Is it tennis elbow or golfer's elbow?
Both are tendinopathies at the elbow, and the names are misleading. Tennis elbow sits on the outside of the elbow at the lateral epicondyle, where the wrist extensor tendons meet the bone. Golfer's elbow sits on the inside, at the medial epicondyle, where the wrist flexor and forearm pronator tendons attach. Same tissue type, opposite sides, different provocation patterns. People end up confusing them because the pain can spread down the forearm in both cases.
Written by Kareem Hassanein, Registered Physiotherapist. Burlington, Ontario. This is a guide, not a diagnosis. A brief in-person exam sorts these out reliably.
Side by side
The patterns that separate tennis elbow from golfer's elbow in clinic. Read across each row and compare.
| Aspect | Tennis elbow | Golfer's elbow |
|---|---|---|
| Where it hurts | Outside of the elbow, over the bony point on the lateral side. Often spreads down the back of the forearm toward the wrist. | Inside of the elbow, over the bony point on the medial side. Often spreads down the front of the forearm toward the palm side of the wrist. |
| Movement that provokes it | Gripping, lifting with the palm down, backhand strokes, wringing a towel, opening jars. Wrist extension against resistance is the classic trigger. | Gripping hard, wrist flexion, forearm rotation on the golf downswing, carrying heavy bags with the palm up, throwing. |
| Who typically gets it | Trades, office workers with sustained mouse and keyboard loads, racquet sports players (especially faulty backhand technique), new guitarists. | Golfers, pitchers, climbers, weightlifters doing heavy pulling and grip work, tradespeople with repeated hammering or screwing. |
| What it feels like with a cup of coffee | Pain at the outside of the elbow when lifting the mug with the palm facing down. This is one useful clue, but it cannot confirm the diagnosis on its own. | Pain at the inside of the elbow when lifting the mug with the palm facing up or carrying groceries with the arm at the side. |
| How tender the bone is | Sharp tenderness when I press on the lateral epicondyle, the bony bump on the outside of the elbow. | Sharp tenderness when I press on the medial epicondyle, the bony bump on the inside of the elbow. |
| Nerve-type symptoms | Rarely involves numbness or tingling. If that is present, the radial nerve can be irritated as a secondary issue. | Can overlap with ulnar nerve irritation at the cubital tunnel, producing tingling into the ring and little fingers. That changes the plan. |
| How common it is | More common than golfer's elbow. Lateral elbow pain affects roughly 1 to 3 percent of adults. | Less common, roughly a third as frequent as tennis elbow in the general population. |
Where it hurts
Tennis elbow
Outside of the elbow, over the bony point on the lateral side. Often spreads down the back of the forearm toward the wrist.
Golfer's elbow
Inside of the elbow, over the bony point on the medial side. Often spreads down the front of the forearm toward the palm side of the wrist.
Movement that provokes it
Tennis elbow
Gripping, lifting with the palm down, backhand strokes, wringing a towel, opening jars. Wrist extension against resistance is the classic trigger.
Golfer's elbow
Gripping hard, wrist flexion, forearm rotation on the golf downswing, carrying heavy bags with the palm up, throwing.
Who typically gets it
Tennis elbow
Trades, office workers with sustained mouse and keyboard loads, racquet sports players (especially faulty backhand technique), new guitarists.
Golfer's elbow
Golfers, pitchers, climbers, weightlifters doing heavy pulling and grip work, tradespeople with repeated hammering or screwing.
What it feels like with a cup of coffee
Tennis elbow
Pain at the outside of the elbow when lifting the mug with the palm facing down. This is one useful clue, but it cannot confirm the diagnosis on its own.
Golfer's elbow
Pain at the inside of the elbow when lifting the mug with the palm facing up or carrying groceries with the arm at the side.
How tender the bone is
Tennis elbow
Sharp tenderness when I press on the lateral epicondyle, the bony bump on the outside of the elbow.
Golfer's elbow
Sharp tenderness when I press on the medial epicondyle, the bony bump on the inside of the elbow.
Nerve-type symptoms
Tennis elbow
Rarely involves numbness or tingling. If that is present, the radial nerve can be irritated as a secondary issue.
Golfer's elbow
Can overlap with ulnar nerve irritation at the cubital tunnel, producing tingling into the ring and little fingers. That changes the plan.
How common it is
Tennis elbow
More common than golfer's elbow. Lateral elbow pain affects roughly 1 to 3 percent of adults.
Golfer's elbow
Less common, roughly a third as frequent as tennis elbow in the general population.
What I check in person to separate them
These are the clinical tests I actually run in the first visit. You cannot do them all on yourself reliably, but understanding what they look for helps explain why an in-person exam sorts these so quickly.
Cozen's test (resisted wrist extension)
With the elbow straight and the forearm turned palm-down, I resist you extending the wrist. Pain at the outside of the elbow suggests tennis elbow.
Mill's test (passive wrist flexion with the elbow straight)
Stretching the wrist extensors by bending the wrist down while the elbow is straight often reproduces lateral elbow pain in tennis elbow.
Resisted wrist flexion with the forearm palm-up
Pain at the inside of the elbow on resisted wrist flexion is the main resisted test for golfer's elbow.
Resisted forearm pronation
Resisted turning of the palm down against my hand often reproduces medial elbow pain in golfer's elbow because pronator teres shares that origin.
Tinel's at the cubital tunnel
Tapping behind the medial epicondyle. Tingling into the ring and little fingers suggests the ulnar nerve is involved, which changes management and sometimes sits on top of golfer's elbow.
Which pattern fits you better?
Plain-language routing. This is not a diagnosis, and real patients often sit between the two, but the language below is a reasonable starting point.
