Golfer's Elbow: Which Treatments Work Best?

Golfer's elbow, also called medial elbow tendinopathy or medial epicondylalgia, causes pain where the wrist-flexor and forearm muscles attach to the inside of the elbow. It's not limited to golfers, repetitive gripping, throwing, lifting, climbing, weight training and manual work can all overload the flexor-pronator tendon. When it persists, it's better understood as a load-related tendon problem than as ongoing inflammation, which is why the mainstay of treatment is modifying the load and gradually rebuilding the tendon's strength rather than reaching for an injection.

What is golfer's elbow?

Golfer's elbow affects the flexor-pronator tendon, where the muscles that flex the wrist and turn the palm down attach to the bony bump on the inside of the elbow (the medial epicondyle). Repeated or heavy loading, gripping, lifting, throwing, climbing or wrist-curling, can overload that attachment and cause pain. Persistent cases are a tendinopathy: a change in the tendon's structure and capacity, rather than simple inflammation, so the treatment that works best is the one that steadily rebuilds the tendon's tolerance to load.

Symptoms and diagnosis

Symptoms may include:

• pain or tenderness on the inside of the elbow;
• pain when gripping or bending the wrist;
• discomfort turning the palm down against resistance;
• pain during throwing, climbing or weight training;
• reduced grip strength.

The diagnosis is usually made from the history and examination. Imaging isn't routinely needed, but ultrasound can help when symptoms are persistent, the diagnosis is uncertain, or an image-guided procedure is being considered.

Why careful assessment matters

Several important structures sit close to the painful area, and pain that feels like golfer's elbow can sometimes come from something else, including:

• the ulnar nerve, particularly if there's tingling in the ring or little finger;
• the ulnar collateral ligament, especially in throwing athletes;
• the elbow joint itself;
• the neck or another part of the upper limb;
• a partial tendon tear;
• valgus overload from throwing technique.

Ulnar-nerve symptoms, a feeling of elbow instability, or a sudden loss of strength all warrant a more detailed assessment before any treatment, and certainly before any injection, because the flexor-pronator tendon, the ulnar nerve and the ligament are all close together.

Best initial treatment

1. Modify aggravating activities

Complete rest is rarely needed. The aim is to temporarily reduce the loads that repeatedly provoke symptoms, then build back up as strength and tolerance improve. Depending on the cause, that might mean reducing heavy or repetitive gripping, adjusting lifting or tool technique, temporarily lowering throwing volume, changing golf-club grip, swing or practice volume, easing off painful wrist-curl or pulling exercises, and taking breaks during repetitive manual work. Throwing athletes should also look at shoulder movement, trunk control, workload and technique, rather than treating the elbow in isolation.

2. Progressive strengthening

Rehabilitation usually centres on gradually increasing the capacity of the flexor-pronator tendon and the rest of the upper limb. A programme might include isometric wrist flexion, slow resisted wrist flexion, forearm pronation work, grip strengthening, elbow and shoulder strengthening, and later, activity-specific or throwing exercises. Resistance is increased gradually, mild discomfort can be acceptable, but the programme shouldn't trigger a substantial flare that lasts into the next day.

Evidence specifically for golfer's elbow is limited, and much of the approach is adapted from wider tendinopathy research and studies of tennis elbow. Exercise remains a sensible first-line treatment because it directly targets strength and load tolerance, but recovery can take time, and no single programme works for everyone.

Evidence: exercise is the sensible first line, though golfer's-elbow-specific trials are limited

3. Bracing

A counterforce strap or wrist splint can reduce symptoms during selected activities. It's useful temporarily, but it doesn't correct the underlying loss of tendon capacity, so it shouldn't replace strengthening. A strap should never sit over the ulnar nerve, stop using it if it causes tingling or numbness.

4. Pain medication

A topical anti-inflammatory gel may be appropriate. Oral anti-inflammatories can give short-term relief but aren't right for everyone, particularly with kidney disease, stomach-ulcer risk, cardiovascular disease or certain medication interactions. Pain relief is best used to help you stay active and engage with rehabilitation, not as a treatment on its own.

