Golfer’s elbow, also known as medial epicondylitis, describes pain on the inside of the elbow. It is generally considered to be an overuse injury due to repetitive use of the muscles of the arm and forearm, particularly the muscles that bend or flex the wrist and fingers (flexors). This leads to small tears in the tendons that attach to the inside of the elbow (medial epicondyle) and can result in degeneration. This can then result in pain and inflammation.
Causes of Injury
Golfer’s elbow can occur as a result of any activity that involves repetitive use of the forearm muscles. As the name, suggests, it is also common in golfers. There are a number of factors that can increase a person’s risk of developing golfer’s elbow, including:
- Activities involving prolonged gripping as with racquet sports, gardening or power tools
- Repetitive heavy lifting (bricklaying, weight lifting)
- Tennis players (particularly with frequent forehand shots)
- Recent increases in training intensity, frequency or duration or a change in equipment.
Signs and Symptoms
- Pain and tenderness on the inside of the elbow
- Pain aggravated by activities such as gripping objects, twisting tops off jars or door knobs and carrying heavy objects.
- Pain initially relieved with rest
- Weakness of wrist and finger flexor muscles
- Possible nerve involvement leading to numbness or tingling in the ring and little fingers
The initial aim of treatment is to reduce associated pain and inflammation. Rest from aggravating activities is important. Treatment and management options include:
- Avoidance of aggravating activities
- Anti-inflammatory medication as recommended by a doctor or pharmacist
- Taping, braces or supports as indicated
- Physiotherapy- massage and mobilisations, ultrasound, ice therapy and stretches
- Development of a pain-free exercise program aimed at stretching and strengthening specific muscles around the elbow.
- Education and advice regarding technique correction for the aggravating activity.
A period of three to six weeks (at least) of physiotherapy should allowed prior to considering other options. If symptoms persist, a corticosteroid injection into the painful area may be considered to assist in reducing pain and inflammation. In this case, continuing the exercise program provided is still important. Surgery is a last resort treatment. Surgery generally involves removal of any damaged tendon and repair of any large tears in the tendon. Surgery will only be performed if conservative management over six to twelve months is ineffective.
Return to Activity
Golfer’s elbow will generally last for three to six months and longer in more severe cases. Most individuals will respond well to conservative physiotherapy treatment and a full recovery is likely.