Tennis elbow
Your pattern more likely fits tennis elbow if the pain sits on the outside of the elbow, lifting a coffee mug with the palm down hurts, gripping and wrist extension trigger it, and the bony bump on the outside is tender. It often starts after an increase in gripping work, a change in racquet technique, or a heavy stretch of yard work or trades.
Read the tennis elbow pageGolfer's elbow
Your pattern more likely fits golfer's elbow if the pain sits on the inside of the elbow, carrying a shopping bag or lifting with the palm up hurts, wrist flexion and forearm rotation trigger it, and the bony bump on the inside is tender. It often flares after heavier grip work, a change in a golf or throwing motion, or climbing volume going up. Inner elbow pain can also come from the ulnar nerve or, in throwers, a ligament, so I check those too.
Read the golfer's elbow pageIf you still cannot tell
If you cannot tell whether the pain is on the inside or the outside of the elbow, or if it feels like both, do not keep pushing through. The mug-lifting pattern is one useful clue, but it cannot confirm the diagnosis. An assessment combines your history, the tender area, strength and movement tests, and a nerve screen, and I look upstream at the shoulder and neck because elbow pain can be referred. Self-directed stretching of the wrong tendon can drag the condition out.
When both are going on
Both conditions can coexist in the same arm, particularly in tradespeople and climbers. It is also common to see a tennis elbow picture with a partly irritable neck or a stiff thoracic spine contributing to forearm overload. That is why I always screen the whole upper quadrant on the first visit rather than only treating the elbow.
When to see a doctor first
- A fall onto the arm with swelling, an obvious change in shape, or inability to bend or straighten the elbow. Go to emergency or urgent care to rule out a fracture or dislocation.
- A pop at the elbow during a heavy lift, with sudden weakness or bruising. See a doctor within a few days. A tendon rupture needs prompt assessment.
- Numbness, tingling, or weakness in the hand that is getting worse. See your family doctor before starting physiotherapy.
- A hot, red, swollen elbow with fever or feeling unwell. Seek same-day medical care to rule out an infection.
Questions patients ask about telling these apart
Can I have tennis elbow and golfer's elbow at the same time?
Yes, and it happens more than people expect. Tradespeople, climbers, and anyone doing heavy repeated gripping can overload both the extensor and flexor tendons in the same arm. The tender points sit on opposite sides of the elbow, so the exam can usually tell them apart, but the plan needs to address both origins at once.
I don't play tennis or golf. Can I still have these conditions?
Yes. Many people with lateral or medial epicondyle tendinopathy have never played tennis or golf. The sports lent their names to the conditions, not their exclusive causes. Gripping, lifting, computer work, trades, gardening, guitar playing, and parenting a heavy toddler are all common real-world triggers.
Why does the pain travel down my forearm?
The forearm muscles that attach at the epicondyles run most of the way to the wrist. When the tendon origin is irritable, the muscle belly picks up protective tone, which can feel like a dull ache extending toward the wrist. It does not usually mean something separate is wrong, but if there is numbness, tingling, or weakness in the hand, that warrants a nerve screen.
Does a cortisone injection fix this?
It can reduce pain in the short term, but the longer-term results for cortisone in tennis elbow are poor. The 2013 Coombes et al. trial in JAMA showed corticosteroid injection had worse one-year outcomes than placebo. For many people, a progressive loading program plus sensible load adjustment is the better medium-term option, and any injection decision belongs with a physician.
How long does each usually take to settle with physiotherapy?
Tendons recover slowly. Many people notice real change over a few months of dosed loading, with earlier wins in pain and grip as the irritation calms. Severe or long-standing cases can take longer. If symptoms are getting worse rather than better over three to four weeks of good rehab, I re-examine rather than just pushing on.
Can I keep training or working while I rehab this?
Usually yes, with modifications. I adjust the specific provoking movements, change grip width or handle size where possible, and keep the tendon working at a load it can tolerate. Complete rest does not usually build a tendon's tolerance, so the aim is better dosing rather than no activity.
Evidence this page draws on
Sources I lean on when separating these two conditions in clinic.
Corticosteroid injection was worse than placebo at one year for lateral elbow pain, with a higher recurrence rate.
Coombes BK et al., JAMA 2013; 309(5): 461-469.
Therapeutic exercise, including progressive resistance exercise, is part of the recommended conservative care for lateral elbow pain.
Lucado AM et al., "Lateral Elbow Pain and Muscle Function Impairments: Clinical Practice Guidelines." JOSPT 2022; 52(12): CPG1-CPG111.
Lateral epicondyle tendinopathy affects roughly 1 to 4 percent of the general adult population and is several times more common than medial epicondyle tendinopathy.
Shiri R, Viikari-Juntura E. "Lateral and medial epicondylitis: role of occupational factors." Best Practice & Research Clinical Rheumatology 2011; 25(1): 43-57.
Treatments that commonly sit inside either plan
The specific mix depends on the assessment and your goals. These are the pieces I draw from most often for both conditions.
Exercise Therapy
Personalized exercise programs designed to restore strength, flexibility, and function.
Dry Needling
Thin needles placed in tight, tender bands of muscle. It can help ease pain and muscle tension in the short term.
Soft Tissue & Myofascial Therapy
Targeted hands-on techniques to ease muscle tension, tenderness, and stiffness.
Joint Mobilization
Graded techniques to restore joint movement and reduce stiffness.
Cupping Therapy
Technique using controlled suction to address muscle tension and localized pain.
Book an assessment
If this page has helped you narrow things down, or if it has left you wanting a proper exam, I see patients at Endorphins Health & Wellness Centre in Burlington. Direct insurance billing is available, and a physician referral is not required.
4631 Palladium Way, Unit 6
Burlington, ON L7M 0W9
Direct billing. No referral needed.
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