Golfer's Elbow (Medial Epicondylitis)

The suffix "-itis" is a historical mistake. Tissue samples show degenerative change and disorganised collagen, not inflammatory cells. This is why anti-inflammatory treatment gives short-lived relief and why rest alone leaves the tendon just as unable to tolerate load as before.

The practical consequence: the tendon has to be loaded to recover, gradually and in a controlled way, and that takes months rather than weeks.

Progressive resistance work for the wrist flexors and pronators, combined with correcting the load that caused it — grip size, technique, workstation, or the training error in a throwing athlete. Shockwave therapy has little supporting evidence at the inner elbow: in an early study of 30 patients with long-standing golfer's elbow, only 7 had a good or excellent result at one year, clearly worse than identically treated tennis elbow 1.

Corticosteroid injection reduces pain only in the short term: in a randomised trial at the inner elbow, the benefit seen at six weeks had gone by three months 2. In tennis elbow, a larger randomised trial found that an injection led to worse results at one year than a placebo injection 3. We will say that to a patient asking for an injection rather than simply providing one.

Ulnar nerve irritation at the elbow produces pain in a similar area but with tingling in the ring and little fingers. Medial collateral ligament injury in throwing athletes is a different problem with different consequences. Both are checked before treating the tendon.

The ulnar nerve runs immediately behind the inner elbow, and irritation there produces tingling in the ring and little fingers alongside the tendon pain.

When both are present the treatment has to address each, and loading a tendon while an irritated nerve is being compressed by the same activity does not work. This is checked at assessment rather than assumed.

Thinner than for tennis elbow, because far fewer trials have been done at the inner elbow. A systematic review of exercise and manual therapy for elbow tendon pain found 12 randomised trials, and every one of them was in tennis elbow 4. A 2026 review of eccentric exercise for golfer's elbow found only five studies, with 143 patients in total: pain and function improved, but the certainty of the evidence was low 5. In practice, treatment borrows its principles from tennis elbow and other tendon problems, and progress is judged on the individual patient's pain and grip rather than on a published timetable.

For most people it does not come to that: non-operative treatment has high success rates, and surgery is reserved for symptoms that persist despite a thorough course of it 6. A systematic review of 16 studies covering 479 elbows reported surgical success rates between 63% and 100% and a complication rate of 4.3% 6.

The review rated its evidence as low level, and it could not establish whether open, arthroscopic or percutaneous surgery is better 6. Because the ulnar nerve runs just behind the inner elbow, nerve symptoms are assessed before any procedure is considered.