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Tennis Elbow vs Golfer's Elbow: What's the Difference and What Actually Works

The two most common causes of elbow pain in Indian adults do not require you to play tennis or golf. They occur in software engineers who type all day, in people who lift groceries the wrong way, in cricket players, in gym-goers who lift weights with poor form, and in homemakers who repeatedly wring out wet clothes. The sports names are historical — the conditions are not.

Understanding the difference between the two is clinically important because they affect different tendons, respond to different treatments, and have different recovery timelines.

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The Anatomy: Why Side Matters

The elbow has two bony prominences that you can feel on the outer and inner sides:

• The lateral epicondyle (outer elbow) is where the extensor forearm tendons attach
• The medial epicondyle (inner elbow) is where the flexor forearm tendons attach

Tennis elbow (lateral epicondylitis) affects the outer elbow — specifically the extensor carpi radialis brevis (ECRB) tendon, which is the primary wrist extensor. Pain is on the outer elbow, worsened by gripping, lifting, and extending the wrist.

Golfer's elbow (medial epicondylitis) affects the inner elbow — specifically the flexor-pronator tendons. Pain is on the inner elbow, worsened by gripping, flexing the wrist, and activities that involve forearm rotation.

Tennis elbow is approximately 7 to 10 times more common than golfer's elbow. Both are forms of tendinopathy — a condition of degeneration and failed healing in the tendon, rather than true inflammation.

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What Is Actually Happening in These Conditions

The traditional name "epicondylitis" — from "itis" meaning inflammation — is misleading. Biopsy studies of affected tendons consistently show a degenerative process (tendinosis) rather than acute inflammation: disorganised collagen, micro-tears, and a failed healing response with abnormal blood vessel ingrowth. There are very few inflammatory cells in the tissue.

This matters for treatment because it means anti-inflammatory approaches (ice, NSAIDs, steroid injections) are addressing a symptom (pain) without treating the underlying tendon pathology. The definitive treatment must stimulate the healing response to produce organised, strong new collagen — which is why progressive loading exercises are the cornerstone of management.

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Tennis Elbow: Recognition and Treatment

Who Gets It

Despite the name, the majority of tennis elbow patients in Noida are:

• IT professionals and office workers (repetitive keyboard and mouse use, particularly with the wrist in extension or with a mouse positioned too far from the body)
• Cricket players (particularly batsmen with poor grip mechanics)
• Gym athletes (barbell and dumbbell exercises with insufficient wrist support)
• People who perform repetitive manual tasks (painting, plumbing, carpentry)
• Homemakers (repetitive wringing, gripping, and lifting)

Symptoms

• Pain and tenderness directly over the lateral epicondyle (outer elbow)
• Pain provoked by gripping — coffee mug, handshake, turning a doorknob
• Pain with extending the wrist against resistance
• Weakness of grip — difficulty lifting objects that previously caused no issue
• The Cozen test (resisting wrist extension with the elbow straight) reproduces the characteristic pain

Evidence-Based Treatment

Stage 1: Load Reduction (Weeks 1 to 4)

Reduce activities that provoke pain — not complete rest, but avoiding the specific aggravating tasks. For an office worker, this might mean switching the mouse to the non-dominant hand, reducing keyboard time, or repositioning the workstation.

A counterforce brace (a strap worn 2 to 3 cm below the lateral epicondyle) reduces the strain at the tendon attachment during gripping activities and provides meaningful symptomatic relief for many patients during this phase.

Stage 2: Eccentric and Isometric Loading (Weeks 3 to 12)

This is the most important and most consistently skipped phase of tennis elbow management in India. The evidence from multiple randomised trials shows that progressive tendon loading — specifically eccentric exercises (the muscle lengthens under load) — stimulates the production of organised, strong new collagen in degenerative tendons.

The standard eccentric exercise for tennis elbow: with the elbow straight, hold a light weight in the hand with the wrist extended. Use the other hand to raise the wrist (concentric phase), then slowly lower it under the affected tendon's control (eccentric phase, 3 to 5 seconds). 15 repetitions, 3 times daily. Progress the weight gradually.

This is uncomfortable — performing these exercises produces the characteristic pain, which settles after 20 to 30 minutes. This discomfort is appropriate and does not indicate damage. The exercises should be at a 3 to 5 out of 10 pain level during the movement.

Steroid Injection: Short-Term Benefit, Long-Term Caution

Corticosteroid injection into the lateral epicondyle is one of the most commonly performed procedures for tennis elbow in India — and one of the most misused. A 2002 landmark study by Bisset et al. in The Lancet found that while steroid injection produced rapid short-term pain relief (at 6 weeks, the injection group was better than the physiotherapy and wait-and-see groups), at 52 weeks the injection group had significantly worse outcomes than physiotherapy — higher recurrence rate, more persistent pain.

