Medial Epicondylitis (Golfer's Elbow)
Golfer's elbow — medial epicondylitis — is a tendinopathy of the flexor-pronator mass originating at the medial epicondyle of the humerus. Despite the name, most patients are not golfers; the condition is common in carpenters, plumbers, manual laborers, and racquet sport athletes. Accurate diagnosis is critical because medial elbow pain has several other important causes — especially ulnar collateral ligament (UCL) injury and cubital tunnel syndrome — that require different management. At Maryland Orthopedic Specialists, we provide precise diagnosis and a structured, evidence-based treatment pathway to get you back to full function.
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What is medial epicondylitis (golfer's elbow)?
Medial epicondylitis results from repetitive tensile overload at the common flexor-pronator origin, primarily the pronator teres and flexor carpi radialis tendons. Histologically, the tissue shows angiofibroblastic tendinosis — not true inflammation — with collagen disorganization, neovascularization, and absence of inflammatory cells.
Medial epicondylitis results from repetitive tensile overload at the common flexor-pronator origin, primarily the pronator teres and flexor carpi radialis tendons. Histologically, the tissue shows angiofibroblastic tendinosis — not true inflammation — with collagen disorganization, neovascularization, and absence of inflammatory cells. This explains why the term "epicondylitis" is something of a misnomer and why long-term anti-inflammatory strategies alone are insufficient.
The injury mechanism is typically chronic overuse: repetitive wrist flexion and forearm pronation (golf downswing, pitching follow-through, racquet strokes, hammering) creates cumulative micro-damage at the tendon insertion that outpaces the body's repair capacity.
Distinguishing from UCL injury is clinically important:
- Medial epicondylitis pain is reproduced by resisted wrist flexion and pronation with the elbow extended.
- UCL injury pain is reproduced by valgus stress at 30° of elbow flexion (the moving valgus stress test or milking maneuver).
- UCL laxity and medial instability are absent in pure epicondylitis.
- MRI arthrogram or stress radiographs can differentiate the two when clinical examination is equivocal.
Treatment options
Conservative Management (First-Line)
Physical therapy is the cornerstone of treatment: -Eccentric and concentric progressive loading protocols targeting the flexor-pronator musculature. -Manual therapy and soft-tissue mobilization. -Activity modification and ergonomic assessment. Counterforce (epicondyle) bracing: A proximal forearm strap reduces tensile forces at the common flexor origin during activity and provides symptomatic relief. Other modalities — including extracorporeal shockwave therapy (ESWT), ultrasound-guided percutaneous tenotomy (Tenex), and dry needling — have supporting evidence and are used selectively.
Corticosteroid Injection
Corticosteroid injection: Provides rapid short-term pain relief (4–6 weeks). Note that while corticosteroid is effective for short-term symptom relief, multiple injections may impair tendon integrity. Use is generally limited to 1–2 injections.
Platlet Rich Plasma (PRP)
Platelet-rich plasma (PRP): PRP carries stronger and more consistent randomized evidence for medial epicondylitis than for lateral epicondylitis. Multiple RCTs have demonstrated superiority of PRP over corticosteroid at 3, 6, and 12 months for pain and functional outcomes. PRP is a preferred second-line option at our practice, particularly for patients who have failed a corticosteroid injection or prefer to avoid repeated steroid use.
Frequently Asked Questions
Is golfer's elbow the same as tendinitis?
How is golfer's elbow different from tennis elbow?
Will PRP cure my golfer's elbow?
When should I consider surgery?
Can golfer's elbow recur after surgery?
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Related conditions
References
- Creaney L, Wallace A, Curtis M, Connell D. Growth factor-based therapies provide additional benefit beyond physical therapy in resistant elbow tendinopathy: a prospective, single-blind, randomised trial of autologous blood injections versus platelet-rich plasma injections. British Journal of Sports Medicine. 2011;45(12):966–971. https://doi.org/10.1136/bjsm.2010.082503
- Peerbooms JC, Sluimer J, Bruijn DJ, Gosens T. Positive effect of an autologous platelet concentrate in lateral epicondylitis in a double-blind randomized controlled trial: platelet-rich plasma versus corticosteroid injection with a 1-year follow-up. American Journal of Sports Medicine (AJSM). 2010;38(2):255–262. https://doi.org/10.1177/0363546509355445
- Ciccotti MG, Ramani MN. Medial epicondylitis. Techniques in Hand and Upper Extremity Surgery. 2003;7(4):190–196. https://doi.org/10.1097/00130911-200312000-00007
- American Academy of Orthopaedic Surgeons. Golfer's Elbow (Medial Epicondylitis) — OrthoInfo. https://orthoinfo.aaos.org/en/diseases--conditions/golfers-elbow (accessed May 2026).
- Vinod AV, Ross G. An effective approach to diagnosis and surgical repair of refractory medial epicondylitis. Journal of Shoulder and Elbow Surgery (JSES). 2015;24(8):1172–1177. https://doi.org/10.1016/j.jse.2015.04.001