Tennis elbow (lateral epicondylitis) and golfer's elbow (medial epicondylitis) are tendinopathies on opposite sides of the elbow. Tennis elbow involves the wrist extensor tendons that originate on the lateral (outside) bony bump. Golfer's elbow involves the wrist flexor and forearm pronator tendons that originate on the medial (inside) bony bump. Neither requires the named sport. The diagnosis is based on where the pain is and which provocative test reproduces it. Treatment overlaps substantially. The labels matter for self-tracking. The location of pain matters more.
Two Bony Bumps, Two Different Problems
The elbow has two prominent bony landmarks at the lower end of the humerus: the lateral epicondyle on the outside and the medial epicondyle on the inside. Each is the origin of a group of forearm muscles whose tendons converge at that point.
The lateral epicondyle is the origin of the wrist extensors, the muscles that pull the back of the hand up. The most commonly involved tendon is the extensor carpi radialis brevis (ECRB). When this tendon develops a degenerative tendinopathy, the condition is called lateral epicondylitis or, popularly, tennis elbow.
The medial epicondyle is the origin of the wrist flexors and forearm pronators, the muscles that curl the wrist down and turn the palm to face the floor. The most commonly involved tendon is the pronator teres or flexor carpi radialis at their shared origin. When this group develops a degenerative tendinopathy, the condition is called medial epicondylitis or golfer's elbow.
The pathology is the same on both sides: small tears in the tendon origin that fail to heal normally and progress to a chronic degenerative tendinopathy. The location is what makes the conditions different.
Where the Pain Is
The most reliable way to distinguish the two is the location of point tenderness:
- Tennis elbow: point tenderness directly over or just distal to the lateral epicondyle (the bony bump on the outside of the elbow, on the same side as the thumb when the palm faces forward).
- Golfer's elbow: point tenderness directly over or just distal to the medial epicondyle (the bony bump on the inside of the elbow, on the same side as the small finger).
Press firmly on each bump. The side that reproduces your pain is the side with the tendinopathy. It is possible to have both conditions simultaneously, but most patients have one or the other.
Provocative Tests
Three classical maneuvers reproduce tennis elbow pain:
- Cozen's test: the elbow is held at 90 degrees and the patient resists wrist extension while making a fist. Pain at the lateral epicondyle is positive.
- Mill's test: the patient extends the elbow fully with the wrist passively flexed and the forearm pronated. Stretch over the lateral epicondyle reproduces pain.
- Maudsley's test: the patient resists extension of the long (middle) finger. The ECRB tendon attaches in line with this finger, so resisted extension specifically loads the involved tendon. Pain at the lateral epicondyle is positive.
For golfer's elbow, the analogous maneuvers reproduce medial elbow pain:
- Resisted wrist flexion: the elbow is held at 90 degrees with the forearm supinated (palm up) and the patient resists wrist flexion. Pain at the medial epicondyle is positive.
- Resisted forearm pronation: the elbow is held at 90 degrees and the patient resists turning the palm toward the floor. Pain at the medial epicondyle is positive.
- Passive stretch: the elbow is extended fully with the wrist passively extended and the forearm supinated. Stretch over the medial epicondyle reproduces pain.
A short reel from Dr. Loredo on elbow pain. View on Facebook.
Neither Requires the Named Sport
The names are misleading. The vast majority of patients with these conditions have never played tennis or golf.
Tennis elbow is far more commonly caused by:
- Computer mouse use, particularly with poor wrist position
- Painting, especially overhead
- Plumbing, electrical work, carpentry
- Repetitive gripping with wrist in extension (manual labor)
- Weightlifting, particularly with poor wrist position during pulling exercises
- Cooking and food preparation with heavy implements
Golfer's elbow is more commonly caused by:
- Repetitive forceful gripping (pliers, hammers, weight training)
- Throwing sports, including baseball pitching
- Shoveling, raking, hoeing, and similar yard work
- Manual labor that involves twisting motions of the forearm
- Heavy lifting from the floor with the palms facing up
Knowing the activity that triggered the symptoms helps shape the activity-modification plan but does not change the diagnosis. The diagnosis is the location and the provocative test.
Treatment Overlap
The first-line treatments are nearly identical for both conditions:
- Activity modification: identify and reduce the triggering activity. Modify ergonomics. Adjust grip size, wrist position, and load.
- Counterforce brace: a strap worn 1 to 2 inches below the affected epicondyle. The brace dissipates load away from the diseased tendon origin. Worn during activity, not at rest.
- Eccentric strengthening exercises: the most evidence-based exercise approach. Slow lengthening contractions of the affected muscle group. A common protocol is 3 sets of 15 repetitions, twice daily, for 8 to 12 weeks.
- Physical therapy: a structured program of stretching, eccentric strengthening, and soft tissue work. Often combined with manual therapy and ultrasound.
