How Is Tennis Elbow Different From Golfer’s Elbow?

Tennis elbow (lateral epicondylitis) causes pain on the outer elbow and usually develops from overuse of the forearm extensor tendons. In contrast, golfer’s elbow (medial epicondylitis) causes pain in the inner elbow due to repetitive gripping motions or wrist flexion.

Since both conditions can cause similar symptoms, you should consult Dr. Charles Ruotolo at Total Orthopedics and Sports Medicine for an accurate diagnosis. He performs a detailed physical examination to identify the exact source of your pain. If needed, he uses advanced diagnostic testing to evaluate tendon damage and other underlying conditions before developing a personalized treatment plan. Call 855-321-6784 to book your appointment in Syosset.

What Is the Difference Between Tennis Elbow and Golfer’s Elbow?

Tennis elbow, or lateral epicondylitis, typically causes pain on the outer elbow that may extend down the forearm, worsening with gripping activities. In contrast, pain from golfer’s elbow is localized to the inside of the elbow. In some cases, this discomfort may extend toward the pinky side of the forearm. Although both tennis elbow and golfer’s elbow result from overuse, they affect different tendon groups, including:

• Lateral Epicondylitis: Tennis elbow affects the extensor muscle or tendons, which help with wrist extension and finger movement.
• Medial Epicondylitis: Golfer’s elbow affects the flexor tendons, which help with wrist flexion and gripping activities.

In addition, a PubMed study reports that tennis elbow pain often results from repetitive wrist extension and forearm movements. On the other hand, golfer’s elbow commonly causes pain during forceful gripping, fist-making, or repetitive wrist-flexion activities. In fact, the National Library of Medicine found that more than 90% of golfer’s elbow cases occur in people who do not play tennis or golf. As a result, both conditions can affect different daily activities and may require different treatment approaches.

What Does Inner vs. Outer Elbow Pain Usually Feel Like?

Outer elbow pain often begins as a dull ache, sharp shooting pain, or a burning sensation that worsens when lifting objects or extending the wrist against resistance. In contrast, golfer’s elbow (inner elbow pain) often causes tenderness around the bony bump on the inside of the elbow and may radiate down the forearm toward the wrist. Based on these symptoms, self-assessments for tennis elbow and golfer’s elbow can help you identify the source of pain. However, the exact symptoms often vary depending on the underlying structures and require professional evaluation for proper diagnosis.

Which Everyday Activities Worsen Elbow Pain?

Elbow discomfort often worsens with repetitive gripping, twisting, wrist flexion, and forceful forearm movements. Prolonged computer work, frequent mouse or keyboard use, and repetitive sports motions, such as swinging a golf club, tennis racket, or pickleball paddle, can also worsen symptoms. In some cases, pain may be triggered by repeatedly raising and lowering objects, particularly when the wrist and forearm are under load. Moreover, the following activities place strain on the tendons around the elbow and cause severe pain.

• Weight Training: Heavy pulling and curling exercises with poor form can strain the inner elbow tendons.
• Baseball or Softball: Repetitive throwing places stress on the elbow and forearm muscles.
• Pickleball: Frequent gripping and swinging can irritate the affected tendons.
• Using a Screwdriver: Repeated twisting motions increase strain on the inner elbow.
• Heavy Chopping: Continuous cutting motions can strain the forearm muscles.
• Kneading Dough: Repetitive hand and wrist movements place stress on the tendons.
• Raking the Yard: Prolonged gripping and repetitive motion can aggravate symptoms.
• Pull-Ups and Chin-Ups: Strong gripping and pulling forces can overload the inner elbow tendons.

Can the Pain Travel Into the Forearm, Wrist, or Hand?

Yes, pain can radiate into the forearm, wrist, or hand in people with tennis or golfer’s elbow. This often happens because the affected tendons extend from the elbow into the forearm and connect to the wrist and fingers. In some cases, irritation of nearby nerves may also cause radiating symptoms such as tingling, numbness, or burning, especially in overhead athletes. As a result, you may feel significant discomfort in the arm even if the problem originates near the elbow.

In fact, a case study published in The Journal of Emergency Medicine reported a 42-year-old woman who experienced elbow and forearm pain that radiated into her hand after an injury to the inner elbow. She reported a popping sensation followed by pain extending from the elbow into the hand. Researchers found that irritation or compression of the ulnar nerve can cause pain, numbness, and tingling that radiates through the forearm, wrist, and hand. For this reason, doctors often evaluate nearby nerves to identify the exact source of the symptoms and rule out conditions such as Cubital Tunnel Syndrome.

Can You Have Both Conditions at the Same Time?

Yes, repetitive strain can cause both tennis and golfer’s elbow at the same time. For example, rock climbing, heavy manual labor, and other repetitive activities can place stress on both the inner and outer elbow tendons. In some cases, changing your movements to avoid pain on one side of the elbow may place extra stress on the tendons on the opposite side. As a result, pain and tenderness may develop on both sides of the elbow. Because both conditions can cause similar symptoms, a professional evaluation is essential to identify the source of the pain and guide the most appropriate treatment.

