Tennis Elbow vs. Golfer’s Elbow: What’s the Difference?

You have elbow pain when you grip, lift or move your wrist. But is it tennis elbow or golfer’s elbow?

Despite their names, you don’t need to play either sport to develop these conditions. Both affect tendons around the elbow and can cause pain during everyday activities, but there is one key difference: tennis elbow typically causes pain on the outside of the elbow, while golfer’s elbow affects the inside.

The location of your pain can therefore provide a useful first clue. However, not all elbow pain follows the same pattern, and persistent or unexplained symptoms may need further assessment.

Tennis elbow or golfer’s elbow? Start with where it hurts

The location of the pain is often the first clue. Tennis elbow affects the outer side of the elbow, while golfer’s elbow affects the inner side.

This difference comes down to which tendons are affected. Tennis elbow involves tendons connected to muscles that extend the wrist and fingers, while golfer’s elbow involves those that flex them.

Why does tennis elbow hurt on the outside?

Tennis elbow affects the tendons that attach to the bony prominence on the outside of the elbow. These tendons connect to muscles that extend the wrist and fingers, which is why gripping, lifting and certain wrist movements can trigger pain.

The pain may stay around the outer elbow or extend into the forearm. You may notice it when you:

• Grip something firmly
• Lift a cup, bag or pan
• Shake hands
• Turn a door handle
• Use hand tools
• Extend your wrist against resistance
• Play tennis or other racquet sports

You may also notice that your grip feels weaker, particularly when lifting or holding objects.

Why does golfer’s elbow hurt on the inside?

Golfer’s elbow affects the tendons that attach to the bony prominence on the inside of the elbow. These tendons connect to muscles used to flex the wrist and fingers, so pain often becomes more noticeable during gripping, lifting or wrist flexion.

The discomfort can remain around the inner elbow or travel down the inner forearm. Common triggers include:

• Gripping or carrying an object
• Lifting weights
• Bending your wrist forwards
• Throwing repeatedly
• Using hand tools
• Repetitive manual work
• Playing golf

Despite the name, golf is only one possible trigger. Activities at work, in the gym or during everyday life can place similar demands on these tendons.

So why do they feel so similar?

Both conditions affect tendons around the elbow and can cause pain during gripping, lifting and other everyday movements. These activities rarely rely on just one muscle or tendon group, so there can be some overlap in how the symptoms feel.

For example, lifting a heavy bag requires several forearm muscles to work together. If one of the tendons is already irritated, the movement can hurt even if it does not specifically involve wrist extension or flexion.

Symptoms can also develop gradually, making it difficult to pinpoint exactly when the problem started. This is why where the pain is located is an important clue, but not enough on its own to make a diagnosis.

What causes tennis elbow and golfer’s elbow?

Both conditions can develop when the tendons around the elbow are repeatedly placed under more strain than they can adapt to. This can happen gradually through work, exercise, sport or other repetitive activities.

The difference lies in which tendon group is affected:

• Tennis elbow – involves the tendons on the outside of the elbow, particularly those used to extend the wrist and fingers.
• Golfer’s elbow – involves the tendons on the inside of the elbow, particularly those used to flex the wrist and fingers.

Symptoms do not always follow a specific injury. A sudden increase in training, heavier lifting or a new repetitive task can place unfamiliar demands on the tendons and trigger pain. In some cases, symptoms can also begin after an acute injury.

How are tennis elbow and golfer’s elbow diagnosed?

Diagnosis usually starts with a discussion of your symptoms and a physical examination. Dr James Tan will look at where the pain occurs, what tends to trigger it and whether there are other symptoms such as weakness, numbness or restricted movement.

During the examination, Dr Tan may use several tests to reproduce the pain and identify which tendon group is affected:

• Palpation – pressing around the inner and outer bony prominences of the elbow to identify areas of tenderness.
• Resisted wrist extension – pain on the outside of the elbow during this movement can indicate tennis elbow.
• Resisted middle finger extension – this can reproduce pain around the outer elbow in people with tennis elbow.
• Resisted wrist flexion – pain around the inside of the elbow can indicate golfer’s elbow.
• Passive wrist stretching – stretching the affected forearm muscles may reproduce pain at their tendon attachment.
• Grip strength testing – the doctor may compare grip strength between the affected and unaffected arm and check whether gripping reproduces the pain.

Dr Tan may also assess the elbow, wrist and neck or perform nerve tests when the symptoms suggest another possible cause.

Imaging is not always necessary when the symptoms and examination findings are typical. If the diagnosis is unclear, the doctor may recommend an X-ray, ultrasound or MRI to assess the elbow further or rule out another condition.

How is treatment different for tennis elbow and golfer’s elbow?

Treatment for tennis elbow and golfer’s elbow follows similar principles. In both cases, the aim is to reduce strain on the affected tendon, manage pain and gradually restore strength. The main difference is which tendon group the treatment targets.

Non-surgical treatment

Most people start with non-surgical treatment, which may include:

• Activity modification – reducing or adjusting movements that repeatedly aggravate the elbow rather than stopping all activity.
• Physiotherapy – strengthening exercises are tailored to the affected tendon group. Tennis elbow rehabilitation focuses more on the wrist and finger extensors, while golfer’s elbow rehabilitation targets the wrist flexors and pronator muscles.
• Pain relief – pain-relieving medication, heat or cold therapy can help manage symptoms while the tendon recovers.
• Injection treatments – for persistent symptoms, the doctor may discuss options such as platelet-rich plasma (PRP), depending on the condition and response to other treatments.

Is surgery different for tennis elbow and golfer’s elbow?

Yes. Although surgery for both conditions generally involves removing damaged tendon tissue and repairing the tendon where necessary, the location and tendons involved are different.

• Tennis elbow surgery – targets the common extensor tendon origin on the outside of the elbow. The surgeon may remove damaged tissue and repair or reattach the affected tendon.
• Golfer’s elbow surgery – targets the common flexor-pronator tendon origin on the inside of the elbow. The surgeon may debride and repair the affected tendon. The ulnar nerve, which runs close to this area, may also need to be assessed when nerve symptoms are present.

Surgery is generally considered when symptoms remain persistent despite an appropriate course of non-surgical treatment.

When should you get your elbow pain checked?

Mild elbow pain after an unfamiliar activity may improve with rest and changes to the activity that triggered it. However, consider seeing an orthopaedic specialist if:

• The pain persists or continues to worsen
• Everyday activities such as gripping or lifting become difficult
• You notice weakness in your grip or arm
• The symptoms keep returning
• Your elbow movement becomes restricted
• You experience tingling or numbness
• The pain started after an injury

Seek prompt medical attention after a significant injury if the elbow looks deformed, becomes very swollen or you are unable to move or use the arm normally.

Tennis elbow vs golfer’s elbow: the key difference

Ultimately, the difference between tennis elbow and golfer’s elbow largely comes down to one question: is the pain on the inside or outside of your elbow? Tennis elbow affects the outer side, while golfer’s elbow affects the inner side.

Either way, the pain still needs to be managed appropriately, particularly if it is persistent or starting to interfere with everyday activities. If your elbow has been bothering you or isn’t improving, schedule a consultation with Dr James Tan in Singapore for an assessment and treatment plan.

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