Golfer's elbow (medial epicondylitis)

Anatomy: What hurts a golfer's arm

On the inside of the elbow lies the medial epicondyle - a bony projection of the humerus. This is where the flexors and pronators of the forearm originate. This tendon plate is called the flexor-pronator attachment.

• Typical muscles involved: Pronator teres, Flexor carpi radialis/ulnaris, Palmaris longus, Flexor digitorum superficialis
• Task: Bend your wrist, turn your forearm inwards (pronation), stabilize your strong grip
• Problem mechanism: Repeated tensile stress leads to microdamage (tendinopathy) at the tendon insertion

In medial epicondylitis, degenerative changes (“tendinosis”) predominate over acute inflammation. This explains why active rehabilitation is more important than pure rest.

Symptoms: This is how golfer's elbow manifests itself

• Pressure pain on the inside of the elbow, often exactly on the bony prominence
• Increased pain when flexing the wrist against resistance and during forearm pronation
• Pain when grasping forcefully, carrying, wringing out or typing with a bent wrist
• Radiating into the forearm, occasionally into the wrist
• Morning stiffness, pain during everyday life and during sports
• Sometimes accompanying: tingling in the ring and little fingers due to irritation of the ulnar nerve (not always)

The symptoms often develop gradually after increased stress, unusual activities or changes in technique in sports (e.g. golf, climbing, throwing and hitting sports).

Causes and risk factors

Medial epicondylitis is an overload reaction at the tendon insertion. Microtraumas exceed the tissue's ability to regenerate, resulting in structural changes and pain.

• Repetitive wrist flexion/pronation (e.g., crafts, gardening, screwdriving, typing with awkward position)
• Sudden increase in stress or too little recovery time
• Technical and material factors in sports (grip strength, racket weight, racket head speed)
• Limited strength and stability in the shoulder/scapula and forearm, limited mobility
• General factors: Nicotine, diabetes, thyroid disease can affect tendon healing

Direct trauma is rarely the cause. There are often unfavorable ergonomic conditions in the workplace.

Delimitation: Which diagnoses are still possible?

Not all pain on the inside of the elbow is golfer's elbow. A careful assessment prevents misdiagnosis and unnecessary therapy.

• Ulnar groove syndrome (nerve irritation at the elbow) with tingling/numbness in the ring and little fingers
• Ligament irritation or partial tears of the ulnar collateral ligament (especially throwing sports)
• Osteoarthritis/chondropathy of the elbow, free joint bodies
• Pronator teres syndrome (median nerve), rare
• Apophysitis/epicondylopathy in adolescents
• Rare: bone edema, stress fractures, inflammatory systemic diseases

Also to be distinguished: tennis elbow (lateral epicondylitis) with pain on the outside of the elbow.

Diagnostics: How we make the diagnosis

The diagnosis is in most cases a clinical diagnosis. Imaging is added if the course is atypical, the symptoms have persisted for a long time or other causes need to be ruled out.

Conservative therapy: gradual and effective

In the vast majority of cases, golfer's elbow heals with conservative measures. Load control and targeted, progressive construction are crucial.

• Stress adjustment: temporary reduction of pain-causing activities, not complete immobilization
• Pain management: short-term anti-inflammatory medications or topical gels (after informed consent, not a permanent solution)
• Orthoses/Tapes: Epicondylitis braces or tape to provide relief from everyday and sports stress
• Physiotherapy: technique training, manual therapy, stretches, progressive strengthening (eccentric-concentric) of the flexor-pronator approach
• Nerve mobilization in the event of ulnar nerve irritation, mobilization of the cervical/thoracic spine and shoulder girdle
• Ergonomics: neutral wrist angle when typing/mousing, appropriate grip strengths and tools
• Shock wave therapy (ESWT): can be considered for chronic courses; the benefit is individual and variable

Cortisone injections can provide short-term pain relief, but are associated with higher relapse rates and possible tendon weakening. We use them – if at all – cautiously and specifically.

