Overview

If you’re dealing with persistent elbow pain and wondering whether it’s tennis elbow or golfer’s elbow, you’re not alone. Understanding the differences can help you manage your symptoms effectively and prevent further complications. While both conditions involve strain and degeneration of the tendons in the elbow, they differ in several key ways:

• Tennis elbow affects the outer part of the elbow, while golfer’s elbow causes pain on the inner side of the elbow
• Tennis elbow is caused by repetitive wrist extension and gripping, common in tennis, carpentry, and typing.⁷ Golfer’s elbow results from repetitive wrist flexion and forearm pronation, seen more in golf, weightlifting, and throwing sports²
• Tennis elbow affects the extensor tendons, particularly the extensor carpi radialis brevis (ECRB),⁸ while golfer’s elbow affects the flexor tendons, including the flexor carpi radialis and pronator teres¹
• While they have similar risk factors, tennis elbow is more frequently found in individuals aged 40 to 60,⁸, whereas golfer’s elbow is more common between 45 and 64³ 
• Tennis elbow is five times more common than golfer’s elbow⁴
• Both conditions can be treated with rest, bracing, and physical therapy; however, this involves different strengthening and stretching exercises based on the affected tendons
• If the condition persists, distinct surgical procedures are used to treat the two injuries

Definition and causes

Tennis elbow (Lateral epicondylitis)

Tennis elbow is an overuse injury, affecting the common extensor tendon at the lateral epicondyle of the humerus,⁴ the outer part of the elbow. It typically results from repetitive wrist and forearm motions, commonly seen in sports like tennis, as well as occupations such as painting, carpentry, and prolonged computer use. 

Medically, tennis elbow is classified as a tendinosis, meaning it involves tendon degeneration. The repeated stress leads to microscopic tears in the extensor carpi radialis brevis (ECRB), resulting in pain and inflammation. Over time, structural changes occur in the tendon, including the presence of excessive fibroblasts, disorganized collagen, and abnormal blood vessel growth.⁴

This condition is most common in individuals between the ages of 40 and 60. Studies have also linked it to certain risk factors such as smoking, obesity, and jobs that involve repetitive arm movements or forceful gripping. In some cases, an injury or a condition affecting connective tissues in the body may also contribute to the development of tennis elbow.⁷ 

Golfer’s elbow (Medial epicondylitis)

Golfer’s elbow affects the common flexor tendon at the medial epicondyle (inner elbow bone). This is less common than tennis elbow, accounting for only 10% to 20% of all epicondylitis cases.¹ It is caused by repetitive wrist flexion and gripping activities, often seen in golfers, baseball pitchers, weightlifters, and manual laborers. However, more than 90% of cases are non-sport related.³ 

The condition develops due to small tears and degeneration in the tendon, leading to pain and stiffness. Over time, this leads to the formation of weak, disorganized tissue. This process, similar to what happens in tennis elbow, results in tendinosis, where the tendon becomes thickened and less flexible due to the buildup of immature collagen and blood vessels. 

Risk factors include being between 45 and 64 years old, obesity, smoking, type II diabetes mellitus, and performing repetitive wrist and forearm motions for at least two hours a day.³ 

In some cases, golfer’s elbow can coexist with ulnar nerve issues, causing tingling and numbness in the ring and little fingers. This is sometimes referred to as "country club elbow."⁴

Symptoms and diagnosis

Tennis Elbow symptoms

• Pain and tenderness on the outer elbow
• Weak grip strength
• Increased pain with wrist extension or when holding objects like a coffee cup
• Forearm pain that may radiate to the wrist
• Swelling in the elbow⁷

Golfer’s Elbow symptoms

• Pain and tenderness on the inner elbow, which may extend down the forearm
• Weakness in the wrist and hand grip
• Stiffness and pain when making a fist
• Numbness or tingling extending into the ring and little fingers²

Tennis Elbow diagnosis

Diagnosis primarily relies on a thorough patient history and physical examination. Specific tests are often employed to confirm this, including:

• Cozen’s test: involves resisting wrist extension while the patient maintains their forearm in a neutral position, which typically reproduces pain over the lateral epicondyle.
• Maudsley’s test: applying resistance to the middle finger while the elbow is extended, causing stress to the extensor carpi radialis brevis (ECRB) and triggering pain⁴ 
• Mills’ test: the forearm is placed in pronation and wrist flexion with the elbow fully extended. A positive test would result in pain over the lateral epicondyle⁴ 

These tests must be interpreted carefully, as they may also be positive in the case of radial tunnel syndrome.⁴ Imaging techniques, such as X-rays or MRI, can be used to make the distinction. 