- Anti-inflammatory medication: short-term ibuprofen or naproxen for pain control. Tendinopathy is more degenerative than inflammatory, so anti-inflammatories are symptomatic, not curative.
- Cortisone or PRP injection: when symptoms persist beyond 8 to 12 weeks of conservative treatment. Cortisone provides short-term relief but does not improve long-term outcomes. PRP (platelet-rich plasma) shows better long-term healing in some studies.
- Surgery: reserved for symptoms that persist beyond 6 to 12 months of comprehensive conservative care. Open or arthroscopic debridement of the diseased tendon origin. Recovery is 3 to 6 months. Most patients improve.
The treatment differs in two ways: brace position and which mimic to rule out. The lateral counterforce brace sits 1 to 2 inches distal to the lateral epicondyle. The medial counterforce brace sits 1 to 2 inches distal to the medial epicondyle. On the medial side, the surgeon must rule out cubital tunnel syndrome (ulnar nerve compression at the elbow), which presents with similar pain plus tingling and numbness in the ring and small fingers and can require very different treatment.
Why Labels Matter for Self-Tracking but Symptoms Matter More
The label is helpful for tracking and communication: telling your physical therapist that you have golfer's elbow is faster than describing medial-sided pain with resisted wrist flexion. The label is also useful for finding educational resources and exercise programs.
The label is not the diagnosis. The diagnosis is what your hand and upper extremity surgeon establishes after asking about activity history, examining the pain location, performing the provocative tests, and ruling out mimics like cubital tunnel syndrome, radial tunnel syndrome, posterior interosseous nerve compression, ulnar collateral ligament injury (medial side), and cervical radiculopathy. Imaging is rarely needed unless symptoms are atypical or persistent.
If your self-applied label is wrong, your self-applied treatment may also be wrong. A counterforce brace placed on the wrong side does nothing. Eccentric exercises for the wrong muscle group can aggravate the actual problem. When in doubt, see someone who can examine you.
When to See a Specialist
See a hand and upper extremity surgeon when:
- Pain has persisted for 6 weeks or longer despite rest, brace, and over-the-counter anti-inflammatories.
- There is associated tingling or numbness in the ring and small fingers (suggests cubital tunnel syndrome).
- There is weakness with grip or wrist extension that does not improve with rest.
- There is a history of acute injury rather than gradual onset.
- Both sides of the elbow hurt, or pain radiates from the neck.
- Cortisone injection has provided only short-lived relief and the pain has returned.
Frequently Asked Questions
Do you have to play tennis to get tennis elbow?
No. Most patients with tennis elbow have never played tennis. The condition is named for the sport because tennis players were among the first described, but the underlying problem is overuse of the wrist extensor tendons. Computer mouse use, painting, plumbing, electrical work, gardening, weight lifting with poor wrist position, and any repetitive gripping or wrist extension activity can cause tennis elbow. The diagnosis is based on the location of pain (lateral elbow) and the provocative tests, not the activity.
How do I tell tennis elbow from golfer's elbow at home?
Find the bony bump on each side of your elbow. The bump on the outside (thumb side when the palm faces forward) is the lateral epicondyle. The bump on the inside (pinky side) is the medial epicondyle. Press firmly on each. The side that hurts is the side with the tendinopathy. Tennis elbow hurts when you resist wrist extension (lift the back of your hand against resistance) or grip a heavy object. Golfer's elbow hurts when you resist wrist flexion (curl your wrist down) or make a strong fist.
Are the treatments the same for both?
Treatment overlaps significantly. Both conditions respond to activity modification, a counterforce brace, anti-inflammatory medication, eccentric strengthening exercises, and physical therapy. Both can be treated with corticosteroid or PRP (platelet-rich plasma) injection if conservative care fails. Both can be treated surgically (debridement of the diseased tendon origin) when symptoms persist beyond 6 to 12 months of comprehensive conservative treatment. The brace is positioned differently for each: a counterforce strap sits below the lateral epicondyle for tennis elbow and below the medial epicondyle for golfer's elbow.
When should I see a hand and upper extremity specialist?
See a specialist when elbow pain has persisted for 6 weeks or longer despite rest, brace, ice, and over-the-counter anti-inflammatories, when there is associated tingling or numbness in the ring and small fingers (which suggests cubital tunnel syndrome on the medial side), when there is weakness with grip or wrist extension, or when there is a history of injury. Mimics of medial and lateral epicondylitis include cubital tunnel syndrome, radial tunnel syndrome, posterior interosseous nerve compression, and cervical radiculopathy. A hand and upper extremity specialist can distinguish these and direct appropriate treatment.
Related Reading
- Tennis Elbow: full condition page covering lateral epicondylitis evaluation and treatment.
- Golfer's Elbow: full condition page covering medial epicondylitis evaluation and treatment.
- General Hand and Elbow Pain: triage page that helps identify when to seek evaluation.
- Call Us: schedule an elbow evaluation.