What Causes Golfer’s Elbow?

The elbow joint allows for a wide range of motion, facilitating everything from a powerful golf swing to the simple act of turning a doorknob. However, this complex structure is also susceptible to injury, particularly from repetitive stress. One of the most common conditions affecting the inner elbow is medial epicondylitis, more widely known as golfer’s elbow. This condition causes pain and tenderness on the inside of the elbow.

Patients frequently ask, “What causes golfer’s elbow?” In this post, we’ll explore the mechanisms, risk factors, and activities that can contribute to the development of this painful condition.

• Golfer’s elbow involves damage and degeneration of the forearm tendons due to chronic, repetitive strain.
• The condition specifically targets the common flexor tendon, which attaches the muscles responsible for wrist flexion and forearm pronation (palm down motion) to the medial epicondyle (the bony bump on the inside of the elbow).
• While named for the sport, many activities, including throwing, racquet sports, and certain occupational tasks, can cause this condition. Any activity requiring forceful, repetitive gripping or wrist movements may contribute.

The elbow joint connects the upper arm bone (humerus) to the two forearm bones (radius and ulna). On the inner side of the elbow, you can feel a prominent bony bump. This is the medial epicondyle. This small, bony prominence serves as the anchor point for a group of muscles. These muscles are the forearm flexors and pronators. They allow you to bend your wrist forward (flexion) and turn your palm downward (pronation). The tendons of these muscles merge together to form the common flexor tendon, which attaches directly to the medial epicondyle.

When you grip an object, twist a screwdriver, or swing a club, the muscles contract. This contraction pulls on the common flexor tendon at its attachment point on the medial epicondyle.

Golfer’s elbow develops when the flexor tendon on the inside of the elbow is stressed more than it can handle. Instead of a sudden injury, it’s usually an overuse problem and a gradual breakdown of the tendon over time.

Repetitive or forceful motions (like swinging a golf club, throwing, or gripping tightly) can create tiny microtears in the tendon. Normally, with adequate rest, the body repairs these small injuries. However, if the activity continues without enough rest, the tendon may not fully recover. Over time, the tendon tissue becomes disorganized and weaker instead of healing into strong, healthy fibers. This is the hallmark of tendinopathy.

Another contributor is eccentric loading, when a muscle lengthens while it’s still working. Movements like slowing down a golf swing or a pitcher decelerating their arm put a heavy “braking” load on the flexor muscles. This puts extra strain on the tendon, which can worsen the breakdown if the tissue isn’t getting adequate time to recover.

Despite its name, the majority of people who develop golfer’s elbow are not golfers. In the following subsections, we’ll explore common athletic and occupational causes.

The repetitive, high-stress nature of certain sports makes them potential contributors to medial epicondylitis.

• Throwing Sports: Baseball and softball pitchers, javelin throwers, and even football quarterbacks can develop this condition. The immense forces generated during the acceleration and deceleration phases of a throw can stress the medial elbow structures.
• Racquet Sports: Tennis, squash, and badminton players are at risk, especially if they use an improper technique for the serve or forehand, or if their equipment is too heavy or the grip size is incorrect.
• Weight Training: Lifting weights with poor form, particularly during exercises like bicep curls or heavy gripping exercises, may overload the flexor tendons.
• Climbing: Rock climbing and bouldering require prolonged, forceful gripping, which can place continuous, high-intensity strain on the forearm flexors.

Many non-athletic activities can also lead to the chronic microtrauma that defines golfer’s elbow. These activities often involve repetitive or forceful use of the wrist and fingers.

• Manual Labor: Occupations involving repetitive gripping, lifting, or twisting motions are high-risk. This includes carpenters, plumbers, and construction workers who frequently use tools like hammers, wrenches, and screwdrivers.
• Certain Repetitive Tasks: Workers performing some repetitive tasks, such as those in manufacturing or food processing, often use the same wrist and finger movements for hours on end.
• Computer Use: While less common, prolonged, improper use of a computer mouse or keyboard, especially with poor ergonomic setup, may contribute to chronic strain on the forearm muscles.
• Repetitive Hobbies: Hobbies like knitting, crocheting, or playing certain musical instruments (e.g., violin, cello) may also involve the sustained or repetitive wrist and finger movements that stress the medial elbow.

The common thread among all these activities is the repeated, forceful engagement of the forearm flexor-pronator muscle group. When these muscles are overworked, they can transmit excessive tension to the common flexor tendon, leading to the degenerative changes that manifest as pain.

Several underlying factors may increase an individual’s susceptibility to developing the condition.

• Age: Medial epicondylitis most commonly affects people between the ages of 40 and 60. As we age, the blood supply to our tendons naturally decreases, making them less elastic and less efficient at self-repair.
• Smoking: Nicotine may constrict blood vessels, reducing blood flow and oxygen delivery to tissues, including tendons. This may compromise the tendon’s ability to heal and repair the microtears caused by repetitive stress.
• Diabetes: Individuals with diabetes may have a higher risk of developing tendinopathies. High blood sugar levels can affect the structure of collagen, making the tendons stiffer and more brittle, which increases their vulnerability to injury.

