Golfer's Elbow (Medial Epicondylitis): Causes, Symptoms, and Treatment

What Is Golfer's Elbow?

Golfer's elbow (medial epicondylitis) is a painful condition involving degeneration of the common flexor tendon where it attaches to the medial epicondyle — the bony prominence on the inner (medial) side of the elbow. It is the medial counterpart to tennis elbow (lateral epicondylitis).

Like tennis elbow, the primary pathology is tendinosis (tendon degeneration) rather than true inflammation, caused by repetitive microtrauma to the flexor-pronator musculature.

Anatomy

The flexor-pronator muscle group — including the flexor carpi radialis, flexor carpi ulnaris, palmaris longus, and pronator teres — originates from the medial epicondyle. These muscles flex the wrist and rotate the forearm palm-downward (pronation). Repetitive forceful use of these motions creates microtears in the common flexor tendon at its origin.

Causes

Golfing: The leading wrist/forearm during the downswing and impact
Throwing sports: The valgus stress of pitching also loads medial structures
Rock climbing: Sustained gripping in finger flexion
Manual labor: Plumbing, hammering, using wrenches
Racket sports: Heavy topspin forehands

Symptoms

Pain and tenderness over the medial epicondyle (inner elbow bump)
Pain with wrist flexion or forearm pronation against resistance
Grip weakness
Pain when shaking hands or squeezing objects
Pain provoked by swinging a golf club or throwing

Important distinction: Medial elbow pain should be evaluated carefully — the ulnar nerve runs directly behind the medial epicondyle in the cubital tunnel. Cubital tunnel syndrome (ulnar nerve compression) often coexists with or mimics golfer's elbow. Numbness or tingling in the ring and little fingers suggests nerve involvement.

Diagnosis

Resisted wrist flexion test: Pain at medial epicondyle with resisted wrist flexion
Palpation: Tenderness directly over medial epicondyle
Neurological exam: Check for ulnar nerve symptoms — ring/little finger numbness, grip weakness from intrinsic muscle wasting

Imaging rarely required; MRI or ultrasound for surgical planning or atypical cases.

Treatment

Very similar to lateral epicondylitis:

Conservative (First-Line)

Activity modification and rest
Ice after activity
NSAIDs for pain control
Physical therapy: Eccentric flexor strengthening, stretching, manual therapy
Medial elbow strap (worn on the forearm 2–3 inches below elbow)
Wrist flexion splint for nighttime or during provocation

Injections

Corticosteroid injection provides short-term relief
PRP injection shows promise for chronic cases

Surgery (Rare — <5%)

For refractory cases >12 months: debridement of degenerated tendon tissue through a small medial incision.

Recovery

Conservative: 3–6 months for most cases. Surgical: 3–4 months return to full activity.