When Should You Seek Medical Attention for Elbow Pain?

You should consult a doctor if your elbow pain persists and does not improve after 1 to 2 weeks of conservative treatments such as rest, ice, or anti-inflammatory medication. You should also seek immediate medical attention if you notice an obvious deformity, a protruding bone, severe swelling, or an inability to bend or straighten your arm after a traumatic injury. If left untreated, these symptoms may lead to worsening tendon damage, loss of function, or long-term chronic pain. You should also consult a shoulder specialist if you experience symptoms such as:

• Uncontrolled or severe bleeding
• A sudden popping sound with severe pain or weakness
• Numbness, tingling, or weakness in the hand, wrist, or arm
• Difficulty gripping objects, turning doorknobs, or lifting items
• Fever, redness, warmth, or blistering around the elbow

How Can Early Treatment Improve Long-Term Outcomes?

Early treatment helps prevent ongoing tendon damage and reduces the risk of chronic pain. It also allows you to begin stretching and strengthening exercises before the affected tendons become weaker. As a result, you can restore flexibility, improve muscle endurance, and reduce stress on the injured area.

In addition, treatments such as soft tissue therapy may help break up scar tissue and improve blood flow to support healing. This approach promotes healthier tissue repair and may prevent long-term stiffness. Over time, early rehabilitation can reduce the need for medication and lower the risk of surgery.

How Do Doctors Tell the Difference Between These Conditions?

Our board-certified surgeon, Dr. Charles Ruotolo, examines the location of the pain and reviews your medical history to identify the underlying condition. He also asks about your daily activities, lifestyle, and movements that may place repetitive stress on the affected tendons. If needed, he may recommend advanced imaging tests, such as ultrasound or MRI (Magnetic Resonance Imaging). These tests provide detailed images of the tendons, ligaments, or nerves and help confirm the diagnosis.

In addition, Dr. Charles Ruotolo evaluates elbow tenderness, strength, range of motion, and movements that trigger pain. During a physical exam, he may perform the following specialized tests to identify the affected tendons:

• Cozen’s Test (Tennis Elbow Test): Pain around the lateral epicondyle during resisted wrist extension may indicate tennis elbow. In fact, an NIH study reported that Cozen’s Test has a sensitivity of 91% for identifying this condition.
• Reverse Cozen’s Test (Golfer’s Elbow Test): Pain on the inner elbow during resisted wrist flexion may indicate medial epicondylitis.
• Mill’s Test: Stretching the wrist while fully straightening the elbow may reproduce symptoms associated with tennis elbow.
• Maudsley’s Test: Discomfort around the lateral epicondyle during resisted middle-finger lifting may suggest tennis elbow.
• Passive Stretch Test: Stretching the forearm muscles with the palm facing upward may cause pain and point to golfer’s elbow.

What Conditions Are Mistaken for Tennis vs Golfer’s Elbow?

Tennis elbow is commonly misdiagnosed as nerve compression, Osteochondritis Dissecans (OCD), elbow instability, or rheumatoid arthritis. In contrast, golfer’s elbow is often misdiagnosed as Cubital Tunnel Syndrome, Medial Ulnar Collateral Ligament (MUCL) sprains, or cervical radiculopathy. Because these conditions can cause similar symptoms, an accurate diagnosis is essential for proper treatment.

Here is how these conditions may cause symptoms similar to tennis elbow or golfer’s elbow:

• Cubital Tunnel Syndrome: Compression of the ulnar nerve can cause inner elbow pain, tingling, and numbness that resemble golfer’s elbow.
• Medial Ulnar Collateral Ligament (MUCL) Sprain: This ligament injury can cause pain on the inner side of the elbow, especially during throwing or lifting activities.
• Cervical Radiculopathy: A pinched nerve in the neck can cause pain, numbness, or weakness in the arm and elbow.
• Osteochondritis Dissecans (OCD): This condition may cause elbow pain, stiffness, and catching sensations during movement.
• Rheumatoid Arthritis: Joint inflammation can lead to elbow pain, swelling, and stiffness.
• Elbow Instability: Loose or damaged ligaments can cause pain, weakness, and a feeling that the elbow may give way.

Which Treatments Help Restore Elbow Strength?

Guided resistance training and targeted range-of-motion exercises can help rebuild the affected tendons and muscles. As strength improves, these exercises support better arm function and help promote healing after overuse injury. Specialized elbow straps and braces also provide relief by reducing stress on the injured tendons. However, throughout the recovery, healthcare professionals recommend rest, ice, and anti-inflammatory medication for both tennis elbow and golfer’s elbow.

In severe cases of tennis or golfer’s elbow, cortisone injections may help relieve pain and reduce inflammation when conservative treatments fail to provide adequate relief. In fact, a PubMed clinical study involving 67 patients found that corticosteroid injections provided pain relief in 80% of cases. Patients experienced symptom relief for an average of 12.5 weeks after their first injection. This temporary reduction in pain may help patients perform rehabilitation exercises with less discomfort.

