Understanding Medial Epicondylitis
Golfer's elbow (medial epicondylitis) is a breakdown of the tendons on the inner side of the elbow, where the forearm muscles that flex the wrist attach to the bone. Despite the name, it's common in anyone who repeats gripping or wrist-flexing motions, not just golfers.
Causes
Golfer's elbow develops from repetitive strain on the inner elbow tendons:
Repetitive wrist-flexing or forearm-rotating motions, like a golf swing or throwing motion.
Manual labor or weightlifting involving repeated gripping.
Poor technique or equipment (grip size, swing mechanics).
Age-related tendon degeneration.
Symptoms
Common symptoms include:
Pain and tenderness over the bony bump on the inner elbow.
Pain that worsens with wrist flexion, gripping, or shaking hands.
Weak grip strength.
Occasional tingling or numbness in the ring and pinky fingers if the nearby ulnar nerve is irritated.
Seek prompt medical care if: Elbow pain follows a fall or injury with deformity or inability to move the elbow, or the joint becomes hot, red, and swollen, especially with fever.
Imaging Studies to Consider
Imaging helps confirm the diagnosis and rule out other causes:
Ultrasound is usually the first test; evaluates the tendon and can guide precise injections.
X-ray of the elbow rules out other bony causes of pain or calcification.
MRI of the elbow is used if the diagnosis is unclear or symptoms are severe and refractory.
Physical Therapy, Home Exercise & Other Conservative Techniques
A structured loading exercise program is well studied and usually the first treatment tried for golfer's elbow:
Physical Therapy
Eccentric wrist flexor strengthening is one of the best-studied treatments for this condition.
Manual therapy to the forearm and elbow.
Activity and technique modification education.
Home Exercise Program
Eccentric and concentric wrist curls with light resistance.
Forearm flexor stretching.
Other Studied Techniques
Counterforce brace, worn just below the elbow during aggravating activity.
Activity or technique modification (grip size, swing mechanics, tool handles).
Ice after activity.
Interventional Treatment Options
When bracing, activity modification, and a structured loading exercise program aren't enough, several non-opioid procedures can help:
Ultrasound-guided PRP injection: Has fewer dedicated studies than tennis elbow, but the evidence that exists suggests PRP may match surgery for long-term relief; it is a reasonable option once bracing, stretching, and physical therapy haven't fully resolved symptoms. Typically given as a single injection, repeated once if the response is incomplete.
Peritendinous corticosteroid injection: Used selectively, and placed around (not directly into) the tendon, due to a risk of tendon weakening with repeated steroid use.
Dry needling or percutaneous tenotomy: Stimulates a localized healing response in the degenerated tendon tissue.
Ulnar nerve hydrodissection: If the nearby ulnar nerve is contributing to symptoms, fluid is used to gently separate it from surrounding irritated tissue.
Acupuncture: A technique that may reduce elbow tendon pain alongside a loading exercise program.
Neuromodulation: Spinal Cord & Peripheral Nerve Stimulation
Neuromodulation is not typically needed for golfer's elbow, but may be considered for chronic, refractory elbow or forearm pain:
Peripheral nerve stimulation (PNS): May be an option for persistent forearm or elbow pain, particularly when nerve irritation is a significant contributor.
How Strong Is the Evidence?
A summary of the evidence supporting key treatments for medial epicondylitis:
How to read this: Strong means consistent results from multiple high-quality studies. Moderate means generally favorable results with some limitations. Mixed or early means results so far are inconsistent or still emerging. Limited means few or lower-quality studies; these options can still be considered in select cases following a discussion with your healthcare provider.
Platelet-rich plasma (PRP): Mixed or early evidence.
Corticosteroid injection: Moderate evidence, short-term benefit.
Acupuncture: Mixed or early evidence.
Evidence reviewed November 2026. These ratings summarize published research and major medical society guidelines available at that time. Research continues to evolve, and we will go over the most current evidence for your situation at your visit.
Pain Psychology Techniques
Pain psychology techniques support tendon recovery:
Graded activity pacing: a gradual, structured loading program is key to tendon healing.
Cognitive behavioral therapy (CBT) for pain helps manage frustration with a slow recovery.
Relaxation training and diaphragmatic breathing.
Non-Opioid Medication Options
Medications play a supporting role alongside a structured exercise program:
For pain relief
Short-term NSAIDs or topical NSAID gel can help during flare-ups, though prolonged oral use is generally avoided as it may impair tendon healing.
Acetaminophen is a good ongoing option that doesn't affect tendon healing.
Related Procedures
Related Conditions
Talk With Us About Your Options
Call 650-507-4113 or send us a message to schedule a consultation at our Daly City, Los Altos, or Stockton office. We will review what may be causing your pain and walk through the risks, benefits, and alternatives of each option with you.
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This information is provided for general patient education and does not replace individualized medical advice. Please discuss your specific symptoms, diagnosis, and treatment options with your pain management physician.
