Tennis Elbow and Golfer’s Elbow

Tennis elbow affects the outer side of the elbow, golfer’s elbow the inner side. Most people who develop either have never played the sport in the name — repetitive gripping, lifting, using a mouse or carrying shopping are far more common causes. Both are tendon problems at the point where the forearm muscles anchor to the bone.

Pathophysiology: why the old name was wrong

These conditions were called tendonitis for decades, on the assumption that the tissue was inflamed. When surgical specimens were examined properly, classical inflammatory cells were largely absent. What was present was degeneration.

In lateral epicondylalgia — tennis elbow — the common extensor origin, and particularly the extensor carpi radialis brevis tendon, shows what is described as angiofibroblastic hyperplasia: disorganised collagen, an immature and disordered vascular ingrowth, and increased ground substance. The tendon is not inflamed so much as failing to repair itself properly under repeated load. Nerve endings accompany the new vessels, which contributes to the pain.

Golfer’s elbow — medial epicondylalgia — is the same process at the common flexor origin on the inner side.

Two consequences follow directly from this, and they explain why so many people struggle with these conditions:

• Anti-inflammatories give limited and short-lived benefit, because the primary problem is not inflammation
• Rest does not fix it. Degenerative tendon needs controlled mechanical load to remodel. Prolonged rest lets it deteriorate further

Symptoms

• Pain over the bony point on the outer elbow (tennis) or inner elbow (golfer’s), tender to direct pressure
• Pain on gripping — a kettle, a door handle, a shopping bag
• Pain on resisted wrist extension (tennis) or wrist flexion (golfer’s)
• Weak grip, often the symptom that interferes most with daily life

Diagnosis is usually clinical. Imaging is reserved for cases that do not behave as expected, or where another cause such as nerve entrapment or joint pathology needs excluding.

First-line treatment

A progressive loading programme for the forearm tendons is the single most effective measure, and it is the one most often abandoned early. Loaded exercise — often eccentric or heavy slow resistance — gives the tendon the stimulus it needs to remodel.

Alongside it: modify the aggravating activity rather than stopping entirely, and consider a counterforce brace or strap in the short term to reduce load at the attachment point.

How long it takes

Longer than most people expect. Meaningful improvement usually takes three to six months of consistent loading. That is not a failure of treatment; it is the timescale on which tendons remodel.

Injection options

Injections are not a treatment on their own. Used well, they reduce pain enough that you can do the rehabilitation that actually changes the outcome. Used as a substitute for that work, they buy time and little else. These are the options we discuss.

Corticosteroid

A strong anti-inflammatory placed directly into the painful structure. Onset is fast — usually within days — and for someone who cannot sleep or cannot work, that speed matters.

The limitation is duration. The effect fades over weeks to months, and repeated injections into the same tendon carry a real risk of weakening the tissue. In tendon problems specifically, the evidence is uncomfortable: corticosteroid outperforms doing nothing in the short term but does worse over a year. We use it deliberately and sparingly, and we will tell you if we think it is the wrong choice for your problem.

Platelet-rich plasma (PRP)

A sample of your own blood is spun in a centrifuge to concentrate the platelets, which carry the growth factors involved in tissue repair. The concentrate is injected into the injured tissue.

PRP works in the opposite direction to corticosteroid: onset is slower, often several weeks, but the effect tends to last longer. Preparation matters — leukocyte-poor systems, which remove most white cells, have performed better than leukocyte-rich ones in comparative studies. We use a leukocyte-reduced system.

PRP is a genuinely promising option and we are honest about where the evidence sits: the trials are smaller and less consistent than we would like, and some professional bodies still recommend against it on those grounds. We think it is reasonable for selected patients, and we will say so if we do not think you are one.

How the injection is given

Accuracy matters more than most people expect. Injections placed by landmark alone miss the intended target a meaningful proportion of the time, particularly in deep joints like the hip and in the small spaces around the shoulder and wrist. Ultrasound guidance lets us see the needle reach the structure we are aiming at, which improves both accuracy and safety.

The injection itself takes a few minutes. Most people feel some soreness for a day or two afterwards. We usually ask you to avoid heavy loading of the area for a short period, then start or resume the rehabilitation programme.

A specific warning about steroid in tennis elbow

This is the condition where the corticosteroid trade-off is starkest, and we would rather you heard it from us. Corticosteroid injection reliably reduces tennis elbow pain in the first weeks. Over twelve months, however, people who receive it have tended to do worse than those who received no injection at all, with higher recurrence rates.

That does not make steroid never appropriate — for someone who cannot work or sleep, a short-term window has real value. But it does mean we will not offer it as a default, and if you have already had one or two into the same elbow we will usually advise against another.

PRP is the more logical choice here in principle, since the problem is failed tendon repair rather than inflammation, and it is what we more often discuss for persistent cases.

When to see a doctor

See someone if elbow pain has persisted beyond a few weeks of modified activity, if grip weakness is affecting your work, or if pain is spreading down the forearm. Numbness or tingling into the hand suggests nerve involvement and is worth assessing rather than treating as simple tendon pain.

Part of the other joints we treat. See also shoulder pain, wrist and hand pain.

Written by Dr Gerard Ee. Last medically reviewed and updated: September 2026.