Steroid injection for tennis elbow is appropriate as a short-term pain management bridge for patients in significant acute pain that is limiting function. It is not an appropriate first-line treatment or a substitute for the loading exercises that actually address the tendinopathy.

PRP Injection: Stronger Evidence for Tennis Elbow

PRP injection for lateral epicondylitis has a growing evidence base that outperforms steroids for longer-term outcomes. Studies show PRP produces slower initial improvement than steroid (no dramatic 2-week pain reduction) but significantly better outcomes at 6 to 12 months. For patients where conservative management with exercises has failed, PRP is a rational next step before considering surgery.

Surgery

When conservative management has failed after 6 to 12 months and significant functional limitation persists, surgical debridement of the degenerative tendon tissue can be performed arthroscopically. Success rates of 85 to 90 percent are reported for surgical management of refractory tennis elbow. This is a small procedure with a relatively short recovery.

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Golfer's Elbow: Recognition and Treatment

Who Gets It

• Cricket bowlers (the medial elbow is under significant valgus stress during bowling, particularly fast bowling)
• Gym athletes performing heavy curls, pull-ups, and rows
• Golfers (this one is accurate)
• People who perform sustained gripping or forearm rotation tasks

Symptoms

• Pain and tenderness over the medial epicondyle (inner elbow)
• Pain provoked by resisting wrist flexion or forearm pronation (rotating palm downward)
• Sometimes associated with ulnar nerve symptoms — tingling in the ring and little finger (cubital tunnel syndrome can coexist with medial epicondylitis)
• The medial epicondyle is tender to direct palpation

Treatment Differences from Tennis Elbow

Management of golfer's elbow follows the same principles as tennis elbow — load reduction, progressive loading exercises, and PRP for refractory cases. The loading exercises target the wrist flexor tendons rather than extensors.

An important difference: medial elbow structures are in close proximity to the ulnar nerve. Steroid injection near the medial epicondyle carries a small risk of nerve injection — this injection should only be performed by an experienced clinician with knowledge of the relevant anatomy.

Cricket bowlers with medial epicondylitis require biomechanical assessment of their action — certain bowling mechanics (particularly bowling with a hyperextended elbow) significantly increase medial elbow stress. Return to bowling should be combined with technical assessment.

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General Principles for Both Conditions

Recovery timeline: Tennis and golfer's elbow are notoriously slow to fully resolve. Most patients see gradual improvement over 3 to 6 months with consistent management. Some cases take 12 to 18 months. Expecting rapid resolution leads to premature conclusions that treatment has failed and premature escalation.

The ergonomic modification that is often missed: Both conditions are significantly worsened by mouse and keyboard use with the wrist in sustained extension. Ergonomic assessment of the workstation, including mouse position, keyboard height, and chair height, is a first-line intervention for desk workers that is rarely recommended.

Workstation modification for Noida IT professionals:

• Mouse should be as close to the body as possible, not at arm's reach
• Keyboard should allow the elbows to be at approximately 90 degrees with the wrist in neutral position (not extended)
• Consider a vertical mouse (which keeps the forearm in a neutral rotation) for persistent lateral epicondylitis

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Frequently Asked Questions

How do I know if I have tennis elbow or golfer's elbow? The simplest test: touch the bony prominence on the outer elbow — if it is tender, you likely have tennis elbow (lateral epicondylitis). Touch the bony prominence on the inner elbow — if that is tender, golfer's elbow (medial epicondylitis) is more likely. Both can coexist.

Can I continue exercising in the gym with tennis elbow? Yes, with modifications. Avoid exercises that provoke the characteristic pain: barbell rows, wrist curls, supinated grip exercises. Substitute with movements that keep the wrist in neutral position and reduce grip demand. Continue lower body and cardiovascular training without restriction.

I had a steroid injection three months ago and the pain is back. What should I do now? This is the common recurrence pattern after steroid injection for tendinopathy. The appropriate next step is a structured eccentric loading programme (which addresses the underlying tendinopathy) or PRP injection (which provides biological stimulus for tendon healing). A second early steroid injection is unlikely to produce sustained benefit.

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Dr. Ankur Singh | Orthopedic Specialist Noida | Tennis Elbow Golfer's Elbow Treatment India | Elbow Pain Noida | Sarvodaya Healthcare Noida | Renew Orthopedic Clinic Sector 47 Noida