Golfer's Elbow vs Tennis Elbow: Inside vs Outside Elbow Pain
Understanding the key differences between Medial Epicondylitis (Golfer's Elbow) and Lateral Epicondylitis (Tennis Elbow)
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⚡ Quick Summary
Golfer's elbow = INSIDE elbow pain (wrist flexor tendons, worsened by gripping/flexing wrist). Tennis elbow = OUTSIDE elbow pain (wrist extensor tendons, worsened by lifting palm-down). Tennis elbow is 4-7x more common. Both are treated with eccentric exercises, bracing, and activity modification. Neither requires surgery in 80-90%+ of cases.
Overview
[Medial epicondylitis (golfer's elbow)](/condition/medial-epicondylitis) and [lateral epicondylitis (tennis elbow)](/condition/lateral-epicondylitis) are the two most common overuse tendinopathies of the elbow — and they're often confused because both cause elbow pain with gripping activities. The fundamental difference is **location**: golfer's elbow affects the **INSIDE** (medial) of the elbow where the wrist flexor tendons attach, while tennis elbow affects the **OUTSIDE** (lateral) where the wrist extensor tendons attach. Tennis elbow is **4-7x more common** than golfer's elbow. Both are degenerative tendinopathies (tendinosis, not tendinitis) treated with eccentric exercises as the cornerstone therapy. Despite their names, most cases of both conditions are caused by **non-sport activities** — particularly occupational overuse and repetitive computer/desk work.
Key Differences at a Glance
| Feature | Medial Epicondylitis (Golfer's Elbow) | Lateral Epicondylitis (Tennis Elbow) |
|---|---|---|
| Pain location | INSIDE (medial) of the elbow — the bony bump on the inner side | OUTSIDE (lateral) of the elbow — the bony bump on the outer side |
| Tendons affected | Wrist FLEXOR-PRONATOR tendons — muscles that bend the wrist toward the palm and rotate palm downward | Wrist EXTENSOR tendons — muscles that bend the wrist backward (toward the back of the hand) and stabilize the wrist |
| Aggravating movement | Wrist FLEXION against resistance (gripping, squeezing, turning palm down) | Wrist EXTENSION against resistance (lifting with palm down, gripping with extended wrist) |
| Prevalence | LESS common — accounts for 10-20% of epicondylitis cases | MORE common — accounts for 80-90% of epicondylitis; affects 1-3% of the population |
| Sports association | Golf (late downswing/impact), throwing sports, racquet sports (topspin forehand), rock climbing | Tennis (backhand), racquet sports, weightlifting, rowing |
| Nerve involvement | Ulnar nerve irritation in 20-50% (numbness in ring/little fingers — "funny bone" area) | Posterior interosseous nerve (PIN) entrapment in 5-10% (wrist/finger extension weakness) |
Symptoms Comparison
Symptoms Both Share
- • Elbow pain that develops gradually over weeks to months
- • Pain worsened by gripping, squeezing, or lifting objects
- • Reduced grip strength on the affected side
- • Morning stiffness at the elbow
- • Pain radiating down the forearm from the elbow
- • Difficulty with everyday tasks: opening jars, turning doorknobs, carrying bags
Medial Epicondylitis (Golfer's Elbow) Specific
- • Pain specifically on the INNER (medial) side of the elbow
- • Pain with wrist flexion (bending wrist toward palm) against resistance
- • Pain with forearm pronation (turning palm downward)
- • Numbness or tingling in ring and little fingers (ulnar nerve irritation in 20-50%)
- • Pain during golf swing (impact/follow-through), throwing, or forehand topspin
- • Pain with carrying heavy bags with a bent wrist
Lateral Epicondylitis (Tennis Elbow) Specific
- • Pain specifically on the OUTER (lateral) side of the elbow
- • Pain with wrist extension (bending wrist backward) against resistance
- • Pain with lifting objects with palm facing down (like lifting a coffee mug by the handle)
- • Pain with the "Cozen test" — resisted wrist extension with elbow extended
- • Pain during tennis backhand, lifting weights, or turning wrenches
- • Pain that may radiate down the outer forearm to the back of the hand
Causes
Medial Epicondylitis (Golfer's Elbow) Causes
- • Repetitive wrist flexion and gripping — occupational tasks, computer/mouse use, manual labor
- • Golf (improper mechanics, particularly hitting the ground), throwing sports, racquet sports topspin
- • Weight training — bicep curls, pull-ups with supinated grip
- • Carrying heavy objects with a flexed wrist
- • Age-related tendon degeneration (peak 35-55 years)
- • Ulnar nerve proximity makes this condition more complex in 20-50% of cases
Lateral Epicondylitis (Tennis Elbow) Causes
- • Repetitive wrist extension and gripping — occupational overuse is the #1 cause
- • Tennis (particularly backhand technique), racquet sports, weightlifting
- • Frequent use of tools: screwdrivers, wrenches, hammers with extended wrist
- • Computer use with wrist in extension position on desk edge
- • Age-related tendon degeneration (peak 40-60 years)
- • Lateral epicondyle attachment has less vascular supply — slower healing
Treatment Options
Medial Epicondylitis (Golfer's Elbow) Treatment
- ✓ Eccentric wrist FLEXION exercises — slowly lower a weight with palm up; 3 sets of 15, twice daily for 12+ weeks
- ✓ Counterforce brace worn just below the medial epicondyle during gripping activities
- ✓ Wrist flexor stretching — arm extended, palm up, pull fingers back; 30 sec, 3 reps, 3x daily
- ✓ Ice massage to the medial epicondyle after activities
- ✓ PRP injection (superior to corticosteroid at 6-12 months) for refractory cases
- ✓ If ulnar nerve symptoms present — may need concurrent ulnar nerve treatment
Lateral Epicondylitis (Tennis Elbow) Treatment
- ✓ Eccentric wrist EXTENSION exercises — slowly lower a weight with palm down (Tyler Twist with FlexBar is gold standard)
- ✓ Counterforce brace worn just below the lateral epicondyle during gripping activities
- ✓ Wrist extensor stretching — arm extended, palm down, gently flex wrist; 30 sec, 3 reps, 3x daily
- ✓ Ice massage to the lateral epicondyle after activities
- ✓ PRP injection for refractory cases (better long-term than corticosteroid)
- ✓ Topical nitroglycerin patches — some evidence for lateral epicondylitis specifically
How Long Does It Last?
