Golfer's Elbow

Upper Limb

Overview

Golfer's elbow is an overuse injury characterized by inflammation and micro-tears of the flexor-pronator muscle group origin at the medial epicondyle of the humerus. It presents with medial elbow pain that worsens with gripping, wrist flexion, and pronation activities. The condition is common in repetitive gripping activities including golf, racquet sports, throwing, and occupational tasks.

Pathophysiology

Repetitive or forceful wrist flexion, pronation, and gripping activities create cumulative microtrauma to the common flexor tendon origin. This leads to degenerative changes, inflammation, and tendinopathy rather than acute inflammation. The primary muscles affected include flexor carpi radialis, palmaris longus, flexor carpi ulnaris, and pronator teres. Chronic cases involve tissue remodeling with collagen disorganization and possible calcification.

Patient Education

Gradual return to activity with proper technique and adequate rest between sessions is essential; avoidance of repetitive gripping motions and consistent strengthening of wrist and forearm muscles will prevent recurrence.

Typical Presentation

Site

Medial epicondyle of the humerus, with radiation into the medial forearm and occasionally into the wrist and hand

Quality

Dull ache progressing to sharp pain with activity; may describe tightness or stiffness

Intensity

Mild to moderate (3-7/10) at rest, increasing significantly with gripping or wrist flexion activities

Aggravating

Gripping activities, wrist flexion against resistance, pronation, forceful finger flexion, repetitive throwing or swinging motions, activities requiring sustained grip strength

Relieving

Rest, ice application, anti-inflammatory medication, gentle passive stretching, avoiding provocative activities, heat in subacute phase

Associated

Weakness in grip strength, reduced pronation strength, morning stiffness, possible referred pain to medial forearm, compensatory tension in shoulder and neck, difficulty with fine motor tasks

Orthopaedic Tests

Test descriptions are written with AI assistance from standard clinical texts. Where a test lists Sources, its description has been checked against them; those sources are independent and do not endorse OsteoKit. Accuracy figures and grades (A–D) appear only when checked against the published study; tests without one are marked “No accuracy study”.

Further reading: full test procedures are described in standard clinical examination texts, e.g. Magee & Manske, Orthopedic Physical Assessment (7th ed.), and Cook & Hegedus, Orthopedic Physical Examination Tests: An Evidence-Based Approach (2nd ed.).

No accuracy study

Resisted Wrist Flexion Test (Medial Epicondylalgia)

Procedure

Patient's elbow is extended and the forearm pronated. The examiner resists active wrist flexion while palpating the medial epicondyle and the flexor-pronator mass.

Positive Finding

Pain at the medial epicondyle or in the proximal forearm flexor muscles during resisted wrist flexion.

Interpretation

Loads the common flexor origin at the medial epicondyle. Pain here supports medial epicondylalgia. This test is sometimes wrongly labelled "Cozen's test" — Cozen's is a lateral elbow test and the two should not be confused. No study has measured the accuracy of any physical test for medial epicondylalgia.

Sources

No accuracy study

Golfer's Elbow Test (Mill's Reverse Test)

Procedure

Patient extends the elbow with the forearm supinated. Examiner palpates the medial epicondyle while passively extending the wrist and fingers.

Positive Finding

Reproduction of pain at the medial epicondyle during passive wrist and finger extension

Interpretation

Direct stress applied to the common flexor origin; pain reproduction indicates medial-sided tendinopathy or epicondylitis No published study reports the sensitivity or specificity of any physical examination test for medial epicondylalgia. A systematic review of elbow examination (Zwerus et al., Br J Sports Med 2018, PMID 28249855) searched for such studies and found none eligible. Treat a positive test as part of the clinical picture, not as a diagnostic finding.

Sources

No accuracy study

Medial Epicondyle Palpation

Procedure

Patient seated with elbow flexed to 90°. Examiner palpates the medial epicondyle and the adjacent soft tissues of the flexor-pronator mass.

Positive Finding

Tenderness, nodularity, or reproducible point tenderness over the medial epicondyle or common flexor tendon origin

Interpretation

Identifies where the pain is coming from. Tenderness here is consistent with medial epicondylalgia but is not specific — the medial epicondyle is tender in several conditions, including ulnar nerve irritation and medial ligament injury. Palpation locates a problem; it does not confirm what the problem is, and it cannot show inflammation.

Sources

No accuracy study

Pronation Stress Test

Procedure

Patient flexes elbow to 90° and supinates the forearm. Examiner applies passive pronation torque while maintaining elbow flexion.

