Which side of the elbow hurts tells you most of what you need. Outside is usually tennis elbow. Inside is golfer’s elbow, or the ulnar nerve if the little and ring fingers tingle. The back is usually bursitis or triceps tendon. The front is usually the biceps tendon. Tendon problems need progressive loading, nerve problems need position changes and gliding, and bursitis needs protecting.
Where the pain sits on the outside of the elbow and grip is the thing that provokes it, the full loading programme is set out in PhysioHub’s guide to tennis elbow exercises.
The elbow is a small joint with four distinct sides, and each one produces a fairly recognisable problem. Start by working out which bony landmark you would press on if asked to point at the pain.
| Where it hurts | Usual cause | Telltale sign | What it needs |
|---|---|---|---|
| Outside | Tennis elbow | Worse gripping, shaking hands, lifting a kettle | Progressive loading over 6–12 weeks |
| Inside | Golfer’s elbow | Worse squeezing or bending the wrist down | Progressive loading, same principles |
| Inside, with tingling | Cubital tunnel syndrome | Little and ring fingers tingle, worse with the elbow bent | Position changes, nerve gliding, night splinting |
| Back, on the point | Olecranon bursitis | Soft swelling over the tip, often painless | Protection, compression, avoiding leaning |
| Front, in the crease | Distal biceps tendinopathy | Ache turning a screwdriver or carrying palm-up | Load management and graded strengthening |
Two of these five are tendon problems that share a treatment. One is a nerve. One is a fluid sac. One needs urgent attention if it arrives with a pop during a lift.
This is a documentary review of published evidence and guidance rather than a diagnosis of your elbow. The five here account for the large majority of elbow pain seen in musculoskeletal practice. Others considered and left out because they are less common include elbow osteoarthritis, radial tunnel syndrome, loose bodies, ligament sprains, referred pain from the neck, and inflammatory arthritis.
The order reflects how often each explains elbow pain in adults, weighed against how clearly it can be recognised without imaging.
The sources read were Tyler and colleagues’ 2010 randomised trial of eccentric wrist extensor exercise, Coombes and colleagues’ 2013 JAMA trial of corticosteroid injection and physiotherapy in 165 people with tennis elbow, and the 2021 systematic review with meta-analysis of upper limb strength in lateral elbow tendinopathy. Evidence checked in August 2026.
What could not be checked: no study has ranked these five by frequency in a UK primary care population, so the order rests on presentation patterns rather than a count. Three situations override everything here: numbness or weakness in the hand, a tip of the elbow that is red and hot with a fever, and a sudden pop at the front of the elbow during a heavy lift.
Find the bony landmark. Press the bump on the outside, then the bump on the inside, then the point at the back. Tenderness on one of the three narrows the field immediately, and tendon problems are usually tender to a fingertip rather than to a whole hand.
Ask whether anything tingles. Numbness or pins and needles in the little and ring fingers moves the answer from tendon to nerve, and changes the treatment completely.
Test with a grip rather than a stretch. Squeezing hard reproduces both tennis and golfer’s elbow reliably. Which side it fires on is the answer.
Notice the moment of onset. Tendon problems build over weeks. Bursitis often follows leaning or a knock. A biceps tendon rupture has a distinct pop during a heavy pull, and people remember it.
What it is
A load capacity problem in the common extensor tendon where it attaches to the bony bump on the outside of the elbow. Despite the older name ending in "itis", long-standing cases show tendon disorganisation rather than active inflammation.
Who it affects
Anyone who grips repeatedly: trades, keyboard and mouse users, gardeners, and racket players. It is by a clear margin the most common elbow diagnosis in adults between 35 and 55.
How it presents
Pain on the outer bump, worse gripping, shaking hands, lifting a kettle or turning a door handle. Tender to one fingertip on the bump. Often no single moment of onset.
What the evidence supports
Progressive loading. Tyler and colleagues randomised 21 people and found adding eccentric wrist extensor work to standard physiotherapy improved pain by 81 per cent against 22 per cent, on a small sample. Coombes and colleagues randomised 165 people and found a steroid injection produced worse one-year outcomes than placebo, with recurrence at 54 per cent against 12 per cent.
What it needs
Isometric holds while irritable, then heavy slow resistance and eccentric work three days a week for 6 to 12 weeks. Our tennis elbow loading programme covers it in full.
Why it ranks first
It is the most common cause by some distance, and it is the one most often made worse by the two things people instinctively try: complete rest and aggressive stretching.
What it is
The same problem as tennis elbow on the opposite side, affecting the common flexor tendon at the inner bump.