Medial Epicondylitis (Golfer's Elbow)
6-12 months with conservative treatment (eccentric exercises + bracing). 80-90% resolve without surgery. Recurrence 8-25%. More complex if ulnar nerve is involved.
Lateral Epicondylitis (Tennis Elbow)
6-12 months with conservative treatment. 80-95% resolve without surgery. Recurrence 8-15%. May take longer due to poorer blood supply to the lateral epicondyle tendon attachment.
When to See a Doctor
Seek medical attention if you experience any of the following:
- ⚠️ Elbow pain lasting more than 2-4 weeks despite rest and ice
- ⚠️ Significant weakness in grip strength affecting work or daily activities
- ⚠️ Numbness or tingling in the fingers (ring/little for medial; thumb/index area may indicate a different condition)
- ⚠️ Unable to fully extend or flex the elbow
- ⚠️ Pain at rest or waking you at night
- ⚠️ Symptoms not improving after 6-8 weeks of consistent eccentric exercises
- ⚠️ Both inner AND outer elbow pain simultaneously (may need broader evaluation)
- ⚠️ Elbow pain after a direct injury or fall (may be fracture or ligament injury)
Frequently Asked Questions
Frequently Asked Questions about Medial Epicondylitis (Golfer's Elbow) vs Lateral Epicondylitis (Tennis Elbow)
Click on a question to see the answer.
Yes — though it's uncommon (5-10% of epicondylitis patients). Having both suggests significant overuse across multiple forearm muscle groups, often from occupational activities involving heavy gripping with repetitive wrist motions in multiple directions. When both are present, treatment should address both sets of tendons with separate eccentric exercise programs — [wrist flexion exercises](/condition/medial-epicondylitis) for the medial side and wrist extension exercises for the [lateral side](/condition/lateral-epicondylitis). Evaluate ergonomics and work modifications comprehensively.
[Medial epicondylitis (golfer's elbow)](/condition/medial-epicondylitis) is potentially more complex because the ulnar nerve runs directly behind the medial epicondyle, and 20-50% of patients develop concurrent ulnar nerve symptoms (numbness in ring/little fingers). This may require additional nerve-specific treatment. [Lateral epicondylitis (tennis elbow)](/condition/lateral-epicondylitis) is more common but has a slightly better prognosis — 80-95% resolve conservatively. Both have excellent outcomes with proper eccentric exercise programs.
Despite the names, **90% of both conditions** are caused by non-sport activities. The most common cause is occupational overuse — construction work, plumbing, assembly line work, carpentry, and prolonged computer/mouse use. Any repetitive gripping, twisting, or wrist bending can cause either condition. The names are historical and misleading — a better description would be 'inner elbow tendinopathy' and 'outer elbow tendinopathy.'
With your palm facing up: [golfer's elbow](/condition/medial-epicondylitis) pain is on the side CLOSEST to your body (medial/inner), and [tennis elbow](/condition/lateral-epicondylitis) pain is on the side FARTHEST from your body (lateral/outer). A quick test: (1) Make a fist and flex your wrist toward your palm against resistance — if this causes pain on the inner elbow, it's likely golfer's elbow. (2) Extend your wrist backward against resistance — if this causes pain on the outer elbow, it's likely tennis elbow.
Medical Disclaimer
The information on this page is for educational purposes only and is not intended as medical advice. It should not be used for self-diagnosis or self-treatment. Always seek the guidance of a qualified healthcare professional with any questions you have regarding a medical condition. If you are experiencing a medical emergency, call your local emergency services immediately.