Golfer’s Elbow

Medically known as medial epicondylitis, golfer’s elbow is a type of tendinitis wherein a tendon becomes irritated or inflamed. In the case of golfer’s elbow, the tendons that connect the forearm muscles to the medial epicondyle, located on the inside of the elbow, become swollen and painful due to small tears due to overuse.

Description of Golfer’s Elbow

The muscles of the hand and forearm originate from the medial epicondyle of the humerus, which is found on the ulnar side of the elbow. Medial epicondylitis occurs due to chronic and repetitive contractions of the muscles of the forearm and wrist, which cause micro tearing in the tendon. Golfer’s elbow usually affects the medial epicondyle itself; but tears can also occur in the muscles of the ulna, as well as the ulnar side of the wrist and hand.

Pain from medial epicondylitis usually radiates up and down the ulnar side of the forearm, wrist, and even in the fingers. Localized tenderness of the medial epicondyle and the associated tendon is also common. Patients also complain of stiffness of the elbow, weakness in the wrist and hand, and numbness or a tingling sensation in the ring and little fingers.

Pain can be sudden or develop gradually.

Causes and Risk Factors of Golfer’s Elbow

Overuse puts excess or repeated stress on the muscles attached to the medial epicondyle tendons, which cause damage to the muscles and tendons that control the wrist and fingers. The condition is so-named because it’s common among golfers, although not exclusively. Athletes who use the forearm, wrist, and finger muscles repeatedly, as well as people who engage in activities that regularly cause forceful twisting or bending of the wrist and flexing of the fingers also have a higher risk of developing medial epicondylitis. These include:

• Tennis, racquetball, and squash players
• Baseball players
• Weight-lifters
• Rowers
• Regular computer users
• Painters
• Cooks
• Butchers
• Assembly line workers
• Construction workers
• Plumbers

Poor conditioning; inadequate warm-up; and improper techniques in throwing, lifting, or hitting also contribute to golfer’s elbow.

In general, golfer’s elbow becomes a risk when an activity involving the aforementioned muscles and tendons is done repeatedly for more than an hour a day and several days a week.

Golfer’s Elbow Symptoms and Diagnosis

Symptoms associated with golfer’s elbow may be mild to severe and include:

• Elbow pain that radiates down the inside of the forearm to the wrist, on the same side as the pinky finger.
• Numbness and tingling that extend from the elbow to the pinky and ring fingers.
• Pain when wrist is flexed, facing down.
• Pain when shaking hands.
• Weakened grasp and/or wrist.
• Elbow stiffness.
• Gradual or sudden pain that gets worse when flexing the wrist or grasping things.

Combined with the risk factors, any of these symptoms warrant immediate diagnosis by a health care provider. Diagnosis involves assessment of medical history and a physical exam.

Examination of the elbow, wrist, and fingers will help evaluate pain and stiffness, and may include application of pressure to the affected area and various movements of the elbow, wrist, and fingers. The doctor will look for signs of pain or tenderness when the affected tendon is pressed, and/or pain near the elbow when the wrist is bent downward.

An x-ray may also be required to help eliminate other possible causes.

Golfer’s Elbow Treatment and Prognosis

Golfer’s elbow usually gets better with adequate rest, ice compress, and pain relievers. If the damage is severe, however, you might experience pain for months or years, even with proper treatment and exercise. For some, the pain becomes a recurring or chronic condition.

Primary treatment for golfer’s elbow involves resting your arm; applying ice on the affected area; and avoiding the activity that triggered the condition for at least 2 weeks, or until the pain is gone.

Golfer’s Elbow Therapy

• Apply an ice compress to your elbow for at least 15 minutes, three to four times a day over the next several days. You can also get more pain relief by massaging your inner elbow with an ice cube. Do this for at least 5 minutes, two to three times throughout the day.
• Wear a brace to prevent added strain on the affected tendon and muscle.
• Perform stretching and strengthening exercises using the affected arm to help the tendon heal faster. Physical or occupational therapy is usually recommended for severe cases. Below are exercises recommended for medial epicondylitis therapy:
  • Ball squeezes using a soft rubber ball or a stress ball. Use the palm of the affected arm to repeatedly squeeze and release the ball.
  • Finger extension exercises involve wrapping a rubber band around the fingers and then extending the fingers outward.
  • Wrist extension exercises involve raising and lowering a 1-pound weight with the affected forearm resting on a knee or a table and the hand, palm up, hanging over the edge.
  • Forearm exercises involve holding a heavy object, such as a 1-pound barbell, with the palm of the affected arm facing inward/toward the body; rotating the hand downward, with the object toward the floor; returning the hand to the starting position; and rotating the hand upward, with the object toward the ceiling. The injured forearm should be placed on a knee or table for support.

Golfer’s Elbow Medication

• You can take ibuprofen, acetaminophen, or naproxen sodium – over-the-counter medications – to help relieve pain.
• In certain cases, your doctor might recommend corticosteroid injections to reduce inflammation. However, studies have shown that this treatment is not an effective long-term option.
• Injection of platelet-rich plasma, taken from your blood, into the affected area is a recently-developed treatment that helps reduce inflammation.

Golfer’s Elbow Surgery

• Golfer’s elbow rarely requires surgery. But if the condition does not show any signs of improvement after 6 to 12 months of conservative treatment, your doctor might recommend surgery for Golfer’s Elbow. This involves the removal of damaged tissue, as well as scar tissue or an extra bone that could be putting added pressure on the tendon. In most cases, surgery relieves pain, restores strength, and allows the patient to return to their former level of sport or activity.
• Post-operative management involves:
  • Removal of splint and sutures
  • Physical therapy, beginning with gentle passive and active hand, wrist, and elbow exercises
  • After 3-4 weeks, the patient can perform gentle isometrics
  • On the 6th week, the patient can perform more resistive exercises
  • Progressive strengthening exercises should be followed afterward

Golfer’s Elbow After-care

Pain from golfer’s elbow, as well as other associated symptoms, usually go away with conservative treatment. Most patients who undergo surgery regain full use of their elbow and forearm.

Returning to the activity that caused the condition must be done gradually and only after the pain has gone away. Practicing the motions involved in the sport or activity and learning proper technique will help prevent the condition from recurring. You should also consider lessening the frequency or intensity of your activity. Changing some of your sports or work equipment can help minimize the risk of the symptoms coming back.

Preventing Golfer’s Elbow

• Muscle strengthening exercises
• Performing adequate warm-up/stretching exercises before and after activity
• Using proper form/technique when performing sport or activity
• Stopping immediately if activity causes pain

Treatment options for pain is best achieved through a combination of injection in conjunction with graded rehabilitative exercise. Individual programs may include a cortisone shot, regenerative medicine, PRP injection, PRP treatment or stem cell therapy which boosts the body’s natural ability to heal.

If your pain does not resolve after a brief period, contact us so that we may help diagnose the problem and treat the underlying cause. Do not let pain persist or else it may become chronic.