Golfer’s Elbow diagnosis

Similarly to tennis elbow, the diagnosis for golfer’s elbow relies on patient history and physical examination. A doctor can request the patient to rest their arm on a table, palm side up, and ask them to raise their hand by bending the wrist against resistance. A positive test will result in the patient feeling pain in the inner aspect of the elbow.⁵ Imaging and radiographic studies need to be performed to rule out other possibilities, such as ulnar neuritis or ulnar collateral ligament instability.⁴ Using tests like the Tinel’s sign or valgus stress tests can aid this process.¹ 

Treatment and management

Conservative treatments

Most cases of tennis and golfer’s elbow heal within 6 to 12 months after applying non-invasive treatments. These include:

• Rest and avoiding repetitive arm movements that worsen symptoms
• Applying ice for 15-20 minutes multiple times a day to reduce inflammation and alleviate pain¹
• Non-steroidal anti-inflammatory drugs (NSAIDs), for example, ibuprofen and naproxen provide relief from discomfort and inflammation⁴
• Wearing a counterforce brace or wrist support helps to alleviate tendon strain and reduce pain.
• Performing stretching and strengthening rehabilitation exercises. 
• Ultrasound therapy to enhance blood flow, stimulate healing, and provide pain relief⁴

Medical interventions

If the conditions are not healed for a prolonged period, further intervention may be needed. Note that these include side effects and must be discussed with a healthcare professional. The most common treatment procedures for tennis and golfer’s elbow include:

• Corticosteroid injections - provide short-term pain relief but are not recommended for long-term use due to potential tendon weakening⁴
• Platelet-Rich Plasma (PRP) injections - promotes tendon healing by using the patient’s platelets to stimulate tissue repair⁴
• Dry needling and needle fenestration - small needle punctures stimulate a healing response in the tendon⁷ 
• TENEX - minimally invasive ultrasound technique using a vibrating needle to liquefy and remove damaged tendon tissue⁷
• Extracorporeal Shock Wave Therapy (ESWT) - uses shock waves to promote healing, though research on its effectiveness is mixed⁷
• Prolotherapy and Botox injections - dry needling, in which a needle pierces the damaged tendon in multiple places to promote healing⁴

Surgical Options

Surgery is considered only for severe, persistent cases that do not improve after 6-12 months of treatment:

• Tennis elbow surgery - aims to remove damaged tissue and repair the tendon through open, arthroscopic, or percutaneous techniques⁴ 
• Golfer’s elbow surgery - similar to tennis elbow surgery, but may also involve addressing ulnar nerve compression, making outcomes less predictable

Prevention strategies

These injuries can be prevented by:

• Ensuring to maintain the correct form in sports and activities to minimize excessive strain on the tendons
• Training the forearm and performing grip-strengthening exercises to enhance tendon resilience.
• Stretching the wrist flexors and extensors to reduce stiffness
• Avoid sudden increases in activity intensity and progressively increase workload to allow the tendons to adapt³

FAQs

Can tennis elbow and golfer's elbow occur at the same time?

Yes, though uncommon, some individuals may develop both conditions simultaneously due to repetitive strain affecting both tendon groups.

When should I see a doctor for elbow pain?

If pain continues, despite the use of home treatments, affects day-to-day activities, or worsens over time, consult a healthcare professional for further evaluation and management. 

How do I know if I have tennis elbow or golfer’s elbow?

Tennis elbow leads to pain on the outer part of the elbow, while golfer’s elbow impacts the inner part. If unsure, a doctor can confirm the diagnosis through physical exams.

Summary

Tennis elbow and golfer's elbow are both caused by repetitive strain, although impacting a different tendon in the elbow. Tennis elbow results from wrist extension and affects the outer elbow, while golfer's elbow can occur due to wrist flexion and impacts the inner elbow. Though tennis elbow is more common, both conditions can be painful and interfere with daily life. Understanding the key differences between them is fundamental in seeking the right treatment and preventing future injuries.