Tennis elbow and golfer’s elbow

Tennis elbow and golfer’s elbow are easy to distinguish: If you have tennis elbow, it’s the outside of your elbow that hurts. If you have golfer’s elbow, the inside of your elbow is painful.

What they do have in common is that the pain mostly occurs when you move or touch your elbow. It can spread into your upper arm and forearm, or even to your hand. Pain that occurs when your wrist is stretched outwards and away from your forearm (tennis elbow) or bent inwards towards your forearm (golfer’s elbow) is also a typical symptom. The range of motion in your arm might be limited. The pain may go away a little when your arm is in a resting position, but sometimes it also comes back at night and makes it difficult to sleep.

The tendons involved in the movements that move your wrist forwards and backwards start at the elbow. Doctors believe that small injuries and wear and tear at the base of the tendons that attach to the muscles are what cause the pain.

These symptoms often develop in people who suddenly put very heavy strain on their forearm muscles. but also after long-term frequent repetitive use. Possible causes include:

• Sports like tennis or rowing (tennis elbow), golf or ball games (golfer’s elbow), strength training
• Manual labor like painting, carpentry or chopping wood
• Heavy lifting
• Playing musical instruments, such as the piano
• Working at a computer or a supermarket cash register
• Cooking, for instance chopping or peeling

So although tennis elbow or golfer’s elbow can in fact be caused by playing tennis or golf, the symptoms most often have other causes.

About 2% of people get tennis elbow, and less than 1% have golfer’s elbow. The symptoms are most common in people between the ages of 40 and 60 – probably because the muscles are more susceptible to overuse in middle and older age. These conditions are equally common in men and women.

Sometimes the symptoms go away after just a few weeks, but they often last several months. The pain goes away within one year about 80% of the time. It will take longer otherwise.

The doctor will first ask you what sort of activities make the pain noticeable and whether you have any other medical conditions. They will then examine the arm and see which movements hurt. This might involve extending your arm with the palm of your hand facing down, and then pressing the same hand up and down against a certain amount of resistance. Pain in the elbow when you’re pressing upwards is a sign of tennis elbow, and pain caused by pressing downwards is a sign of golfer's elbow.

This kind of physical examination is usually enough to make a diagnosis. X-rays, ultrasound scans or MRI ( magnetic resonance imaging) are only considered if doctors think that you might have something else.

It can take several months for the symptoms to go away – usually this happens without any major treatment. It is a good idea to avoid the activities that are causing pain as much as possible at the start, or at least to reduce the strain so that the pain is less.

Special exercises to strengthen the forearm and wrist, called “eccentric exercises,” can help to relieve the pain. The goal of treatment is to relieve the pain and to improve the mobility and strength of your arm and wrist. You can do these exercises as treatment for tennis and golfer’s elbow on your own at home. Manual therapy by a physiotherapist can help too.

NSAID (non-steroidal anti-inflammatory drug) painkillers like ibuprofen can offer temporary pain relief. Steroid injections can also relieve pain, but they may disrupt the healing process. A few studies suggest that ultrasound therapy can somewhat improve the pain caused by tennis elbow.

Surgery may be considered if the symptoms last for a long time despite treatment. There has hardly been any research on its benefits, though.

Many other treatments are available, but they haven’t been proven to help. These include various injections (e.g. autologous blood or Botox), laser therapy, electrotherapy, massages, shock wave therapy and acupuncture. Public health insurers in Germany usually don't cover the costs of these treatments.

When people are ill or need medical advice, they usually go to see their family doctor first. Information about health care in Germany can help you to navigate the German healthcare system and find a suitable doctor. You can use this list of questions to prepare for your appointment.