Positive Finding

Pain or apprehension along the medial forearm or at the medial epicondyle during pronation stress

Interpretation

Stresses the pronator teres and flexor carpi radialis; pain suggests flexor-pronator muscle or tendon involvement No published study reports the sensitivity or specificity of any physical examination test for medial epicondylalgia. A systematic review of elbow examination (Zwerus et al., Br J Sports Med 2018, PMID 28249855) searched for such studies and found none eligible. Treat a positive test as part of the clinical picture, not as a diagnostic finding.

Further reading

No accuracy study

Wrist Flexor Strength Test

Procedure

Patient flexes the wrist against examiner resistance while the elbow is extended and forearm pronated.

Positive Finding

Weakness, pain, or inability to generate normal grip strength during resisted wrist flexion

Interpretation

Assesses functional integrity of flexor musculature; weakness or pain suggests active tendon or muscle pathology No published study reports the sensitivity or specificity of any physical examination test for medial epicondylalgia. A systematic review of elbow examination (Zwerus et al., Br J Sports Med 2018, PMID 28249855) searched for such studies and found none eligible. Treat a positive test as part of the clinical picture, not as a diagnostic finding.

Sources

No accuracy study

Scratch Collapse Test (Medial)

Procedure

Patient sits with the elbows tucked at the sides, flexed to 90°, and resists the examiner pushing the forearms inward (resisted shoulder external rotation). The examiner then lightly scratches the skin over the suspected site of nerve compression and immediately repeats the resisted test.

Positive Finding

A brief loss of resistance — the arm gives way — on the side that was scratched.

Interpretation

A test for focal compression of a peripheral nerve, not for pain sensitivity or central sensitisation. It was developed and studied for cubital tunnel syndrome and carpal tunnel syndrome (sensitivity 69% for cubital tunnel, PMID 18984333). It has not been studied for medial epicondylalgia, so it carries no diagnostic value on this page. If ulnar nerve compression is suspected, see the cubital tunnel syndrome page.

Sources

⚠ Red Flags

  • •Signs of neurovascular compromise (swelling with discoloration, coolness, numbness in hand/fingers)
  • •Severe unrelenting pain unresponsive to conservative treatment for 12+ weeks
  • •Evidence of acute fracture or dislocation on imaging
  • •Signs of infection (warmth, erythema, systemic fever)
  • •Progressive neurological deficit affecting hand function or sensation
  • •History of severe trauma with structural disruption

⚡ Yellow Flags

  • •Prolonged work absence or fear of returning to work
  • •Catastrophic thinking about the condition or fear of re-injury
  • •Psychological distress or depressed mood affecting recovery motivation
  • •Excessive focus on symptoms despite clinical improvement
  • •Secondary gain from disability (compensation, attention seeking)
  • •Poor compliance with rehabilitation despite clear instructions
  • •Beliefs that activity will cause permanent damage

Osteopathic Techniques

More than 90% of patients improve without surgery. Care starts with activity modification and a counterforce strap, then physical therapy that includes soft-tissue mobilisation of the flexor-pronator mass and progresses to eccentric wrist flexor and pronator strengthening; throwers also strengthen the shoulder and scapular muscles. No trials of osteopathic techniques in medial elbow pain were found, so the grades lean on tennis elbow trials.

Region

Medial epicondyle and flexor-pronator mass

Technique

Soft tissue, elbow and forearm
Grade D
Low evidence: expert consensus or could not be verified against literature
No trials in golfer’s elbow. In tennis elbow, deep friction helped but was not shown to beat other treatments.

Rationale

Soft tissue to the forearm muscles and their tendon origins around the elbow, usually alongside a loading programme.

How it's done, cautions & evidence

How it's done

Hands-on kneading, stroking and sustained pressure to the forearm extensor and flexor muscles, their tendon origins at the epicondyles, the supinator, the pronators and the triceps. Deep transverse friction across the tendon origin is part of the Cyriax method for lateral elbow pain.

Cautions

Avoid direct pressure on an olecranon bursitis. A red, warm, tender bursa, especially with fever, may be septic and needs medical review.

Evidence in Golfer's Elbow

Searched 26 Oct 2026: no trials of soft tissue technique in medial epicondylitis (Hoogvliet 2013 found only lateral elbow trials). Indirect: Giannikou 2025 (SR, lateral elbow tendinopathy): moderate evidence for the Cyriax method, not shown to be better than other treatments.

Region

Wrist flexors and pronators

Technique

Muscle energy, elbow and forearm
Grade D
Low evidence: expert consensus or could not be verified against literature
No trials in golfer’s elbow. In tennis elbow, MET did better than a steroid injection at 6 and 12 months in one trial.

