The elbow joint is often associated with overuse-type injuries, two of which are commonly referred to as golfer’s elbow and tennis elbow. Both of these common names refer to what is more technically called tendinosis. You might have previously heard golfer’s elbow and tennis elbow referred to as tendinitis or epicondylitis. However, current research suggests that the more accurate description of these symptoms is actually tendinosis. 

What’s the difference between tendinosis and tendinitis?

Tendinosis means a deterioration of the collagen fibers in the tendon as a result of overuse. Overuse injuries like golfer’s elbow or tennis elbow occur when an action is repeated over time. This is in contrast to an acute type of injury, which might be the result of a fall or an accident. Tendinitis refers to inflammation of a tendon that would occur from micro-tears often as a result of that kind of acute injury. It’s important to distinguish between these two terms because the treatment for each of these two situations can be very different.

Golfer’s elbow and tennis elbow are technically called medial epicondylosis and lateral epicondylosis. The epicondyles are rounded bony protuberances at the distal end of the humerus. They are attachment sites for multiple muscles and tendons. The medial epicondyle is located on the inside of the elbow and the lateral epicondyle is on the outside of the elbow.

Medial epicondylosis means that this degeneration is happening at the tendon which attaches to the medial epicondyle of the humerus. It’s commonly called golfer’s elbow due to the specific repetitive use actions that occur in that sport. 

Lateral epicondylosis specifically refers to degeneration of the attachment of the common extensor tendon at the lateral epicondyle of the humerus. It’s commonly called tennis elbow due to the actions repeated in that sport. 

Why might lateral epicondylosis occur in tennis players?

The common extensor tendon on the lateral epicondyle is where a number of forearm and wrist muscles meet to form that common tendon. Those muscles are generally responsible for extension of the wrist and supination of the forearm. This combination of wrist and forearm movements is repeated frequently in tennis racket strokes, particularly in the backhand stroke. 

Lateral epicondylosis is not unique to tennis players

Other activities that repeat the same actions could cause the same irritation and deterioration of the common extensor tendon attachment over time. Any kind of activity that requires repetitive wrist extension can lead to tendinosis of the extensor tendons (not just tennis). Other activities where lateral epicondylosis could occur include: other racket sports, like racquetball or squash, fencing, and occupations such as meat cutting, plumbing, or painting.

Why might medial epicondylosis occur in golfers?

The specific combination of elbow and forearm movements used in a golf swing can irritate the tendinous attachment of the forearm muscles at the medial epicondyle of the elbow and eventually result in some degeneration of the collagen fibers at those tendinous attachments. In this case it is specifically tendinosis of the tendinous origin of the flexors and pronator muscles which attach to the medial epicondyle of the humerus.

Activities that require repetitive wrist flexion and or forearm pronation, like golf swings, can lead to tendinosis of the flexor and pronator tendons. When this is repeated frequently over time, this can result in medial epicondylosis. 

Medial epicondylosis is not unique to golfers

Other occupational tasks like repetitively using tools (screwdriver, hammer, etc.), bricklaying, typing, or painting can also contribute to tendinosis of the medial epicondyle. You might also see golfer’s elbow come up in other sports such as rowing or pitching in baseball. Golfer’s elbow is a little less common than tennis elbow, but still occurs frequently among elbow and forearm overuse injuries. 

Symptoms of golfer’s elbow and tennis elbow

Symptoms of either lateral or medial epicondylitis tend to show up in the dominant arm and are about equally as common among women as in men (Jobe and Ciccotti, 1994). Symptoms of lateral epicondylosis might specifically include pain on or around the lateral epicondyle which can radiate into the forearm. Symptoms of medial epicondylosis might include pain that is on or around the medial epicondyle. The pain is often worse when a person resists wrist flexion or forearm pronation.

If you experience symptoms of either tennis elbow or golfer’s elbow, see an appropriate medical professional for a thorough assessment and treatment plan.

If you’d like to learn more about structures that make up the elbow joint and forearm, check out the article Exploring The Elbow Joint And Forearm. 

References

Bass, E. 2012. Tendinopathy: Why the difference between tendinitis and tendinosis matters. International Journal of Therapeutic Massage Bodywork. 5(1):14-17.

Jobe, F.W. and M.G. Ciccotti. 1994. Lateral and medial epicondylitis of the elbow. Journal of the American Academy of Orthopaedic Surgeons. 2(1):1-8.

McMurtrie, A. and A.C. Watts. 2012. Tennis elbow and golfer’s elbow. Orthopaedics and Trauma. 26(5):337-344.

Sellards, R. and C. Kuebrich. 2005. The elbow: Diagnosis and treatment of common injuries. Primary Care: Clinics in Office Practice - Journal. 32:1-16.