Self-exercises: A safe introduction to the structure

Regular, appropriately dosed exercises promote tendon healing. A slight aching pain from training is acceptable, but persistent, severe pain is not.

Increase the load in small steps every week. Pause exercises that cause significant aggravation over 24-48 hours and seek physical therapy.

Regenerative processes: when does it make sense?

If symptoms persist despite consistent basic therapy, regenerative procedures can be considered. It is important to carefully establish the indication and provide information about the current state of evidence.

• PRP (platelet-rich plasma): autologous blood preparation with growth factors; In chronic epicondylitis, the course is sometimes favorable, results are individual
• Peppering/microinsertion: targeted needle stretching of the tendon insertion, sometimes in combination with PRP
• Ultrasound-targeted infiltrations: precise application, protection of surrounding structures

These options do not replace active training, but complement it. Possible risks (e.g. temporary increase in pain, bruising) are discussed in advance. Costs vary.

Surgery: Rarely necessary, clearly defined

Intervention can be considered if conservative treatment has been consistently unsuccessful for 6-12 months or if there are partial tears/structural damage that are relevant to imaging.

• Goal: Removal of degenerative tendon parts (debridement) and refixation/refreshing of the tendon attachment
• Technique: open or minimally invasive; Decision based on findings and experience
• Take comorbidities into account, e.g. B. Ulnar nerve irritation (own assessment and strategy)

Follow-up treatment: short rest, early functional mobilization, gradual strength building. Return to office work usually after a few days to weeks, manual work and sports after 6-12 weeks depending on the strain, throwing sports later. Individual courses vary and are closely monitored.

Course and prognosis

Many patients experience significant improvement within a few weeks to months with structured conservative therapy. Patience and continuity are key – tendon tissue regenerates more slowly than muscles.

• React early: adjust the load and train in a targeted manner
• Avoid relapses: increase gradually, plan recovery times
• Address comorbidities: e.g. B. Avoid nicotine, optimize metabolism

The individual chances of success depend on the duration and extent of the symptoms, stress profile, cooperation in therapy and accompanying factors. A promise of healing cannot be given.

Prevention and everyday tips

• Ergonomics: Position the keyboard/mouse so that the wrist remains neutral; Use soft contact surfaces
• Adjust tool/racquet: appropriate grip thickness, anti-vibration grips, technique training
• Dose the load: divide longer activities into intervals with micro-breaks (30-60 minutes).
• Warm up before sport/work, stretching and strength exercises 2-3 times per week
• Train shoulder and core stability – relieves strain on the elbow

At the first warning signals, it is better to adjust the load early instead of continuing to “pull through”. This speeds up recovery.

When to see a doctor? Warning signs

• Sudden shooting pain with “snapping” and acute loss of strength (suspected tear)
• Persistent numbness/tingling in the ring and little fingers, nighttime discomfort
• Severe swelling, redness, fever (suspected infection)
• Pain that increases or lasts weeks despite relief and basic measures

If you experience such signs, you should see a doctor as soon as possible to avoid complications.

Your orthopedics in Hamburg: personal, structured, modern

In our practice at Dorotheenstrasse 48, 22301 Hamburg, we advise and treat you individually. First of all, the focus is on a thorough investigation with functional analysis and the common definition of goals. We plan the therapy step by step - from everyday stress management to evidence-based physiotherapy and additional procedures if necessary.

Depending on the findings, we work closely with physiotherapy, sports science and – if appropriate – with diagnostic imaging (ultrasound, MRI). Surgical options are only discussed if there is a clear indication.

What you can bring with you to the appointment

• Preliminary findings and imaging (X-ray, MRI, ultrasound), if available
• A list of typical triggers in everyday life/sports and previous treatment attempts
• Comfortable clothing to freely examine the elbow and forearm

This means we can provide targeted advice and treatment from the first appointment.

Related topics

Elbow pain has different causes. You might also be interested in these posts.

• Tennis elbow (lateral epicondylitis)
• Tendinitis of the forearm muscles
• Dumbbell arm – Inflammation of the distal biceps tendon
• Distal biceps tendon rupture
• Distal triceps tendon tear