Were You Told You Have Golfer's Elbow and Offered Another Cortisone Shot? There Is a Better Option.
Golfer's elbow — medial epicondylitis — causes pain on the inner side of the elbow, where the flexor and pronator tendons attach to the bone. It is roughly one-fifth as common as tennis elbow, which means it gets far less attention, far less research, and often far less careful treatment.
It is also the condition where a wrong diagnosis does the most damage, because in a large share of patients the problem is not only the tendon. The ulnar nerve — the nerve that runs behind your "funny bone" — is frequently involved as well. If that part of the problem is missed, treatment fails no matter how good it is.
Dr. Raffy Mirzayan is a double board-certified orthopedic sports medicine surgeon and elbow specialist in Los Angeles who treats the medial elbow as a single interconnected problem: the tendon, the nerve, and the ligament that all attach to the same small piece of bone.
Golfer's Elbow Is Not Inflammation — And That Changes Everything
The name ends in -itis, meaning inflammation. The name is wrong.
When the diseased tissue is removed at surgery and examined under a microscope, it does not contain inflammatory cells. What it contains is disorganized collagen, abnormal fibroblasts, and immature blood vessels — the signature of a failed healing response rather than an inflammatory one. This was established definitively for elbow tendinopathy by Kraushaar and Nirschl, who studied surgical specimens with histology, immunohistochemistry, and electron microscopy and found a general absence of the neutrophils, lymphocytes, and macrophages that define an inflammatory process (Kraushaar & Nirschl, Journal of Bone and Joint Surgery, 1999). The correct term is tendinosis — degeneration — not tendinitis.
So the obvious question: if there is no inflammation in the tissue, what is a powerful anti-inflammatory steroid injection supposed to accomplish?
The answer from the clinical literature is that cortisone produces real short-term relief and worse long-term outcomes. A systematic review in The Lancet examining corticosteroid injection across tendinopathies found exactly this pattern — beneficial early, harmful later, with higher recurrence rates than other treatments or placebo (Coombes et al., The Lancet, 2010).
There is an additional concern specific to the medial elbow. The medial epicondyle is the attachment point not just for the flexor-pronator tendons but also for the ulnar collateral ligament — the Tommy John ligament — and the ulnar nerve passes directly behind it. Repeated steroid injection into this small, crowded area risks weakening tissue that is doing critical structural work.
If you have had one or two injections, this is not a crisis. It is a reason to change the plan rather than repeat it.
The Ulnar Nerve: What Makes Golfer's Elbow Different
This is the single most important distinction between golfer's elbow and tennis elbow, and the reason golfer's elbow needs a specialist.
The ulnar nerve runs through the cubital tunnel, immediately behind the medial epicondyle. In a substantial proportion of golfer's elbow patients, the nerve is irritated or compressed along with the tendon problem. In Dr. Mirzayan's practice, a majority of patients presenting with golfer's elbow have some degree of ulnar nerve involvement; published series report concomitant ulnar neuropathy in roughly 40% to 60% of cases (Gabel & Morrey, Journal of Bone and Joint Surgery, 1995).
Symptoms that point to ulnar nerve involvement:
- Numbness or tingling in the small finger and the ring finger
- Symptoms worse when the elbow is bent — holding a phone, driving, sleeping
- Weakness of grip or difficulty with fine finger movements
- An electric sensation when the inner elbow is tapped
If you have these symptoms alongside inner elbow pain, you do not have a simple tendon problem, and treating it as one will not work.
This matters enormously for outcomes. Gabel and Morrey demonstrated that patients treated surgically for medial epicondylitis without significant ulnar neuropathy did very well, while patients with moderate to severe ulnar neuropathy did substantially worse — a statistically significant difference. The nerve is not a footnote to the diagnosis. It frequently is the diagnosis.
Non-Operative Treatment
Most golfer's elbow resolves without surgery.
Activity modification and load management. Reducing the provoking loads — gripping, wrist flexion, forearm rotation — while keeping the tendon working.
Progressive loading therapy. Structured, gradual strengthening of the flexor-pronator group is the foundation of tendinosis treatment. It takes months. Patients who stop early are the ones who end up needing surgery.
Nerve-specific management. If the ulnar nerve is involved, treatment must address it directly: avoiding prolonged elbow flexion, night splinting to keep the elbow relatively straight during sleep, and nerve gliding exercises. This is frequently the missing piece in patients who have "failed" treatment elsewhere.
Counterforce bracing and activity-specific technique changes, particularly for golfers and throwing athletes.
