Tennis Elbow and Golfer’s Elbow: Same Joint, Different Problem

When was the last time you played tennis? For most of the people who come in with tennis elbow, the honest answer is never. They moved into a new house, spent a weekend with a drill, carried forty boxes, and a week later could not pick up a coffee cup without a sharp complaint on the outside of the elbow.

The names are misleading. Tennis elbow and golfer’s elbow are the same type of problem in two different places, and most cases have nothing to do with a racquet or a club. Telling them apart is simple once you know what to feel for, and it changes what you should be doing about it.

Same joint, two different tendons

Both problems involve the tendons that anchor your forearm muscles to the bony bumps on either side of the elbow.

• Tennis elbow (lateral epicondylitis) affects the outside of the elbow. These are the tendons of the muscles that extend your wrist and fingers, the ones that work every time you grip something.
• Golfer’s elbow (medial epicondylitis) affects the inside of the elbow, the side closest to your body when your arm hangs down. These are the tendons of the muscles that flex your wrist and turn your palm down.

Tennis elbow is considerably more common of the two. Both are overuse problems: the tendon’s ability to repair itself fell behind the demand being placed on it.

A quick self-check

Rest your arm palm-down on a table. Press one finger on the bony bump on the outside of the elbow, then the one on the inside. One of them will usually be clearly more tender than the other, and that tells you which side you are dealing with.

Another useful clue: with tennis elbow, lifting a full mug with your palm facing down often reproduces the pain immediately. With golfer’s elbow, gripping hard or turning a stiff doorknob is more likely to do it.

Why “itis” is a bit of a misnomer

The traditional names end in “itis,” which implies inflammation. In long-standing cases, what is actually found in the tendon tends to look more like disorganized, poorly healed tissue than an active inflammatory process.

That is not a technicality. It explains why rest and anti-inflammatories often take the edge off without fixing anything, and why loading the tendon in a controlled way is the part that tends to produce lasting change. A tendon that is not asked to do anything does not get stronger.

What actually causes it

Most cases come from work, lifting and hobbies rather than sport. The common thread is repetitive gripping combined with wrist motion, and usually a recent increase in it.

• Tool use and trades work: drills, wrenches, paint rollers, tile work
• Lifting with the palm down, especially repeatedly, such as moving boxes or lifting a toddler the same way a hundred times a week
• Keyboard and mouse work, particularly after a desk or equipment change
• Gym work that added a lot of gripping: deadlifts, rows, pull-ups, kettlebells
• Racquet and club sports, where technique and grip size matter, and where a sudden jump in playing time is the classic trigger

The pattern we look for in the visit is what changed in the four to eight weeks before the pain started. There is almost always something.

What to do first

• Change how you lift, do not stop lifting. Carrying things palm-up, or hugging them to your chest, takes a surprising amount of load off the outside tendons.
• Look at your setup. A thicker grip on tools, a different mouse, a lighter racquet or a changed grip size. Small equipment changes do real work here.
• Reduce the aggravating activity for a couple of weeks without going to complete rest.
• Consider a counterforce brace. The strap worn below the elbow helps some people get through a workday. It is a tool, not a treatment.

If you use anti-inflammatory medication for the first week or two, check with your physician or pharmacist first if you have kidney, stomach or blood pressure concerns or take other daily medications.

The loading program, which is the real treatment

A progressive tendon-loading program is the core of treatment, and it is where most self-managed cases fall short.

The usual approach starts with slow, controlled wrist movements against light resistance, emphasizing the lowering phase, and builds resistance gradually over weeks. Grip strength work gets added as tolerance improves, then a graded return to the full lifting and gripping demands of your actual work or sport.

Be patient with the timeline. Tendons generally respond over months rather than days. Many people are meaningfully better within six to twelve weeks of consistent work, and some take longer, particularly if the elbow has been sore for a year before anyone looked at it. A modest amount of discomfort during the exercises is usually acceptable. Sharp pain, or pain that is worse the next day, means the load was too much.

Injections: where they fit

Most cases resolve without injections or surgery, which is worth knowing before you go looking for a procedure.

When pain is genuinely blocking a loading program, an injection is reasonable to consider. A corticosteroid injection often reduces pain in the short term, though it is used thoughtfully here, since repeated steroid around a tendon is not without tradeoffs. Platelet-rich plasma is sometimes considered for stubborn cases that have not responded to a good rehabilitation program, and our PRP for tennis elbow and golfer’s elbow page explains how we approach it and what it costs.

Either way, an injection works best as a window that makes rehabilitation possible, not as a replacement for it. That ordering is the same one we described in the non-surgical ladder for joint pain.

When elbow pain is something else

• Nerve irritation. Numbness, tingling or pain running into the hand and fingers points toward a nerve rather than a tendon. Our carpal tunnel page covers the most common version of that, though nerves can also be irritated at the elbow or the neck.
• Joint problems. Swelling, locking, or trouble fully straightening the elbow suggests something inside the joint.
• Referred pain from the neck, which is easy to miss if nobody examines above the shoulder.
• Arthritis, more likely with stiffness and a gradual loss of motion. See our arthritis page.

Symptoms that should not wait

Seek prompt care, at an urgent care or emergency department if you cannot reach your physician, for any of the following:

• A red, hot, swollen elbow with fever
• Significant pain or deformity after a fall or direct blow
• Progressive numbness or weakness in the hand, or difficulty gripping that is getting worse
• A sudden pop with immediate loss of strength

What an elbow visit looks like here

Diagnosing this is mostly clinical. The exam localizes the pain to the specific tendon, tests grip strength, separates tendon pain from nerve symptoms, and goes through what your days actually involve at work and at home. For persistent cases, in-office ultrasound can look directly at the tendon during the same visit.

The part that tends to matter most is time. Working out which specific movement in your week is reloading the tendon takes more than a few minutes of conversation, and that is usually the difference between an elbow that settles and one that lingers for a year. Our tennis and golfer’s elbow page has more on how we manage it, and sports medicine pricing is published if you are not a member.

Where to start

If your elbow has been sore for more than a few weeks, interferes with work, or comes back every time you return to an activity, it is worth having it looked at before the next flare.

You can book a free 30-minute meet and greet with Dr. Kroner, or call 720-807-9961. The practice is at 4045 Wadsworth Blvd Ste 300, Wheat Ridge, CO 80033, open Monday through Friday, serving Arvada, Lakewood, Golden, Edgewater and west Denver. Sports medicine visits are open to members and non-members.

Worth stating plainly: a direct primary care membership is not health insurance. It covers your relationship with your physician, and most members keep an insurance plan alongside it for hospital care, specialists and prescriptions.

This article is for educational purposes only and is not medical advice. Please see our medical disclaimer.

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