How common it is, and who gets itEmerging evidence
In a US online survey of 1,758 players (average age 62.7), 18.4% reported elbow trouble in the past year, after the knee, the leg and foot, the shoulder and the back. In South Korean tournament players the elbow or forearm was 18.1% of injuries, and the second commonest site in another Korean survey; in 253 US recreational players, 41% reported an arm injury. These are surveys of players who chose to answer, recalling a year, so they probably run high, and none counted injuries per hour of play. Even among 113 professional players, arm injuries such as elbow tendon problems and wrist ligament tears were 12% of injuries.
Emergency departments see falls instead. In US national data the elbow is only about 2% of pickleball injuries; falls cause about two-thirds of visits, and about a third are fractures, mostly of the wrist and arm in women over 60. Of 397 pickleball fractures, 66% were in the arm and 92% followed a fall.
Sources 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11
Outer or inner elbow: two studies that disagreeEmerging evidence
The American Academy of Orthopaedic Surgeons' patient site (AAOS OrthoInfo) lists pickleball elbow among the sport's overuse injuries. In the 253-player survey, most chronic elbow pain was on the outside (38 of 61, against 13 on the inside and 10 on both). But in 129 players examined at the court, tests for the inner elbow were positive slightly more often than for the outer (7% against 5.4%), and the authors suggest spin shots may load the inner elbow, an idea they didn't test. So the two studies disagree on which is commoner, and pickleball elbow can be either side.
Clinics see more tennis elbow: 6 of 8 elbow cases at one US academic clinic (the other 2 were fractures from falls), 20 of 618 injuries at another, and tennis or golfer's elbow in 30 of 204 patients at a hand surgery practice. In the general population, tennis elbow affects about 1.3% of adults aged 30 to 64 at any one time and golfer's elbow 0.4%, both most often at 45 to 54 and equally in men and women.
Sources 4, 12, 13, 14, 15, 16, 17
What the game asks of the elbow: the evidence is from tennisEmerging evidence
The grip squeezes on every shot, and the forearm muscles that lift the wrist steady it as the paddle meets the ball. No laboratory study has measured the elbow, grip size or paddle vibration in pickleball, so the nearest evidence is from tennis. Players with tennis elbow used their wrist muscles harder at impact in one-handed backhands, with the elbow leading the stroke and the wrist bent back (8 players against 14). Beginners hit the backhand with the wrist bent forward, so the wrist muscles worked while being stretched (8 beginners against 8 experts). Two-handed backhands didn't lower the wrist muscles' work; the authors put the lower rate of tennis elbow down to fewer stroke faults. Off-centre hits and a tighter grip send more shock to the arm.
These are small lab studies of tennis strokes with no injury outcome. In our reading, a tight, wristy, late backhand or punch volley is the likeliest stroke behind pickleball elbow, and the fix is technique and load rather than kit.
Sources 18, 19, 20, 21
Telling the causes apartEmerging evidence
A general practitioner (GP) or physiotherapist presses on the exact spot and tests the wrist and fingers against resistance. Tennis elbow hurts on or just below the outer bump; the NHS says it may be worse lifting or bending your arm, gripping objects and moving your wrist. Golfer's elbow is a problem of the tendons that bend the wrist and turn the forearm where they attach to the inner bump. Tingling or numbness in the ring and little fingers, worse with the elbow bent or leaning on it, points to the ulnar nerve, not a tendon. A pop at the front of the elbow during an effort, with bruising and a weak twist of the forearm, is the distal biceps tendon, most often in middle-aged men (average age 47 in one population study).
Sources 22, 23, 24, 25, 26, 27
When a scan or test mattersStrong evidence
Tennis elbow is diagnosed from the history and examination, as the British Elbow and Shoulder Society's (BESS) care pathway says, so a scan is rarely needed. The AAOS says an X-ray may be taken to rule out arthritis of the elbow, a magnetic resonance imaging (MRI) scan to see the extent of tendon damage or rule out other problems, including the neck, and an electromyography (EMG) test to rule out a squeezed nerve, which can feel like tennis elbow. After a fall, an X-ray comes first.
Sources 28, 29
How it usually goesStrong evidence
In the untreated and placebo groups of 24 tennis elbow trials (1,085 people), about half of those still sore recovered or were much better every 2.5 to 3 months, and about 9 in 10 were much better at a year, however long it had lasted before. Wait-and-see groups did well at a year in two trials. The NHS says it usually goes away with rest but can sometimes last over a year. It can come back, more often after a steroid injection, as our tennis elbow guide explains. Golfer's elbow has been studied far less and is managed the same way. No study has followed pickleball players with elbow pain, and no one can promise a date.
Sources 30, 31, 32, 22
