery, pathologically altered tissue is removed.

In about 80% of patients, golfer’s elbow heals completely or at least improves significantly with conservative therapy. Although surgical treatment is an option, the chances of success are rather uncertain. Without adequate rest, the condition can become chronic; however, with consistent treatment, the pain usually subsides within weeks to months.

After successful treatment, it is important to prevent a recurrence (a return of symptoms).

Using the manual and physical therapy methods mentioned above, along with special exercises and strength training, it is possible to:

• reduce tension at the tendon attachment sites
• correct faulty and one-sided movement patterns, and
• strengthen the muscles

Taping with Kinesio tape or wearing a brace stabilizes the elbow joint. A so-called epicondylitis brace helps reduce stress on the tendon attachment sites.

Golfer’s elbow or tennis elbow? What’s the difference?

Tennis elbow and golfer’s elbow are two forms of epicondylitis. In golfer’s elbow, the flexor tendons on the inner side are affected; in tennis elbow, the extensor tendons on the outer side are affected.

What are the typical symptoms of golfer’s elbow?

The most common symptoms include pain on the inner side of the elbow, tenderness when pressed, loss of strength in the forearm, and pain when moving the wrist.

How long does recovery take?

With early treatment, it often takes a few weeks to months, depending on the level of strain and adjustments to your training routine.

What is the most effective treatment?

A combination of rest, physical therapy, shock wave therapy if necessary, medication, and ergonomic adjustments.

What roles do flexion and extension play?

Both flexion and extension of the forearm place stress on the tendons. However, when performed correctly, therapeutic movements can help relieve the pain.