Golfer’s Elbow

Introduction

Golfer's Elbow (medial epicondylitis) is a type of cumulative trauma injury.  Golfer's Elbow results when the tendons that attach to the inner elbow degenerate.  Tendons do not stretch easily and are vulnerable to degeneration during repetitive motions, such as those used during a golf swing or work activities.  The pain of Golfer's Elbow occurs where the tendons attach to the elbow bone (medial epicondyle) and can radiate down the forearm. The majority of people with Golfer's Elbow find symptom relief with non-surgical methods.  If surgery is necessary, there are open and arthroscopic methods to fix the problem.

Anatomy

Golfer's Elbow involves the common flexor tendon that connects flexor forearm muscles to the inner (medial) side of the elbow bone (epicondyle).  The forearm muscles that flex the wrist move it downward towards the palm side of the hand.

Causes

Repetitive motions and cumulative stress cause the tendons at the inner side of the elbow to deteriorate.  Such motions may occur while playing golf, but also during periods of muscle overuse.

Symptoms

A main symptom of Golfer's Elbow is pain and tenderness at the inner side of the elbow that increases during wrist flexion or grasping motions.  The pain may radiate down the forearm.

Diagnosis

A physician performs an examination and reviews the individual's medical and activity history to make a diagnosis of Golfer's Elbow.  The physician evaluates the forearm and elbow structures with simple tests. X-Rays and, more rarely, MRI imaging, are used to confirm the diagnosis and rule out other causes of elbow pain.

Treatment

Most cases of Golfer's Elbow respond to non-surgical treatments.  Treatment typically includes rest or activity restriction or alteration.  Specific stretching and exercises under the guidance of a therapist are often prescribed.  The therapist may use ultrasound or other modalities to promote healing. A splint, brace, or elbow wrapping may be recommended.  Physicians may instruct the application of ice to the affected areas or recommend medication to relieve pain. Cortisone shots are often used, but have little evidence that they are useful.

Surgery

The majority of people with Golfer's Elbow do not require surgery.  Surgery is considered if significant pain continues after nonsurgical treatments have failed over a long time.  Surgery for Golfer's Elbow is usually an outpatient procedure. The goal of surgery is to remove the damaged tendon and reattach the healthy tendon to the bone.  There are several approaches to the surgery including open surgery, percutaneous, and arthroscopic surgery.

Arthroscopic surgery uses a small camera, called an arthroscope, to guide the surgery.  Only small incisions are used and the joint is not opened. Arthroscopic surgery for Golfer's Elbow is associated with a positive outcome and potential shortened recovery time.

Elbow motion begins almost immediately following surgery, and is gradually increased per the surgeons instructions.  Full recovery from elbow surgery may take several months.

Recovery

Recovery from Golfer's Elbow can take several months.  It is important to manage the condition with rest, rehabilitation, and lifestyle or sports modifications, such as changing the technique of a golf swing.