Rationale

Muscle energy technique to ease tight forearm muscles around the elbow (wrist extensors or flexors, pronators or supinators).

How it's done, cautions & evidence

How it's done

The wrist or forearm is taken to the barrier of the tight muscle group (wrist extensors or flexors, pronators or supinators). The patient pushes gently back, at about 10–20% effort, against resistance for 5–10 seconds, relaxes for 3–5 seconds, and the new barrier is taken up.

Cautions

Not used with an acute fracture, a joint infection or a bone malignancy; take care with severe osteoporosis or after surgery that limits muscle contraction. Use the least force needed: too much can tear a muscle or pull off a tendon, especially in older patients.

Evidence in Golfer's Elbow

Searched 26 Oct 2026: no trials of muscle energy technique in medial epicondylitis. Indirect: Küçükşen 2013 (RCT, lateral epicondylitis, n=82): MET gave better pain and pain-free grip than a steroid injection at 26 and 52 weeks.

Region

Humeroulnar and humeroradial joints

Technique

Articulation, elbow and forearm
Grade D
Low evidence: expert consensus or could not be verified against literature
No trials in golfer’s elbow. In tennis elbow, mobilisation with movement improved pain and grip in a meta-analysis.

Rationale

Gentle glides of the humeroulnar, humeroradial and radioulnar joints to restore elbow and forearm movement.

How it's done, cautions & evidence

How it's done

Passive, rhythmic, low-velocity glides of the humeroulnar, humeroradial (radiocapitellar) and proximal radioulnar joints, within or up to the end of the available range. In lateral elbow pain, trials tested mobilisation with movement (Mulligan) and regional mobilisation.

Cautions

After a fall or a direct blow, rule out a fracture first: a suspected olecranon fracture needs orthopaedic review. A complete ulnar collateral ligament tear is an indication for surgical referral.

Evidence in Golfer's Elbow

Searched 26 Oct 2026: no trials of elbow mobilisation in medial epicondylitis. Indirect: Lucado 2019 (SR/MA, lateral elbow tendinopathy): mobilisation with movement improved pain and grip strength.

Region

Shoulder girdle and rotator cuff

Technique

Muscle energy, glenohumeral (posterior shoulder)No trials found

Rationale

Muscle energy technique for the shoulder girdle and rotator cuff, the next link in the chain above the elbow.

How it's done, cautions & evidence

How it's done

Take the arm to the barrier in horizontal adduction or internal rotation. The patient gently pushes back (horizontal abduction or external rotation) against equal resistance at 10–20% effort for 5–10 seconds, then relaxes for 3–5 seconds, and the arm is taken to the new barrier. Repeat 3–5 times, then re-check range.

Cautions

Very safe, but not used with a fracture, a ruptured ligament, tendon or muscle, or a joint infection.

Evidence in Golfer's Elbow

Searched 26 Oct 2026: no trials of shoulder muscle energy technique in medial epicondylitis.

Rehabilitation Exercises

Wrist Flexion and Extension Pendulum

Range of MotionBeginner

Flexor Carpi Radialis Stretch (Wrist Extension Stretch)

StretchingBeginner

Pronator Stretch (Supination Stretch with Elbow Extended)

StretchingBeginner

Wrist Flexion Strengthening with Resistance Band

StrengtheningBeginner

Eccentric Wrist Flexion Lowering Exercise

StrengtheningIntermediate

Pronation Strengthening Against Resistance

StrengtheningIntermediate

Grip Strengthening with Progressive Resistance

StrengtheningIntermediate

Scapular Stabilization and Shoulder Blade Squeeze

PosturalBeginner

Rotator Cuff Strengthening (External Rotation at Side)

PosturalIntermediate

Forearm Supination and Pronation with Hammer Weight

StrengtheningIntermediate

Elbow Flexion and Extension Active Range

Range of MotionBeginner

Upper Extremity Nerve Gliding Exercises

StretchingIntermediate

Referral Criteria

  • •Failure to improve after 6-8 weeks of conservative management
  • •Persistent severe pain limiting daily function and work capacity
  • •Signs of nerve compression (numbness, tingling radiating into hand)
  • •Suspected fracture, avulsion, or structural disruption on clinical examination
  • •Systemic symptoms suggesting inflammatory or infectious process
  • •Vascular insufficiency signs requiring vascular assessment
  • •Chronic cases (>3 months) with significant functional limitation suitable for imaging or specialist assessment
  • •Consideration for corticosteroid injection or platelet-rich plasma therapy when conservative care plateaus
  • •Psychological distress or difficulty coping with symptoms affecting recovery