Golfer’s Elbow (Medial Epicondylitis)

Overview

Golfer’s elbow is a condition that results in pain on the inside of your elbow, near the “funny bone” region. It has also been referred to as “medial epicondylitis.” Golfer’s elbow results from cumulative damage and irritation to the tendons that attach to the bony bump on the inside of the elbow. These tendons attach to the muscles that run down the forearm and attach by another set of tendons to the wrist and fingers, allowing you to bend and twist your wrist and grip objects like a golf club, tennis racket, or hammer. Repetitive and forceful gripping and twisting activities can damage the tendons at the elbow. Patients often experience soreness or pain at the inside of the elbow during or after activity.

In some cases, it may become difficult to hold on to things like a golf club or tennis racket. The goal of treatment is to identify and treat the cause (which is usually overuse or poor technique), reduce the pain and irritation, promote healing, and strengthen the muscles and tendons to prevent recurrence.  

Golfer’s elbow is the opposite of tennis elbow, which affects the tendons on the outside of the elbow. Similar to tennis elbow, you don’t have to golf to get golfer’s elbow and this condition affects a wide variety of competitive athletes and active individuals.

  • Pain and tenderness on the inside of your elbow, in the region of the bony bump. The pain may extend into the forearm. Initially, the pain may only occur following activity but may eventually interfere with activity, as well as interfere with daily activities such as picking up groceries or twisting door handles.
  • Stiffness on the inside of your elbow, especially in the morning or after the elbow has not moved for a period of time, such as watching a movie. The stiffness is usually most prominent when the elbow is fully straightened but may also occur when the elbow is nearly bent.
  • Weakness of your grip, almost always associated with pain.
  • Swelling is uncommon unless there has been an acute injury.
  • Numbness and tingling are also uncommon and do not directly result from Golfer’s elbow.  The ulnar nerve (“funny bone” nerve) passes close to the tendons and may also become irritated.  This may result in pain, numbness, or tingling shooting into the fingers.

If you are experiencing increasing soreness on the inside of your elbow that is not responding to rest, ice, and over-the-counter medications, you should have your elbow evaluated. You should also seek evaluation if you are experiencing any numbness, tingling, or weakness, or you have had a major injury to your elbow with loss of motion, deformity, or swelling. Your care provider will evaluate you, determine if additional testing is warranted (e.g., X-rays, ultrasound, MRI scan, nerve testing), and help you decide on the best course of treatment.

Golfer’s elbow is caused by damage to the muscles and tendons that control your wrist and fingers, in particular the “gripping muscles.” The damage typically results from overuse – excessive or prolonged activity with inadequate rest. In many cases, improper technique during lifting, throwing, and swinging can contribute to the increased stress. Poor conditioning, lack of flexibility, and inadequate warm-up prior to activity can also increase the risk of injury. As previously stated, although golfer’s elbow is classically associated with golfing, this condition can occur in individuals participating in racket sports, throwing sports, weight training, and forceful, repetitive occupational movements such as plumbing. A single cause may not be identified in all cases and your care provider will develop a comprehensive treatment program based on their evaluation.

The goals of treatment are to identify and treat the cause, reduce the pain and irritation of the elbow, promote healing, and restore strength and flexibility. Over-the-counter medications such as anti-inflammatory medications or Acetaminophen may reduce pain, but they do not treat the cause. Therapy represents the cornerstone of treatment for most individuals. During therapy, your health care provider will discuss activity modification, identify biomechanical faults that will be addressed through changes in technique and exercise, and may prescribe a brace or modalities such as ice.  As part of a multidisciplinary team approach, you may be referred to another professional such as a golf or tennis professional or ergonomic expert to assist with changes in technique or equipment.

Although most cases respond to directed therapy, in some cases your care provider may recommend a cortisone injection or one of the more recently developed treatments such as tenotomy, tenotomy and debridement, or platelet rich plasma injection. A cortisone injection can help many people with golfer’s elbow, but repeated cortisone injections are not usually recommended due to concerns regarding additional tendon damage in the long term. During a tenotomy, the clinician typically uses ultrasound to place a needle into the tendon to break up scar tissue and promote healing. Tenotomy and debridement uses specialized devices to not only break up the damaged tendon tissue but, in part, remove it (called debridement), similar to a traditional surgery. This procedure is also performed using ultrasound guidance and, like the needle tenotomy, can be done using local anesthesia in the office setting.  

Platelet rich plasma (PRP) injections are currently not approved by the FDA and, therefore, many insurance carriers do not pay for this procedure. During a PRP injection, your care provider will draw blood from your arm, process the blood in a centrifuge to concentrate the platelets, and inject them into and around the damaged tendon tissue, typically using ultrasound guidance. The platelets are naturally occurring cells in your body that contain a variety of growth factors and pro-healing bioactive molecules. The clinical results of tenotomy and debridement, and PRP injections have been encouraging and have allowed many athletes and active individuals with resistant golfer’s elbow to avoid traditional surgery.

Traditional open surgery is not commonly required for golfer’s elbow. Surgery is typically reserved for cases that do not respond to 6-12 months of appropriate treatment or in which there is significant tearing of the muscles and tendons. During surgery, the surgeon will make an incision, remove the damaged tissue, and, as necessary, repair the tendon.  

Other than loss of function, golfer’s elbow is not typically associated with complications. In some cases, the tendon damage can be progressive and severe enough that surgical repair becomes necessary. When the ulnar nerve becomes involved, specific treatments directed at reducing nerve irritation become necessary. This may ultimately include surgery to decompress or move the nerve.

Although there is no scientifically proven preventative program, most clinicians agree that optimizing strength, flexibility, equipment, and technique in combination with avoiding overuse can potentially prevent the development of Golfer’s elbow. Components may include preventative elbow muscle stretching and strengthening exercises, appropriate pre-activity warm-up, working with a qualified professional to ensure proper equipment fit and technique, and knowing when to rest. In some cases, individuals may benefit from total body conditioning to minimize elbow stress during sports, occupation, or daily life activities.

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