Are corticosteroid injections helpful?

A corticosteroid injection may reduce pain for a short period, but the evidence specifically for golfer's elbow is limited, and research into elbow tendinopathy more broadly suggests that early pain relief does not necessarily translate into a better long-term result. Steroid also carries local risks, including temporary post-injection pain, skin thinning or loss of pigment, fat atrophy, infection, and, if placement is poor, tendon weakening or injury to a nearby nerve.

Because the flexor-pronator tendon, ulnar nerve and ulnar collateral ligament are so close together, any injection should follow a careful clinical assessment, steroid should not be injected into the tendon itself, and repeated injections are generally avoided.

Evidence: possible short-term relief only, no clear long-term benefit; used selectively

What about PRP and blood injections?

Platelet-rich plasma (PRP) is sometimes offered for persistent golfer's elbow, but the evidence is much less developed than for tennis elbow. A systematic review of PRP for medial epicondylitis found only a small number of relevant studies with important differences in methods and comparison treatments, not enough to establish PRP as a consistently effective or clearly superior option. It might be discussed for selected persistent cases, but you should understand that improvement isn't guaranteed, symptoms can flare afterwards, different PRP preparations aren't equivalent, rehabilitation is still required, and it may not be covered by public healthcare or insurance.

Autologous whole-blood injection is also offered by some clinicians, but the evidence for golfer's elbow is sparse, there's no established protocol and no convincing evidence it should replace a well-designed rehabilitation programme. I should also be clear that I don't currently offer PRP or autologous blood injection at Insight MSK; I've included them here so you have the full picture.

Evidence: limited and inconsistent, not established treatments

What is the role of ultrasound?

Ultrasound can help identify flexor-pronator tendon changes, a partial tendon tear, ulnar-nerve enlargement or abnormal movement, possible injury near the ulnar collateral ligament, or another cause of medial elbow pain. During a procedure, it shows the tendon and the nearby nerve in real time, which can improve confidence in needle placement and help avoid injecting into the tendon or close to the ulnar nerve. It's worth being honest, though: accurate placement doesn't prove the injected treatment itself works. Ultrasound is a way to improve the assessment and the control of the procedure, not a guarantee of a better clinical outcome.

Needle fenestration and tenotomy

Needle fenestration or percutaneous tenotomy, which aim to stimulate a healing response or remove abnormal tendon tissue, may be considered when symptoms remain significant despite rehabilitation. The evidence specifically for golfer's elbow is limited, and it's uncertain whether these procedures beat continued rehabilitation, PRP or a placebo, so they're best reserved for carefully selected patients after other diagnoses have been excluded.

Evidence: limited, for selected refractory cases

When is surgery considered?

Surgery is uncommon. It may be considered when pain and loss of function stay substantial after comprehensive non-operative treatment. The operation may involve removing abnormal tendon tissue and repairing the flexor-pronator attachment, and if ulnar-nerve compression or ligament injury is also present, that may need addressing too. Recovery takes several months and rehabilitation is essential, potential complications include stiffness, nerve symptoms, infection, persistent pain and incomplete recovery of strength.

Evidence: effective for the small number who fail thorough conservative care

Recommended treatment pathway

A practical sequence looks like this:

1. Confirm the pain is coming from the flexor-pronator tendon.
2. Assess for ulnar-nerve symptoms, ligament injury and referred pain.
3. Reduce or modify aggravating loads without completely resting the arm.
4. Begin progressive wrist-flexion, pronation, grip and upper-limb strengthening.
5. Consider a temporary brace or topical pain treatment if appropriate.
6. Review technique and workload, particularly for golfers and throwing athletes.
7. Reassess the diagnosis if symptoms persist.
8. Discuss the limited evidence before any injection, fenestration or tenotomy.
9. Reserve surgery for substantial symptoms that haven't responded to comprehensive non-operative care.

When should you seek further assessment?

Key message

Frequently asked questions

References