In addition, the following treatment options may help promote healing and improve tendon function:

• Platelet-Rich Plasma (PRP) Therapy: Supports tendon repair using your own blood platelets.
• Shockwave Therapy (ESWT): Uses sound waves to reduce pain and promote healing.
• Prolotherapy and Biostimulator Injections: Stimulate natural healing and strengthen damaged tissue.
• Instrument-Assisted Soft Tissue Mobilization (IASTM): Breaks up scar tissue and improves elbow mobility.
• Automated Mobilization Devices: Help reduce scar tissue and improve grip strength over time.

When Is Surgery Needed for Tennis vs Golfer’s Elbow?

Our surgeon, Dr. Charles Ruotolo, may recommend surgery if symptoms persist despite 6 to 12 months of conservative treatment. He may also recommend surgery if imaging studies show significant tendon damage, tears, or nerve involvement. In these cases, surgery can remove damaged tissue, relieve pressure on the affected structures, and restore tendon function. As a result, you may experience less pain, improved strength, and a better return to daily activities.

Here are the common surgical options based on the location and severity of the tendon damage:

Open Tendon Debridement and Repair

During this procedure, the surgeon makes an incision over the affected side of the elbow to access the damaged tendon. Then, they remove the diseased or scarred tissue while preserving healthy tendon tissue. After that, they reattach the healthy tendon to the bone using sutures or anchors. This approach helps restore tendon function and reduce long-term pain.

Percutaneous Tenotomy

This minimally invasive procedure uses ultrasound guidance to target the damaged tendon with a specialized instrument. The device breaks down and removes unhealthy tendon tissue while preserving healthy tissue. In fact, a study published in the Journal of Orthopedic Case Reports found significant long-term improvement in patients with chronic tennis elbow who underwent percutaneous tenotomy. After 3 years of follow-up, researchers found the following clinical outcomes among patients:

• Pain Scores Improved: Average pain scores decreased from 7.1 to 0.2 at the follow-up.
• Arm Function Improved: DASH scores improved from 75.8 to 17.7.
• Elbow Performance Increased: Oxford Elbow Scores increased from 25.7 to 44.1, which shows improvement in elbow function.

Tendon Lengthening (Fasciotomy)

This procedure reduces excessive tension on the affected tendon attachment. During surgery, the surgeon makes a small cut in the tendon or surrounding tissue to decrease strain. This reduces the constant pulling force on the elbow’s bony attachment site. As a result, the remaining tendon tissue can heal more effectively.

Ulnar Nerve Transposition

Our orthopedic specialist, Dr. Charles Ruotolo, may perform ulnar nerve transposition when golfer’s elbow is accompanied by ulnar nerve compression. During this procedure, he carefully moves the nerve to a position at the front of the elbow where it experiences less pressure and friction. This helps reduce symptoms such as numbness, tingling, or weakness in the hand and fingers. As a result, patients experience improved nerve function and greater comfort during daily activities. Call 855-321-6784 for advanced surgical treatment.

How Soon Can You Return to Sports, Work, and Daily Activities?

Recovery from tennis or golfer’s elbow surgery usually takes 3 to 6 months. During the first few weeks, most patients can return to light daily activities. As healing progresses, you may gradually resume more demanding tasks under your surgeon’s guidance. However, returning safely to sports, heavy lifting, or repetitive work activities often takes 4 to 6 months. The overall recovery period also depends on several factors, including:

• Type of Procedure: Minimally invasive procedures often have shorter recovery times than open surgery.
• Extent of Tendon Damage: More severe tendon damage may require a longer healing period.
• Nerve Involvement: Recovery may take longer if the procedure also addresses nerve compression.
• Overall Health: General health and healing ability can affect recovery speed.
• Rehabilitation Progress: Consistent exercise and rehabilitation can support a smoother recovery.
• Activity Level: Tennis players and individuals with physically demanding jobs may require additional recovery time before returning to full activity.

How Can You Prevent Reinjury While Recovering?

To prevent reinjury, you should avoid activities that trigger pain and follow your prescribed exercise program. You should also use braces or supports as recommended to reduce stress on the healing tendon. Beyond that, maintain a healthy diet, modify activities that overload the elbow, and warm up before exercise. As your symptoms improve, gradually increase activity levels and follow proper technique to help protect the elbow from further injury.

Stop Guessing What’s Causing Your Elbow Pain — Get an Accurate Diagnosis from Our Specialist!

Both tennis elbow and golfer’s elbow can cause pain and tenderness around the elbow joint. If your symptoms persist, it can be difficult to determine whether the pain originates from a tendon injury, a nerve problem, or another underlying condition. In such cases, many patients delay care, which can prolong recovery.

Recognized as a Castle Connolly Top Doctor, our surgeon, Dr. Charles Ruotolo, at Total Orthopedics and Sports Medicine, carefully reviews your symptoms and medical history to confirm the diagnosis and create a treatment plan. He also explains your treatment options, recovery timeline, and activity restrictions. Beyond treatment, our team guides you through referrals and co-pays to ensure a smooth recovery. Call 855-321-6784 or visit our clinic for a proper diagnosis.

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