Elbow

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.

Symptoms — do you recognize these?

Medial elbow pain at or just distal to the medial epicondyle
Pain worsening with wrist flexion, forearm pronation, or gripping
Morning stiffness of the medial elbow
Tenderness directly over the flexor-pronator origin (5–10 mm distal to the medial epicondyle)
Possible associated ulnar nerve symptoms (ring/small finger tingling) if cubital tunnel syndrome co-exists — present in up to 60% of cases
Weakness of grip in severe or chronic cases

Call us at (301) 515-0900. Same-day appointments available at our Bethesda and Germantown locations.

How we diagnose it

Clinical Examination

Medial epicondyle palpation: Point tenderness at the flexor-pronator origin.
Medial Cozen test (resisted wrist flexion test): The examiner resists wrist flexion and forearm pronation with the elbow extended; reproduction of medial elbow pain is a positive test.
Valgus stress test at 30°: If medial pain is produced with a valgus load (rather than resisted flexion), UCL injury must be evaluated.
Neurologic examination for cubital tunnel syndrome (Tinel sign at medial elbow, Elbow Flexion Test, intrinsic muscle testing).

Imaging

Plain radiographs: Usually normal; may show medial epicondyle calcification in chronic cases.
MRI: Confirms tendinopathic changes (T2 signal increase at the flexor-pronator origin), excludes UCL tear, and evaluates for concomitant pathology.
Ultrasound: A cost-effective dynamic alternative that demonstrates tendon thickening, hypoechogenicity, and neovascularity; also used to guide therapeutic injections.

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.

Surgical Procedure

Elbow Arthroscopy

Minimally invasive joint scope to address loose bodies, osteochondritis dissecans, posterior impingement, and selected cases of refractory lateral epicondylitis through small portals at the elbow.

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Recovery & rehabilitation

Conservative treatment: Most patients see meaningful improvement within 6–12 weeks of structured PT; full resolution may take 6–12 months.
Post-surgical: Protective splinting for 2 weeks; formal PT from week 3; return to light activities at 6–8 weeks; return to heavy labor or throwing sport at 4–6 months.

Frequently Asked Questions

Is golfer's elbow the same as tendinitis?

Not exactly. The underlying pathology is tendinosis (collagen degeneration), not active inflammation. This is why treatments targeting inflammation alone (e.g., NSAIDs, steroids) provide only partial and temporary relief.

How is golfer's elbow different from tennis elbow?

Tennis elbow (lateral epicondylitis) affects the extensor tendons on the outer side of the elbow. Golfer's elbow affects the flexor-pronator tendons on the inner side. Both involve tendinosis from repetitive overload, but at different insertion sites.

Will PRP cure my golfer's elbow?

PRP accelerates healing in the degenerative tendon and shows better long-term outcomes than cortisone injection in multiple trials. It is not a single-session cure, but is an effective and durable treatment for many patients when combined with rehabilitation.

When should I consider surgery?

Surgery is appropriate after 6–12 months of dedicated conservative therapy (including supervised PT and at least one injection) with persistent, functionally limiting pain.

Can golfer's elbow recur after surgery?

Recurrence is uncommon (< 10%) after complete surgical debridement, particularly when the post-operative rehabilitation program is completed.

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Peter G. Fitzgibbons, MD

Hand Surgery · Orthopedic Surgery

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Related conditions

UCL Injury (Tommy John)Cubital Tunnel Syndrome

Medically reviewed by Peter G. Fitzgibbons, MD

Last reviewed May 1, 2026

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