PRP for Golfer's Elbow
Platelet-rich plasma addresses the actual pathology. Instead of suppressing an inflammation that is not present, PRP delivers a concentrated dose of your own platelets and growth factors into the degenerated tendon to restart a healing response that stalled.
Dr. Mirzayan will be straightforward with you about the evidence base here. The research on PRP for medial epicondylitis is considerably thinner than for tennis elbow, where a large randomized trial supports it. A systematic review has examined PRP as an alternative to surgery in medial epicondylitis and found encouraging results (Alzahrani, Cureus, 2022), and a comparative study has evaluated PRP outcomes for medial versus lateral epicondylitis directly (Journal of Orthopaedic Surgery and Research, 2023), but the total body of evidence is smaller and of lower quality than what exists on the lateral side. Much of the rationale for treating golfer's elbow with PRP is extrapolated from tennis elbow, where the underlying pathology is the same disease on the opposite side of the same joint.
Two practical points:
It takes time. PRP stimulates biology. Meaningful improvement typically appears between two and six months, not in the first few weeks.
The preparation matters. For tendon conditions, leukocyte-rich PRP appears to be the appropriate formulation — the opposite of what is preferred inside an arthritic joint. Many PRP systems cannot produce both. Dr. Mirzayan uses the Arthrex Angel system, which allows him to control both the platelet dose and the leukocyte content.
One important caveat: if your ulnar nerve is significantly involved, PRP addresses only half your problem. Dr. Mirzayan will tell you this before you spend money on an injection that cannot fix nerve compression.
Learn more about PRP, the Angel system, and how to prepare for your injection →
Surgery for Golfer's Elbow
If six months of genuine non-operative treatment has failed, surgery is reasonable. What operation you need depends on whether the ulnar nerve is involved.
If the nerve is not involved: debridement and repair
Dr. Mirzayan uses the same principle he applies to tennis elbow. He elevates the diseased tendon off the medial epicondyle, debrides the degenerated tissue back to healthy tendon and clean bone, and then repairs the healthy remaining tendon back to the bone with anchors.
The alternative — simply releasing the tendon origin and leaving it detached — is faster and technically simpler, and it does relieve pain in many patients. But it does not restore a tendon-to-bone attachment, and Dr. Mirzayan's preference is to reconstruct the anatomy rather than remove it.
If the nerve is involved: partial medial epicondylectomy
This is where Dr. Mirzayan's approach solves two problems with one procedure.
The medial epicondyle — the bony prominence you know as the funny bone — is simultaneously the attachment point of the diseased tendon and the wall the ulnar nerve is pressed against. A partial medial epicondylectomy removes a portion of that bone. Doing so decompresses the ulnar nerve by eliminating the surface it is being compressed against, and at the same time addresses the diseased tendon origin attached to it.
The technique is well described for ulnar nerve decompression, and the critical parameter is how much bone is removed. Resecting too much risks the anterior bundle of the ulnar collateral ligament, which originates from that same epicondyle and is the primary restraint against valgus stress. A properly performed partial epicondylectomy removes a limited portion of the bone and preserves the ligament entirely (Plastic and Reconstructive Surgery – Global Open, 2025).
Protecting the Tommy John ligament
This is where subspecialty elbow training matters most.
The ulnar collateral ligament — the Tommy John ligament — originates from the medial epicondyle, directly adjacent to everything being worked on. Damaging it during medial elbow surgery converts a tendon problem into an instability problem.
Dr. Mirzayan has performed hundreds of ulnar collateral ligament reconstructions and is the inventor of the Double Button Tommy John technique. He knows this ligament's anatomy, its footprint, and its margins as well as anyone operating on elbows, and his technique is specifically designed to protect it. If the ligament is compromised — whether from prior injections, from the disease, or encountered during surgery — he is equipped to repair or reconstruct it in the same operation.
Biologic augmentation with PRP or bone marrow aspirate concentrate is frequently added at the time of repair to support healing at the tendon-to-bone interface.
What to Expect
Dr. Mirzayan has performed close to one hundred golfer's elbow procedures — fewer than his tennis elbow volume, because the condition itself is roughly five times less common. In his experience, patients who have the nerve and the tendon addressed together in a single well-planned operation recover reliably and are among his more satisfied elbow patients.
He will also tell you what the published literature says, which is more cautious: surgical outcomes for medial epicondylitis have historically been reported as less predictable than for tennis elbow, particularly in patients with significant ulnar neuropathy. Dr. Mirzayan's view is that much of that gap reflects the nerve being under-recognized and under-treated rather than an inherent limitation of the surgery — but that is his clinical judgment, and he will present it to you as such rather than as established fact.