Who it affects
People who grip and pull rather than grip and lift: climbers, throwers, weight trainers doing heavy pulling work, and manual trades. It is roughly a fifth as common as tennis elbow.
How it presents
Pain on the inner bump, worse squeezing, bending the wrist down against resistance, or carrying heavy bags. Tender to a fingertip on the inner bump. Importantly, nothing tingles.
What the evidence supports
The same principles as tennis elbow. The trial evidence is thinner on this side, so the programme is built by extension from the lateral evidence, which is worth knowing.
What it needs
Isometric wrist flexion holds, then eccentric wrist flexion and grip work, three days a week. Our golfer’s elbow exercise guide sets out the four exercises and the timeline.
Limits and cautions
The ulnar nerve runs immediately behind the inner bump, so inner elbow pain with any tingling is a different problem, or both at once. Checking the fingers takes two seconds and changes the plan.
Why it ranks second
It is common, it is straightforward to identify, and it responds to the same loading approach, provided the nerve has been ruled out first.
What it is
Compression or repeated stretching of the ulnar nerve where it passes through a narrow groove behind the inner bump of the elbow. It is the funny bone nerve.
Who it affects
People who sleep with the elbow fully bent, drivers and desk workers who rest the elbow on a hard edge for hours, and anyone who spends long periods on the phone.
How it presents
Tingling or numbness in the little and ring fingers, worse with the elbow bent and often waking people at night. In longer-standing cases, weakness of grip and difficulty separating the fingers.
What the evidence supports
Position modification is the first-line treatment: keeping the elbow from full bend at night with a soft splint or a folded towel, and stopping the leaning. Nerve gliding exercises are commonly used alongside. Where weakness or muscle wasting is present, that changes the urgency and needs a specialist opinion.
What it needs
Night positioning, removing the leaning, and gliding exercises. Our guide to nerve glides covers the technique, though it is written for the median nerve at the wrist rather than the ulnar nerve at the elbow.
Limits and cautions
Loading exercises for tendon pain do nothing for this, and stretching an irritated nerve hard tends to inflame it. Numbness that is constant rather than intermittent, or any visible wasting of the muscle between thumb and index finger, needs assessing promptly.
Why it ranks third
It is common enough to matter, it is regularly mistaken for golfer’s elbow, and the treatments for the two are almost opposite.
What it is
Swelling of the small fluid-filled sac that sits between the skin and the bony point at the back of the elbow.
Who it affects
People who lean on their elbows at a desk or in a vehicle, anyone who has knocked the point of the elbow, and people with gout or inflammatory arthritis.
How it presents
A soft, often surprisingly large swelling over the point of the elbow, frequently more alarming to look at than it is to feel. Bending fully is uncomfortable because the swelling is compressed.
What the evidence supports
Most settle with protection, avoiding pressure on the tip, and an elastic compression sleeve. Drainage is sometimes done and it commonly refills unless the cause of the pressure changes.
What it needs
Two to three weeks of keeping pressure off the point of the elbow, which usually means changing how you sit at a desk or in a car. Compression and cold help the swelling.
Limits and cautions
This is the one on the list with a genuine emergency version. A bursa that becomes red, hot and tender, particularly with a fever or feeling unwell, may be infected and needs same-day medical assessment and antibiotics.
Why it ranks fourth
It is less common than the tendon problems, it is usually self-limiting, and it is the only one here where the immediate advice is to protect rather than to load.
What it is
Irritation of the biceps tendon where it attaches into the forearm bone at the front of the elbow crease.
Who it affects
People who lift heavy loads with the palm up, do a lot of screwdriver or spanner work, or have increased curling and pulling volume in the gym.
How it presents
A deep ache in the front crease of the elbow, worse turning a screwdriver, carrying a box palm-up, or lifting with the elbow bent. Tender deep in the crease rather than on a bony bump.
What the evidence supports
It follows the same tendon principles as the two above: reduce the aggravating peaks, then load progressively. Trial evidence specific to this tendon is limited, so the approach is extrapolated from the better-studied tendons.
What it needs
Reducing palm-up heavy lifting for a few weeks, then graded strengthening in both elbow bending and forearm rotation.
Limits and cautions
The important exception is rupture. A sudden pop at the front of the elbow during a heavy pull, followed by bruising and a change in the shape of the upper arm, is a distal biceps tendon rupture. That is time-sensitive and needs assessing within days rather than weeks.
