Tennis elbow vs golfer's elbow: how to tell them apart

Two tendon problems, two sides of the elbow

Tennis elbow and golfer's elbow are both tendinopathies: irritation and change in the tendon where forearm muscles attach to the bony bumps (epicondyles) on either side of the elbow. Despite the names, most people who get them do not play tennis or golf. They are far more often linked to work, DIY, gardening, lifting, computer use or any repeated gripping and wrist movement.

The simplest way to tell them apart is where it hurts:

• Tennis elbow (lateral epicondylalgia) affects the outside of the elbow, where the muscles that extend the wrist and fingers attach.
• Golfer's elbow (medial epicondylalgia) affects the inside of the elbow, where the muscles that flex the wrist and fingers and turn the palm down attach.

Tennis elbow is considerably more common, affecting around one to three per cent of adults at some point, most often between 35 and 55. Golfer's elbow is seen perhaps a fifth as often.

How each one feels

Tennis elbow

• Pain and tenderness on the bony point on the outside of the elbow, sometimes spreading down the back of the forearm.
• Worse with gripping, lifting with the palm down (a kettle, a bag, a laptop), shaking hands, turning a door handle or typing for long periods.
• Pain on straightening the fingers or bending the wrist back against resistance.
• Weak or painful grip.

Golfer's elbow

• Pain and tenderness on the bony point on the inside of the elbow, sometimes spreading into the inner forearm.
• Worse with gripping, lifting with the palm up, carrying heavy bags, pull-ups, throwing or swinging.
• Pain on bending the wrist forwards or turning the palm down against resistance.
• Occasionally tingling into the ring and little fingers, because the ulnar nerve runs close by; your clinician will check for cubital tunnel syndrome, which needs a different approach.

A simple self-check: hold your arm out straight, palm down, and try to lift the back of your hand up against gentle resistance from the other hand. Pain on the outside of the elbow points towards tennis elbow. Repeat with the palm up, pushing the hand down against resistance; pain on the inside points towards golfer's elbow. This is a rough guide, not a diagnosis.

What causes them

Both usually come from a tendon being asked to do more than it has adapted to: a sudden increase in gripping or wrist-heavy activity, a new job or hobby, a change of equipment or technique, or long hours of repetitive work with few breaks. Age-related change in the tendon, smoking and some medical conditions make tendons less tolerant of load. Neck or shoulder problems can also contribute by changing how the arm is used, which is one reason a full assessment matters.

What helps: the shared principles

The approach to both conditions is similar, and most people improve over a few months with the right plan. Rushing is the usual mistake; tendons adapt slowly.

• Modify, don't stop. Reduce the activities that provoke the pain, change grip size or technique, and spread repetitive tasks out, rather than resting the arm completely.
• Progressive loading. Specific strengthening exercises for the forearm, starting with slow, controlled contractions and gradually adding load, are the core of treatment for both. Evidence suggests this may improve pain and function more reliably than rest alone, although results vary.
• Address the whole chain. Shoulder and upper-back strength, neck mobility and workstation set-up all influence the load on the elbow.
• Hands-on treatment and adjuncts. Soft-tissue techniques, dry needling, taping or a counterforce brace may help with symptoms for some people while loading is built up.
• Pain relief. Ask your GP or pharmacist what is suitable for you.

Persistent cases: shockwave and other options

If symptoms have lasted several months despite appropriate exercise and activity changes, other options may be discussed. Focused shockwave therapy, delivered with our piezoelectric focused shockwave unit, may be considered for persistent tennis or golfer's elbow; some research suggests it may reduce pain for some people when combined with an exercise programme, and UK guidance lists it as an option for tendinopathy that has not responded to other treatment. A typical course is three to six sessions; details are on our focused shockwave page. A prescribed anti-inflammatory injection is sometimes discussed for short-term relief, though it may not improve long-term outcomes for tennis elbow, and the pros and cons are talked through with a clinician at assessment. Surgery is rarely needed.

Where the diagnosis is unclear, for example when nerve symptoms, locking or a history of injury suggest something else, we can arrange a fast-track scan through our imaging partner. Outcomes vary from person to person.

When to book

If elbow pain has been there for more than a few weeks, is affecting your grip, work or sport, or keeps coming back, an initial assessment with one of our physiotherapists will confirm which side is involved, check the neck, shoulder and nerves, and give you a loading plan to start straight away. If pain followed a fall or a sudden snap, or the elbow is swollen, hot or deformed, call us for a same-day assessment and imaging; for more severe symptoms, such as a suspected fracture or dislocation, go straight to A&E. Our clinic is in Bloomsbury, a few minutes from Russell Square and Holborn, and fees are on the fees page.