Elbow pain can be agonizing making simple movements of your arm almost impossible What is the difference between Tennis Elbow vs Golfer’s Elbow? Can someone have both of them at the same time? How do you treat them? What is the best treatment? Let’s dig in.
Elbow Anatomy
The elbow joint is a hinged joint that also has the unique ability to rotate. It is composed of three principal bones: the arm bone (humerus) and the two bones that make up the forearm, the radius, and ulna. There are two important boney surfaces on the humerus that are called epicondyles. The medial epicondyle is on the inside of the elbow joint whereas the lateral epicondyle is on the outside. The epicondyle is where tendons and ligaments attach. Tendons are thick bands of connective tissue that connect muscle to bone whereas ligaments connect bone to bone. The lateral epicondyle is where the extensor and supinator tendons and collateral ligaments attach. The medial epicondyle is where the flexor and pronator tendons attach. Tendons are susceptible to injury including inflammation, tears, and ruptures.
What Is the Difference Between Tennis Elbow vs Golfer’s Elbow?
Both conditions involve inflammation, microinjury and degeneration of the tendons at their attachment on the epicondyle which is also called epicondylitis (1). The difference is in the location. Tennis Elbow, also know as lateral epicondylitis, is inflammation and injury and pain on the outside of the elbow whereas Golfer’s Elbow which also known as medial epicondylitis, affects the inside of the elbow. If it helps Tennis, Lateral and outside all have T‘s and is an easy way to remember that Tennis elbow involves the LaTeral or OuTside of the elbow. Pain is the primary symptom.
Tennis Elbow (Lateral Epicondylitis)
Lateral epicondylitis occurs in approximately 1-3% of the population annually and is most common in 30-50-year-olds (2). Symptoms typically occur due to overuse or strain from repetitive gripping or wrist extension. Risk factors for lateral epicondylitis are increased age, increased BMI, rotator cuff disease, carpal tunnel syndrome, oral steroid use, and smoking (3).
Golfer’s Elbow (Medial Epicondylitis)
This condition is less common that lateral epicondylitis with a prevalence of less than 1% (4). Patients at risk include overhead throwers and workers lifting heavy objects (5). Other important causes of pain on the inside of the elbow include ulnar nerve disorders, neck nerve irritation, and laxity or tearing of the collateral ligament (6). Pain is typically gradual in onset and may be accompanied by grip strength weakness.
Can Someone Have Tennis Elbow and Golfer’s Elbow at the Same Time?
While medial epicondylitis, AKA Golfers Elbow, is less common than Tennis elbow it is possible to have both conditions are the same time.
How Do You Treat Tennis Elbow and Golfers Elbow?
Treatment options depend upon the severity of the injury, past medical history, access to medical care and your physician’s preferences. In general, it is always best to start with conservative therapy. Treatment options include:
Conservative Treatment
This includes activity modification, ice, heat, physical therapy, and acupuncture. Research has shown that therapeutic tape helps improve both grip strength and pain. (7)
Medications
When conservative treatment options fail, NSAID and steroid injections are often recommended. NSAIDs are thought to increase viral spread and should be avoided (8). Steroids compromise our immune function and also cause cell death and therefore should also be avoided (9).
Surgery
Many different surgical options exist depending upon the severity of the injury including stripping away a portion of the tendon sheath to promote healing. The goal is to clean out any dead tissue as well as repair any tendon tears. Surgery may also involve the nerves especially with medial epicondylitis where the ulnar nerve is oftentimes decompressed or repositioned (10). Comp[lications occur and include loss of grip strength (11), infection, escalation of pain, ligament instability, neuroma formation and late return to work due to prolonged postoperative recovery time (12).
Does Cortisone Shot Help Golfers Elbow?
Steroids are powerful anti-inflammatory agents that can provide short term benefits. Unfortunately, they can also cause cell death, compromise immune system function and repair and should be avoided.
What is the Best Treatment?
PRP injections have been shown to be more effective than steroids (13). PRP studies have shown PRP to be so effective in the treatment of lateral epicondylitis that is is now the standard of care (14).
At the Centeno-Schultz Clinic, we are experts in the treatment of Tennis and Golfer’s elbow. Under ultrasound guidance, super-concentrated PRP is injected into the areas of injury and tears to reduce swelling, promote healing and accelerate recovery. Board-certified, fellowship-trained physicians are available to evaluate your elbow pain in addition to assessing your shoulder and neck as both my be contributing to your elbow pain. Using the SANS approach which evaluates stability, symmetry, neurologic function and articulation, can optimize your clinical outcome.
Elbow pain can be debilitating. The elbow joint is comprised of three bones which include the humerus, radius, and ulna. Two boney prominences on the humerus bone are called epicondyles and are the site of attachment of tendons and ligaments. Inflammation and microinjury can occur which is called epicondylitis. The difference between Tennis Elbow vs Golfer’s Elbow is one of location. Tennis Elbow involves the lateral or outside of the elbow whereas Golfer’s Elbow involves the inside of the elbow. Both can occur simultaneously. Treatment options include conservative care, medications including steroids and surgery. PRP is an effective, nonsurgical option that is the standard of care for lateral epicondylitis and avoids the risks of surgery, and extensive rehabilitation. In addition, PRP injections avoid the risk of viral infection associated with operating rooms, hospitals and ambulatory surgery centers. Don’t let elbow pain keep you on the sidelines. Let your own cells heal your ongoing elbow pain.
1.Taylor SA, Hannafin JA. Evaluation and management of elbow tendinopathy. Sports Health. 2012;4(5):384-93.
2. Garg R, Adamson GJ, Dawson PA, Shankwiler JA, Pink MM. A prospective randomized study comparing a forearm strap brace versus a wrist splint for the treatment of lateral epicondylitis. J Shoulder Elbow Surg. 2010;19(4):508–512.
3..Lai WC, Erickson BJ, Mlynarek RA, Wang D. Chronic lateral epicondylitis: challenges and solutions. Open Access J Sports Med. 2018;9:243-51.
4. Prevalence and determinants of lateral and medial epicondylitis: a population study. Shiri R, Viikari-Juntura E, Varonen H, Heliövaara M Am J Epidemiol. 2006 Dec 1; 164(11):1065-74.
8.Russell B, Moss C, Rigg A, Van Hemelrijck M. COVID-19 and treatment with NSAIDs and corticosteroids: should we be limiting their use in the clinical setting. Ecancermedicalscience. 2020;14:1023.
9.Pace CS Soft Tissue Atrophy Related to Corticosteroid Injection: Review of the Literature and Implications for Hand Surgeons. J Hand Surg Am. 2018 Jun;43(6):558-563. doi: 10.1016/j.jhsa.2018.03.004. Epub 2018 Apr 3. PMID: 29622410 https://www.ncbi.nlm.nih.gov/pubmed/29622410
10. Reconstruction of the ulnar collateral ligament in athletes. Jobe FW, Stark H, Lombardo SJJ Bone Joint Surg Am. 1986 Oct; 68(8):1158-63.
13.Barnett J, Bernacki MN, Kainer JL, Smith HN, Zaharoff AM, Subramanian SK. The effects of regenerative injection therapy compared to corticosteroids for the treatment of lateral Epicondylitis: a systematic review and meta-analysis. Arch Physiother. 2019;9:12. Published 2019 Nov 13. doi:10.1186/s40945-019-0063-6
Dr. John R. Schultz is an interventional pain management specialist and is double-boarded in both Anesthesiology and Pain Management. He is a member and prior instructor for the Spine Interventional Society (SIS) and holds state licensure in Utah, Colorado and North Carolina... VIEW PROFILE BOOK AN APPOINTMENT