TALMedora Editorial | October 2026 | 4 min read
Golfer's elbow is a painful problem on the inner side of the elbow. Most people never need an operation for it. But a new study suggests tobacco users may be more likely to end up in surgery. The research, by Ernesto Joubran and colleagues, was published in Scientific Reports.
The Short Version
Researchers looked at insurance records for about 8 million people in the United States.
People with a tobacco use diagnosis had slightly higher odds of being diagnosed with golfer's elbow.
They had clearly higher odds of having surgery for it: about 1.6 times those of matched non-users.
This is an association. The study cannot prove that tobacco causes the difference.
What Is Golfer's Elbow?
Golfer's elbow (medial epicondylitis) causes pain where the forearm tendons attach on the inner side of the elbow. Despite the name, over 90% of cases aren't linked to sport. It's usually tied to forceful, repetitive use of the wrist and forearm at work. Most cases improve without surgery, and operations are kept for people whose pain doesn't settle with other treatment.
What Did the Study Do?
The team searched an insurance claims database (Humana records within the PearlDiver database) covering about 8 million patients from 2007 to 2015. They found 23,573 people diagnosed with golfer's elbow.
They then took 1,657,810 people with a diagnosis of tobacco use disorder and matched each one to a person without it, on age, gender and other health conditions such as diabetes, high blood pressure, high cholesterol and obesity. Matching makes the two groups as similar as possible, so tobacco is the main difference.
What Did They Find?
Diagnosis: golfer's elbow was recorded in 0.34% of tobacco users and 0.32% of non-users. That is a small difference (odds ratio 1.05).
Surgery: 158 tobacco users had surgery for it, against 98 non-users (odds ratio 1.62). Looking only at people who had golfer's elbow, 2.83% of tobacco users went on to surgery, compared with 1.85% of non-users.
Who gets it: it was recorded most often between ages 60 and 69, and slightly more often in men. Most were diagnosed in a doctor's office (89%).
Other conditions: high blood pressure and high cholesterol were the most common conditions among patients with golfer's elbow.
Why Might Tobacco Matter?
The authors point out that tobacco is known to affect tendons and slow healing, which could make a stubborn tendon problem more likely to need an operation. This study can't confirm that explanation. It only shows that the two go together in these records.
What the Study Can't Tell Us
It's an association, not proof of cause. Other differences between tobacco users and non-users may play a part.
Tobacco was recorded from a diagnosis code only. There's no information on how much or how long people smoked, what type of tobacco they used, or whether they had quit.
Claims data have gaps. Coding errors are possible, and the data come from one US insurer and may not represent everyone.
The records are old, from 2007 to 2015.
The surgery numbers are small, 256 operations across the two groups, so the surgery finding should be read with care.
What This Means in Practice
For patients, this adds one more reason to take tobacco seriously, but it shouldn't alarm anyone, because most golfer's elbow doesn't need surgery. For clinicians, it supports asking about tobacco use in patients with persistent elbow tendon pain, and discussing it as part of care planning. It doesn't change treatment on its own.
Frequently Asked Questions
Does smoking cause golfer's elbow?
This study can't say. It found only a small link with the diagnosis itself.
Are smokers more likely to need golfer's elbow surgery?
In this study, tobacco users had higher odds of surgery. The figure is about 1.6 times higher, but it comes from observational data, so it shows a pattern and doesn't prove a cause.
Do most people with golfer's elbow need surgery?
No. In this study only 525 of 23,573 patients (about 2%) had surgery.
Is golfer's elbow only a sports injury?
No. More than 90% of cases aren't sport-related, and many are tied to repetitive work.
Where was the study published?
In Scientific Reports, with the DOI 10.1038/s41598-026-74810-y.
Read the Original Research
Source: Joubran E, et al., Scientific Reports (Article in Press, 2026). This article is for general awareness and is not medical advice. Please speak to your doctor about elbow pain or tobacco use.