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Golfer's elbow is also known as medial epicondylitis and is the less common sister condition of tennis elbow, both conditions sharing the tendon degenerative nature without inflammation. They are referred to as tendinopathies due to the pathological changes which occur inside the tendon without an inflammatory process. Not just occurring in golfers, golfer's elbow also appears in racquet sports, cricket bowling, weightlifting and archery.

The forearm muscles, which flex and rotate the forearm, originate in tendon-like tissue at the medial epicondyle, the bony lump on the inside part of the elbow. Due to the lack of inflammation the term tendonitis is not correct and tendinopathy, an internal process of degeneration, is the preferred term. Any activity which pushes the lower arm outwards away from the body, into so-called valgus or "knock elbow", puts extra force on the muscles of the flexor origin which are resisting the movement.

High stresses occur in the cocking phase of a throw and during the subsequent acceleration, and in the golf swing from high backswing down to near the ball strike. Golfers are more likely to have their dominant hand affected and tennis players who use heavy topspin in their forehands are also more at risk.

Golfer's elbow is the most common cause of pain over the inside of the elbow and less common than tennis elbow. Twice as many men are affected as women, with people being affected initially mostly in their twenties to their forties. Golfer's elbow presents in the dominant hand in 60% of occurrences, with 30% of sufferers reporting a sudden and painful onset, the remainder having a slow onset.

Pain and ache over the front of the medial epicondyle is the typical symptom, worse with repeated flexion of the wrist and improved with resting. Shoulder, elbow, forearm or hand pain can occur, with weakness or pins and needles in the lower arm. Physiotherapy examination includes the bony tendon insertions, the elbow joints and the muscles, with palpation of the "funny bone" area behind the elbow where the ulnar nerve lies. Nerve involvement can give weakness in the forearm muscles and sensory symptoms, so an exclusion neurological examination is performed by the physio.

The main treatment of golfer's elbow is conservative, including anti-inflammatories, wrist and forearm splinting, corticosteroid injection and physiotherapy. Modifying the provoking activity is a first line of management, making patient education about the condition and the eliciting factors vital. An example is modifying the golf swing mechanics to avoid setting the problem off continually. The patient is taught to avoid aggravating positions and activities, such as leaning on the elbow if there is nerve involvement.

In the acute phase of golfer's elbow the physiotherapist's aim is to reduce any pain and inflammation using ice treatment, stretching gently, deep frictions, ultrasound and anti-inflammatory medication. Progression into the sub acute phase changes treatment to increasing flexibility, strength and returning to normal activities in a paced manner. Counterforce forearm bracing can help realign the tendon stresses, or a wrist brace can give the muscles a rest. For a chronic syndrome the treatment is similar with reducing splint use and returning to sporting activities.

Corticosteroid injections are commonly used for treatment of longer term medial epicondylitis but are more useful early on in the management of golfer's elbow to relieve pain. Laser and shockwave therapy have no good evidence for usefulness. Surgery is only considered once conservative physiotherapy has failed. Surgery is used to debride the abnormal tissue from the affected area and in the cases of nerve involvement to move the ulnar nerve from its groove round to the front of the elbow.

Correction of sporting technique, such as the golf swing, is best achieved by engaging a professional instructor who can also advise on stretches, fitness work and muscle strengthening. Athletes should warm up well before sport and stretch effectively afterwards, choosing good technique and selection of appropriate equipment. Doctors and physiotherapists may need to monitor patients, especially athletes, very carefully as they tend to continue to perform through the pain.