Tennis Elbow vs. Golfer's Elbow: What's the Difference and How Are They Treated?

Tennis elbow and golfer's elbow are two of the most common causes of elbow pain in adults. Both involve overloaded tendons at the elbow, both can be provoked by sport, work or everyday gripping tasks, and both usually improve without surgery. The key difference is location: tennis elbow affects the outside of the elbow, golfer's elbow affects the inside.

In short: if the pain is on the outer (thumb-side) part of your elbow and worse with gripping or lifting with the wrist bent back, it is more likely tennis elbow. If the pain is on the inner part of your elbow and worse with wrist flexion or a firm handshake, it is more likely golfer's elbow. Despite the names, most people with either condition have never picked up a racquet or a golf club.

Tennis elbow (lateral epicondylitis)

Tennis elbow affects the tendons that attach to the lateral epicondyle, the bony point on the outside of the elbow. These tendons extend the wrist and fingers, so they are loaded every time the hand grips something with the wrist held back, from a handshake to a hammer. The condition is technically a tendinopathy: repeated microscopic strain that outpaces the tendon's ability to repair itself, rather than a simple, single-event injury.

It is common in racquet sports, but the larger group affected is manual and desk-based workers: tradespeople, mechanics, and anyone using a keyboard and mouse for long hours. Pain is felt over the outside of the elbow, often radiating into the forearm, and typically worsens with gripping, lifting a cup, or shaking hands.

Golfer's elbow (medial epicondylitis)

Golfer's elbow is the mirror image: it affects the tendons attaching to the medial epicondyle, on the inside of the elbow, which flex the wrist and fingers. It is less common than tennis elbow but follows the same pattern of overload from repetitive gripping and wrist-flexing movements, seen in golf, throwing sports, weight training and manual trades involving repeated lifting or twisting.

Pain is felt on the inner elbow, sometimes radiating down the forearm toward the little finger side of the hand, and is provoked by wrist flexion, gripping, and a firm handshake. Because the ulnar nerve runs close to this side of the elbow, golfer's elbow can occasionally overlap with ulnar nerve entrapment (cubital tunnel syndrome), causing tingling in the ring and little fingers; this pattern is worth mentioning specifically at assessment.

How both are assessed

Diagnosis is usually clinical: a history of the aggravating activity and a physical examination that reproduces pain at the appropriate epicondyle. Imaging is not always needed, but an ultrasound or MRI scan can be useful if symptoms are atypical, longstanding, or not responding to treatment as expected, or if there is a suspicion of nerve involvement alongside golfer's elbow.

Treatment

The two conditions are managed in much the same way, and the great majority of cases settle without surgery.

• Activity modification and rest from the aggravating movement, without necessarily stopping all activity
• Physiotherapy, with eccentric strengthening exercises the mainstay of treatment for both conditions, alongside stretching and technique correction
• Bracing, such as a counterforce (tennis elbow) strap, which can reduce load on the tendon during activity
• Pain relief with simple analgesia or anti-inflammatory medication for short-term symptom control
• Corticosteroid injection, which can settle pain in the short term in selected patients, though evidence suggests the benefit does not always persist longer term
• Extracorporeal shockwave therapy, considered for persistent cases that have not responded to the above
• Surgery, reserved for the minority of cases that remain significantly symptomatic after a genuine course of non-surgical treatment, typically six months or more; it involves removing degenerated tendon tissue and, where needed, reattaching healthy tendon to bone (see tennis elbow release and golfer's elbow release)

Preventing recurrence

Both conditions respond well to the same preventive principles: maintaining forearm and wrist strength, warming up before repetitive or gripping activity, using well-fitted equipment and tools, correcting technique where a sport or task is the trigger, and building up any new activity or training load gradually rather than in a sudden jump.

The bottom line

Tennis elbow and golfer's elbow sit on the same spectrum of tendon overload, differing mainly in which side of the elbow is affected. Most cases improve with time, activity modification and physiotherapy, and surgery is uncommon. If elbow pain persists beyond a few weeks or is limiting grip strength and daily activity, an assessment can confirm the diagnosis and rule out other causes of elbow pain, such as nerve entrapment, before starting a tailored treatment plan.