Last updated: 2026-09-06
What is the difference between tennis elbow and golfer’s elbow?
The two conditions differ in where they hurt. Tennis elbow causes pain on the outside of the elbow, while golfer’s elbow causes pain on the inside. They simply take their names from sports and can occur even in people who have never held a racket. They are more common in everyday activities that involve repetitive hand use, such as housework or working with tools.
On the outside of the elbow, the tendons of the extensor muscles, which bend the wrist toward the back of the hand, attach to the bony prominence on the outer side of the upper arm bone. These muscles also stabilize the wrist when you grip an object firmly, so exerting force with your fingers can cause elbow pain. Pain on the outside when lifting a cup or twisting a bottle cap is more consistent with tennis elbow.
On the inside of the elbow, the tendons of the flexor muscles, which bend the wrist toward the palm and rotate the forearm, attach to the inner bony prominence. Pain on the inside is more pronounced when lifting something heavy with the wrist bent or applying force while turning the palm downward. The ulnar nerve, which supplies sensation to the little-finger side of the hand, passes behind this inner bony prominence.
However, even a single movement such as twisting a bottle cap involves several muscles working together, so pain with that movement alone does not establish a diagnosis. The assessment also considers which bony prominence the tenderness is centered around.
Why does tendon damage accumulate and cause pain?
Although the name includes a term that means inflammation, what actually occurs is degenerative change in the tendon. Tendons transmit the pulling force of muscles to bones, and each time you lift an object, the attachment site on the bone bears that force. If you suddenly increase your activity or repeat the same task before recovering, microscopic damage accumulates and the tendon fibers lose their orderly alignment.
That is why inflammation alone does not explain elbow pain that persists for months. Even if anti-inflammatory medication has eased the pain, this does not mean the tendon has recovered enough to tolerate its previous workload. If you resume gripping heavy objects for long periods because it hurts less, the same spot will hurt repeatedly.
During the examination, the clinician presses around the bony prominences on the outside and inside of the elbow to locate your usual painful spot, then applies resistance as you extend or flex your wrist to see whether this reproduces the pain. Musculoskeletal ultrasound shows tendon thickness, fiber alignment, and areas of partial tearing. The area of change on the scan must match the actual site of pain for the clinician to identify that tendon as the cause.
If pain on the inside of the elbow accompanies tingling in the little and ring fingers, the clinician also checks for cubital tunnel syndrome. This condition involves compression of the ulnar nerve at the elbow, and it may occur alongside tendon pain. In this case, the first step is to reduce time spent with the elbow bent or with the inside of the elbow pressed against a desk.
What treatments are used if pain persists despite rest?
First, we adjust the load on the tendon. Reduce forceful gripping and twisting movements, and use both hands to lift a pot you previously lifted with one hand. If you hold tools for long periods, take breaks between tasks to release your grip. Replace tools with uncomfortable handles that force you to grip harder.
Start exercising with a manageable level of resistance. For tennis elbow, work the muscles that extend the wrist with your forearm supported; for golfer’s elbow, work the muscles that flex the wrist and rotate the forearm. Repeat the movements slowly against light resistance, and gradually increase the resistance as long as pain does not increase the day after exercise.
If pain persists at the tendon attachment site despite adjusting the load and continuing exercise, we perform extracorporeal shock wave therapy. We use a Swiss STORZ device to deliver shock waves to the painful attachment site to stimulate a healing response.
If pain prevents even lifting a cup or getting dressed, we perform an ultrasound-guided injection. We inject the medication while viewing the needle tip, target area, and surrounding nerves and blood vessels on the screen. We select the medication according to your condition from among high-concentration dextrose, PDRN, and placental-derived preparations. When injecting on the inner side of the elbow, we also check the location of the nearby ulnar nerve.
If the forearm muscles have also become tight and stiff, we use WINBACK radiofrequency therapy to apply heat and relax them. Pain may temporarily increase or bruising may occur after an injection, and there are also risks of infection and nerve or blood vessel injury. Seek medical attention immediately if the injection site becomes red, swollen, and warm, or if you develop reduced sensation.
If you continue to have difficulty lifting objects despite an adequate course of nonsurgical treatment, we then discuss surgery.
When will the pain ease and everyday movements become easier?
Tendons recover more slowly than muscles. Some people experience less pain within a few weeks, while others need several months because they must keep using their hands. A review of the physiotherapy literature describes tennis elbow as a tendon condition that generally has a favorable course but often recurs, without specifying when recovery will be complete.(Landesa-Piñeiro Laura et al., 2022)
Recovery is measured by how well you tolerate the same tasks, rather than by a date. Look at whether you need to put down the same weight less often because of pain, and whether your elbow still hurts the day after work. Having less pain for one day is different from tolerating the same tasks over several days. Less pain does not mean that the tendon structure that showed changes on ultrasound has returned to normal.
A 2024 review of the effects of manual therapy and exercise found that patients with lateral elbow pain had pain scores an average of 0.53 points lower on a 10-point scale at 4 weeks to 3 months compared with those who received minimal treatment. The certainty of the evidence was rated as low, and because the review involved lateral elbow pain, this figure cannot be applied to golfer’s elbow or the effects of a specific injection.(Wallis Jason A et al., 2024)
Once you begin to tolerate light resistance, gradually increase how long you hold an object. If noticeable pain persists into the next day, return to the weight or number of repetitions you used before the most recent increase.
References
- Landesa-Piñeiro Laura, Leirós-Rodríguez Raquel (2022). Physiotherapy treatment of lateral epicondylitis: A systematic review.. J Back Musculoskelet Rehabil. PMID: 34397403
- Wallis Jason A, Bourne Allison M, Jessup Rebecca L (2024). Manual therapy and exercise for lateral elbow pain.. Cochrane Database Syst Rev. PMID: 38802121
Frequently Asked Questions
Q. Can I develop tennis elbow even if I don't exercise?
Yes. Although the name comes from a sport, repetitive hand use causes the condition. It occurs more commonly with housework, tool use, and gripping objects for long periods.
Q. If the pain goes away after taking anti-inflammatory medication, am I fully healed?
Pain relief and tendon recovery are not the same. Medication does not reverse degenerative changes in the tendon, so returning to your previous workload as soon as the pain eases will cause the same area to hurt again.
Q. Can golfer’s elbow also cause numbness in the little finger?
Numbness may also occur because the ulnar nerve passes behind the bony prominence on the inside of the elbow. However, tendon pain and nerve compression are different problems, so clinicians assess both sensation and strength in the hand to determine whether cubital tunnel syndrome is present.
Q. Is it an elbow condition if my elbow swells and I cannot straighten it immediately after an injury?
If your elbow swells and is difficult to straighten after a fall or impact, you should first have it checked for an acute injury such as a fracture. If the swelling is severe or you have reduced sensation in your hand, you should seek medical care without delay.
Medical review: Sung-Woog Lee, Medical Director · Board-Certified Neurologist · Guri Top Bone Clinic