Why it ranks fifth
It is the least common of the five, and it carries the one presentation on this page where waiting genuinely costs you something.
| Cause | Side | Tingling in the hand | Tender to a fingertip | First-line treatment | Typical timescale |
|---|---|---|---|---|---|
| Tennis elbow | Outside | No | Yes, on the outer bump | Progressive loading | 6–12 weeks |
| Golfer’s elbow | Inside | No | Yes, on the inner bump | Progressive loading | 6–12 weeks |
| Cubital tunnel | Inside | Yes, little and ring fingers | Sometimes, over the groove | Position change and gliding | 4–12 weeks |
| Olecranon bursitis | Back | No | Swelling rather than a point | Protection and compression | 2–6 weeks |
| Distal biceps tendinopathy | Front | No | Deep in the crease | Load management then strengthening | 6–12 weeks |
The tingling column is the one that changes the treatment most. Everything else on this table is managed by adjusting load; the nerve is managed by adjusting position.
If gripping hurts on the outer bump, that is tennis elbow. Start isometric holds now and move to loaded work as it settles.
If squeezing hurts on the inner bump and nothing tingles, that is golfer’s elbow, and the same principles apply on the other side.
If the little and ring fingers tingle, especially at night, that is the ulnar nerve. Stop the elbow bending fully in bed, stop leaning on it, and give it a few weeks before adding anything else.
If there is a soft lump on the point of the elbow, keep pressure off it and use a compression sleeve. If it turns red and hot and you feel unwell, get it seen the same day.
If it aches in the front crease when turning a screwdriver, reduce palm-up lifting for a fortnight and build it back gradually.
If you felt a pop at the front during a heavy lift, or the hand is losing strength, get it assessed within days. Both point at something that does not wait well.
Padel has changed the mix of elbow problems arriving in the Uckfield clinic. The courts at Maresfield, a couple of minutes north of the town, put a lot of people into a racket sport for the first time in decades, and the padel swing loads the forearm differently from tennis: shorter, sharper, more wrist, and a great deal more overhead smashing than club tennis produces. The result is a steady flow of elbows that people have already labelled tennis elbow before they arrive.
Rather often it is not. The same racket season produces golfer’s elbow on the inside from heavy grip on the backhand, ulnar nerve irritation in people who then sleep with the arm curled up, and front-of-elbow biceps tendon pain in those doing the overheads. All four feel like "elbow pain from the racket", and pressing three bony landmarks and asking one question about the little finger separates them in under a minute. That matters, because the loading programme that fixes the outside of the elbow does nothing at all for a compressed nerve.
Where an elbow tendon has been sore for more than a few weeks, our page on tendinopathy sets out how it is assessed and loaded back to full capacity.
Why do my little and ring fingers go numb when my elbow is bent?
That is the ulnar nerve, which runs through a narrow groove behind the bony bump on the inside of the elbow. Bending the elbow stretches the nerve around the bone and raises the pressure inside the tunnel, which produces tingling in the little and ring fingers specifically. Sleeping with the elbow bent is the most common reason people wake with it.
How do you tell tennis elbow from golfer’s elbow?
By which bony bump is tender and which movement hurts. Tennis elbow sits on the outer bump and hurts when you straighten the wrist or fingers against resistance, or grip something. Golfer’s elbow sits on the inner bump and hurts when you bend the wrist down against resistance or squeeze hard. Both are tendon problems and both respond to progressive loading.
What is the soft lump on the point of my elbow?
Most often olecranon bursitis, a fluid-filled sac over the tip of the elbow that has become swollen, usually after leaning on hard surfaces or a knock. It is often painless despite looking dramatic. If the lump becomes red, hot and tender and you feel unwell or feverish, that needs seeing the same day, because an infected bursa needs antibiotics.
Why does my elbow hurt when I straighten it fully?
Pain at the very end of straightening points at the joint itself rather than the tendons, which is a different problem from tennis or golfer’s elbow. Where an elbow will not straighten fully at all, particularly after an injury or in someone who has done years of heavy manual work, that is worth having assessed rather than stretching.
How long does elbow tendon pain take to settle?
Six to twelve weeks of consistent loading for meaningful change, and three to six months for full capacity. Tendon problems are slow, and the most common reason a programme appears to fail is that it was judged at four weeks. Cubital tunnel symptoms often improve faster once the sleeping and leaning positions change.
Should I rest my elbow or exercise it?
Load it, with the aggravating peaks removed. Complete rest reduces what the tendon can tolerate, so the same task overwhelms it again when you go back. The exception is bursitis, where protecting the tip of the elbow from pressure genuinely is the treatment for the first couple of weeks.
When should elbow pain be checked?
If the little and ring fingers are numb or the hand is losing grip strength, if the elbow will not fully straighten, if the tip is red and hot with a fever, or if the pain followed a fall or a sudden pop while lifting. A sudden pop at the front of the elbow during a heavy lift can mean a biceps tendon rupture, which is time-sensitive.
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