Medial elbow tendinosis is a stubborn disease. Some patients retain discomfort even after a technically well-performed operation. Knowing that beforehand is better than discovering it afterward.
Out-of-Network and Out-of-State Patients
Dr. Mirzayan's practice is out-of-network with major commercial insurance carriers, which allows him to spend the time each problem actually requires rather than the time an insurance contract allows. Our team will review your benefits and expected costs with you before your visit.
He regularly treats patients traveling from Las Vegas, Henderson, Phoenix, and Scottsdale, as well as from across the country, and also sees patients at his offices in Las Vegas, Nevada, and Long Beach, California. Imaging can be reviewed remotely before you travel, and surgery with the initial post-operative visit can often be coordinated into a single trip. Call (310) 746-5918 to arrange this.
Frequently Asked Questions
What is the difference between tennis elbow and golfer's elbow?
Tennis elbow affects the tendons on the outer side of the elbow; golfer's elbow affects the tendons on the inner side. The underlying disease is the same — tendon degeneration, not inflammation. The critical difference is that golfer's elbow frequently involves the ulnar nerve, which sits directly behind the inner elbow, while tennis elbow usually does not.
Why do my small and ring fingers go numb?
That is the ulnar nerve's sensory territory. Numbness or tingling in those two fingers means the nerve is irritated or compressed at the elbow, and it means your problem is not purely a tendon problem. Tell your surgeon about this symptom specifically — it changes the treatment plan.
Do I need surgery for the nerve and the tendon separately?
No. A partial medial epicondylectomy addresses both in a single operation, because the same piece of bone is the tendon's attachment point and the surface the nerve is compressed against.
Will removing part of my elbow bone make my elbow unstable?
Not when it is done correctly. The concern is legitimate — the ulnar collateral ligament originates from that bone — which is exactly why the amount removed is limited and the ligament is identified and preserved. This is a technique-dependent risk, and it is the reason to have this operation done by a surgeon who operates on the medial elbow regularly.
Can I still play golf or throw afterward?
Most patients return to golf and to overhead activity. Timeline depends on what was done, but expect several months before full return to sport, with progressive loading throughout.
Does insurance cover PRP for golfer's elbow?
No. PRP is not covered by any insurance plan, including Medicare. It is a self-pay procedure. Call (310) 746-5918 for pricing.
I had cortisone injections and now my elbow feels loose or unstable. Is that related?
Possibly. Repeated corticosteroid injection around the medial epicondyle can weaken the ulnar collateral ligament and surrounding tissue. This is evaluable on examination and MRI, and it is reconstructible. Bring any prior imaging and records to your consultation.
You May Also Be Interested In
Elbow Arthroscopy and Tight Elbow Release
Chronic (Old) Distal Biceps Reconstruction
Tommy John Surgey (UCL Reconstruction) with Internal Brace
Lateral Epicondylitis (Tennis Elbow)
Medial Epicondylitis (Golfer's Elbow)
Cubital Tunnel Syndrome (Ulnar Nerve Compression)
Elbow Fracture Radial Head Replacement
Osteochondritis Dissecans (OCD) Capitellum of the Elbow
About Dr. Raffy Mirzayan
Dr. Raffy Mirzayan is a double board-certified orthopedic sports medicine surgeon and Clinical Professor at the Keck School of Medicine of USC, practicing at DOCS Health in Los Angeles. He completed his fellowship at the Kerlan-Jobe Orthopaedic Clinic and has a subspecialty focus on the elbow, with a personal series of more than 1,000 elbow arthroscopies and hundreds of ulnar collateral ligament reconstructions. He is the inventor of the Double Button Tommy John technique and of Biologic Tuberoplasty™. He has authored more than 88 peer-reviewed publications and over 150 total works including book chapters and abstracts, has edited three orthopedic textbooks, and has lectured nationally on orthobiologics and elbow disorders, including at the American Academy of Orthopaedic Surgeons Annual Meeting, the American Orthopaedic Society for Sports Medicine, and the San Diego Shoulder Institute course. He is an Arthrex consultant and educator and co-founder and director of Shoulder360™.
DOCS Health | 8436 W 3rd St #800, Los Angeles, CA 90048 Additional offices in Las Vegas, NV and Long Beach, CA (310) 746-5918 | raffymirzayan.com
Dr. Mirzayan is a paid consultant and educator for Arthrex, the manufacturer of the Angel PRP system. He selected this system for his practice on clinical grounds, and discloses this relationship so patients can weigh it for themselves.
This page is for educational purposes and does not constitute medical advice or establish a physician-patient relationship. PRP and BMAC are not FDA-approved for orthopedic indications and are not covered by insurance.
