-Cyprus Orthopaedics

Golfer’s Elbow

Golfer’s Elbow is a painful condition of the elbow, which commonly affects active individuals over the age of 30 years. The condition, which is also known as “medial epicondylitis”, usually commences with insidious onset of pain on the inner aspect of the elbow. Occasionally the pain may follow an injury to the elbow. The condition is not specific to golfers nor athletes. It often occurs in individuals in manual occupations or those who perform repetitive lifting or carrying tasks.
Elbow Conditions-Cyprus Orthopaedics

Golfer’s Elbow

Golfer’s elbow, also known as medial epicondylitis, is a condition that causes pain and inflammation in the tendons that connect the forearm to the inside of the elbow. Despite its name, this condition can affect anyone, not just golfers. It is a common overuse injury that often occurs due to repetitive motions of the wrist and fingers.

What is Golfer’s Elbow?

Golfer’s elbow is a condition characterized by pain and tenderness on the inner side of the elbow, specifically where the tendons attach to the bony bump (medial epicondyle). These tendons are responsible for flexing the wrist and fingers. When these tendons are overused or strained, they can become inflamed, leading to pain and discomfort.

Causes of Golfer’s Elbow

Golfer’s elbow is primarily caused by repetitive motions and overuse of the forearm muscles. Activities that involve gripping and twisting motions of the wrist and fingers, such as golfing, tennis, and weightlifting, can contribute to the development of this condition. Additionally, occupations that require repetitive actions like typing, painting, and carpentry can also increase the risk of golfer’s elbow.

Symptoms of Golfer’s Elbow

The most common symptom of golfer’s elbow is pain and tenderness on the inner side of the elbow. This pain may radiate down the forearm and worsen with activities that involve gripping or flexing the wrist. Other symptoms may include stiffness, weakness, and difficulty in fully extending the forearm or gripping objects firmly. In some cases, individuals may also experience numbness or tingling in the ring and little fingers.

Diagnosing Golfer’s Elbow

If you suspect you have golfer’s elbow, it’s important to see your doctor for an accurate diagnosis. Initially, your doctor will review your medical history and conduct a physical examination of the affected elbow. They may also order imaging tests such as an X-ray or MRI to rule out other conditions or to assess the extent of any damage.

Treatment Options for Golfer’s Elbow

The treatment of golfer’s elbow focuses on reducing pain and inflammation, promoting healing, and preventing further injury. Initially, conservative treatment options are recommended. These may include:

  • Rest and Activity Modification: Resting the affected elbow and avoiding activities that aggravate the condition is crucial for recovery. Modifying your technique or taking breaks during repetitive tasks can help alleviate symptoms.
  • Medications: Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can help relieve pain and reduce inflammation. However, it is important to consult with a healthcare professional before taking any medication.

If conservative treatments do not provide sufficient relief, your doctor may recommend additional interventions, such as:

  • Physical Therapy: A physical therapist can design a customized rehabilitation program that includes stretching and strengthening exercises to improve flexibility and promote healing. They may also use modalities like ultrasound or electrical stimulation to aid in the recovery process.
  • Corticosteroid Injections: In some cases, corticosteroid injections may be recommended to reduce inflammation and alleviate pain. However, these injections are usually reserved for severe cases or when conservative treatments have not been effective.

Surgery

Surgical intervention is rarely required. However, if conservative treatments fail to alleviate your symptoms within a period of six to 12 months, surgery could be considered as a potential option.

Preventing Golfer’s Elbow

Preventing golfer’s elbow involves taking proactive measures to reduce the risk of overuse and strain on the forearm muscles. Here are some tips to help prevent golfer’s elbow:

  • Warm-Up and Stretch: Before engaging in any physical activity, it is essential to warm up your muscles and stretch properly. This helps prepare your muscles for the task at hand and reduces the risk of injury.
  • Proper Technique: Whether you are playing sports or performing repetitive tasks at work, using proper technique and ergonomics is crucial. This ensures that the stress is distributed evenly across the muscles and joints, reducing the strain on specific areas.
  • Gradual Progression: If you are starting a new sport or activity, gradually increase the intensity and duration to allow your muscles and tendons to adapt. Avoid jumping into high-intensity activities too quickly, as this can lead to overuse injuries.
  • Strength and Flexibility Training: Regular strength training and flexibility exercises can help improve the resilience of your muscles and tendons. Focus on exercises that target the forearm muscles and promote flexibility in the wrist and fingers.

The condition is believed to result from overuse. The tendons of the elbow suffer wear and tear over time. This results in degeneration of the tendons and occasionally there may be microscopic or partial tears in the tendon. Some natural healing may take place but often there is a process of repeated breakdown and incomplete healing which results in pain.

A diagnosis of Golfer’s elbow is made based on the history of pain localised to the inner aspect of the elbow and occasionally down the forearm. Pain is usually intermittent and often experienced with activities. Pain may be associated with weakness of grip. Examination shows localised tenderness on the inner aspect of the elbow and pain with certain provocative manoeuvres such as flexing the wrist or gripping hard against resistance. An X-ray may sometimes show bone spurs or calcium deposits. An ultrasound scan or MRI may be performed to examine the state of the tendons. If associated nerve pain is suspected, electromyography (EMG) or nerve conduction tests may be requested.

In the early phase, pain may be controlled with activity modification and the use of pain relieving or anti-inflammatory medication.  In most individuals, Golfer’s elbow is a self-limiting condition that often resolves slowly over a variable period of time ranging from 6-18 months.

Supervised physiotherapy: You may be advised to see a physiotherapist to start a regime of specific treatment that includes deep friction, stretching of the affected tendons and eccentric strengthening exercises. There is good evidence to suggest that supervised physiotherapy improves symptoms. Instructions on a therapeutic exercise program can be downloaded from the Orthoinfo website. 

Clasp: Wearing an epicondylitis clasp on the forearm will often help ease symptoms particularly if worn during activities. It may also act as a reminder to modify activities.

Steroid injection: A steroid injection placed accurately into the tendon origin will often provide good short to medium term pain relief allowing progress to be made with physiotherapy. The injection will not cure the condition. It is not advisable to have multiple injections.

Platelet-rich-plasma (PRP) injection: A small amount of venous blood is withdrawn from the patient and spun in a special centrifuge for 5-15min. This yields a sample of Plasma rich in platelets, which are the blood cells that play an important role in healing. A small volume (approximately 2ml) is injected into the origin of the tendon using a multiple puncture technique. The procedure is painful and shows some benefit compared with steroid injections over the long term.

Surgery: In a small minority of patients, in whom symptoms have persisted despite adequate nonoperative treatment, it may be appropriate to undertake surgical treatment.  Surgery is performed open. The origin of the affected flexor tendon is released from the bone and the bone may be drilled, abraded or treated with microfracture to promote healing. Following surgery symptoms will usually settle over a period of time. For further information on surgical treatment, please refer to the procedures section.

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