• Poor Technique: In golf, a faulty swing that involves excessive wrist snap or a “casting” motion can increase the load on the medial elbow. In throwing sports, improper mechanics can place stress on the flexor-pronator mass.
• Inadequate Conditioning: Weakness in the forearm muscles, shoulder, and core can force the elbow to compensate. If the forearm muscles lack the strength and endurance to handle the forces of an activity, they fatigue quickly.
• Lack of Flexibility: Tightness in the forearm muscles can increase the resting tension on the common flexor tendon. When the muscle is already taut, any additional force during activity can more easily exceed the tendon’s capacity for stress.
• Improper Equipment: Using a golf club that is too heavy or too stiff, or a racquet with a grip that is too small or too large, may alter the biomechanics of the swing or grip.

The symptoms of golfer’s elbow typically develop gradually, often starting as a mild ache that worsens over weeks or months. Patients rarely recall a single, specific injury that initiated the pain. The hallmark symptom is pain and tenderness located on the inner side of the elbow, directly over the medial epicondyle. Patients often report that the pain is most noticeable during activities that involve forceful gripping or twisting.

Some individuals also experience stiffness in the elbow joint. They might notice a feeling of weakness in the hand and wrist, making it difficult to carry objects or perform simple tasks.

A professional evaluation is important because several conditions may mimic golfer’s elbow. The diagnostic process usually begins with a patient history, where your doctor will ask detailed questions about your symptoms, including when the pain started, what activities make it worse, and what your occupation and hobbies involve.

During a physical examination, your doctor may feel the medial epicondyle, test your wrist flexors against resistance, and assess elbow motion, strength, and stability. They may also check for ulnar nerve irritation, which can sometimes coexist with tendon issues. If needed, imaging tests like X-ray, ultrasound, or MRI may be used to exclude other conditions and support the diagnosis. 

Many cases improve with non-surgical care. Conservative treatment focuses on reducing tendon stress and promoting proper healing.

Rest and protection are frequently the first steps in managing golfer’s elbow. This often begins with activity modification, meaning you temporarily reduce or stop the motions that are putting excessive stress on the tendon. Ice can be helpful early on for pain relief, while heat may be used later to improve circulation and relax the surrounding muscles. Over-the-counter NSAIDs may offer short-term comfort, although they do not address the underlying tendon changes. In some cases, using a counterforce brace can help reduce strain on the tendon during activity and provide additional support while the area heals.

Once the initial pain subsides, a structured physical therapy program may be initiated to support long-term recovery. This phase aims to address the underlying weakness and poor conditioning that contributed to the injury. Exercises may include stretching, eccentric strengthening, progressive loading, and shoulder and core strengthening. The goal is to reduce pain and restore function and resilience.

If these conservative measures fail to provide relief after several months, other interventions may be considered:

• Platelet-Rich Plasma (PRP) Injections: PRP involves injecting a concentration of the patient’s own platelets into the damaged tendon. The growth factors in the platelets may help stimulate the healing process and promote tissue repair. This is a regenerative treatment.
• Surgery: Surgical intervention is reserved for a small percentage of patients whose symptoms are severe and have not improved after dedicated conservative treatment. The procedure typically involves removing the damaged, degenerative tendon tissue and repairing the healthy tendon back to the bone.

Golfer’s elbow is a common, often frustrating condition. The question, “What causes golfer’s elbow?” is answered by understanding the cumulative effect of repetitive strain and microtrauma on the common flexor tendon. It is a degenerative process that results from the body’s inability to keep up with the demands placed upon it. By recognizing the symptoms early, identifying the specific activities that contribute to the problem, and committing to a structured program of rest, modification, and rehabilitation, many patients may achieve a successful recovery.

No, they are similar but distinct conditions. Golfer’s elbow (medial epicondylitis) causes pain on the inner side of the elbow. It affects the tendons that flex the wrist. Tennis elbow (lateral epicondylitis) causes pain on the outer side of the elbow. It affects the tendons that extend the wrist.

Patients are typically advised to avoid any activity that causes pain. Continuing to play through the pain may worsen the tendon damage and prolong your recovery. An experienced elbow specialist can guide you on when and how to safely return to your sport using modified techniques or equipment.

If you experience numbness or tingling, especially in your ring and little fingers, this suggests that the ulnar nerve may be irritated or compressed. The ulnar nerve runs very close to the medial epicondyle. While this can occur alongside golfer’s elbow, it is a separate issue called ulnar neuritis or cubital tunnel syndrome. This requires a specific evaluation by an elbow specialist to determine the appropriate course of treatment.