What is ‘Golfer’s Elbow’ ( Medial Epicondylitis) ?
Golfer’s elbow is a condition which gives rise to pain and weakness in the tendons in the elbow which attach the muscles of the forearm with the inner elbow usually as a result of overuse.
It arises due to overloading of the flexor tendons of the forearm and is often associated with increased periods of unaccustomed strenuous activity with the forearm muscles. Common examples may be an increase in computer use (especially if there is a poor ergonomic setup), DIY tasks involving gripping and twisting with the wrist/hand and sometimes racket sports.
It is often referred to as a ‘Golfer’s Elbow’ due to the fact that this tendon bears high load when playing golf. Excessive right wrist flexion (bending the wrist in the direction of the palm) in a right handed golfer may be responsible.
Although golf players can develop a ‘golfers elbow’ the vast majority of individuals who develop symptoms do so as a result of repetitive flexion at the wrist while performing lifting and carrying tasks. Hence the term medial epicondylitis is frequently used.
Localised pain is felt directly over the common flexor tendon in the inner elbow which sometimes radiates down the inside of the forearm muscle bulk.
Symptoms are aggravated by any activity which requires forceful flexion of the forearm muscles such as gripping, lifting and carrying tasks.
A medial epicondylitis can be reliably diagnosed by your doctor or physiotherapist by taking a history of your condition. In some circumstances it may be necessary to conduct a physical examination but this is usually not necessary.
The main feature is usually pain directly over the tendon when contracting the forearm muscles (when gripping or resisting wrist flexion). X-rays or other scans are not routinely required.
It can be managed very effectively by adhering to the following advice and exercise routine.
Modifying aggravating activities. If there are some particularly stressful tasks such as golf or DIY which seem to be aggravating your symptoms, then the common flexor tendon may need 4-6 weeks of relative rest initially to settle symptoms while you work on strengthening the wrist flexor muscles in the forearm and the common flexor tendon (see below):
Exercises. Regular exercises to strengthen the wrist flexor muscles and tendon in the forearm and stretch the extensor muscles:
3×15 repetitions 3-4x per week
5×30 second holds, 2x per day
These are suggested exercises only. If you are at all concerned about whether these exercises are suitable for you or if you experience any pain while doing them, please seek appropriate clinical advice from your GP or Physiotherapist.
Corticosteroid injection therapy. Evidence suggests that corticosteroid injections are best avoided as patients symptoms are more likely to get better quicker without. The steroid injection may weaken the tendon in the longer term. However, injections may be discussed with individuals who continue to suffer disabling pain (preventing work and leisure activities) and have failed physiotherapy management. You can read more about local corticosteroid injections here.
Your consultant will examine the elbow, and may use imaging technology to view the joint and rule out other causes of pain. You may be prescribed medication to treat the pain and inflammation. You will be required to rest your elbow and abstain from sports or heavy activities for a short time, and you may have to wear a splint to support your elbow.
You may be required to attend physiotherapy sessions which is often a very effective and evidenced based treatment for tennis elbow. Exercises involve gradually strengthening exercises for the forearm muscles which gradually increase the amount of load, thereby strengthening the affected tendon. In severe cases, you may require injections into the elbow joint to relieve swelling and pain.
In some cases, an operation will be required to release the inflamed tendon, debride it and repair where necessary.
Depending on the treatment required you should be able to return home the same day, but your recovery time is dependent on the severity of the injury. Your consultant will advise you and answer any questions you may have.
If a surgical release is considered, this is a generally safe procedure but there are some potential complications you should be aware of. These affect a very small percentage of patients.
- Infection can occur although our theatres have ultra-clean air operating conditions keeping infection rates to the minimum.
- Blood clots are possible after any operation and are more common in patients with some pre-existing medical conditions. However, again they affect a very small percentage of patients and have well established treatments including aspirin.
- Very rarely, damage to the nerves around the elbow leading to numbness, pain and in some cases weakness in the hand - this usually settles on its own.
- There may be continued pain in the elbow following the surgical release.