Golfer's Elbow
And…. You don’t even have to play golf to get it!
What is golfer’s elbow?
Golfer’s elbow, or medial epicondylitis, is a common cause of medial (inside) elbow pain.
Despite the name 90% of golfer’s elbow cases are not related to sport.
Golfer’s elbow is a condition caused by repetitive use of the forearm/elbow. This repetition, if there is an error in technique or a lack of strength/capacity of the forearm muscles, can cause microtrauma and tears to the tendon leading to pain on the inside of the elbow.
It is commonly seen in labour intensive occupations that involve forceful and repetitive actions including gripping, throwing, and lifting such as carpenters, plumbers, and builders. Sports associated with medial epicondylitis include golf, baseball, cricket, rock climbing, fishing, and weightlifting.
How do you diagnose golfer’s elbow?
In most cases, medial epicondylitis can be diagnosed by a physiotherapist (7).
Presentation:
-Gradual onset of pain
-Activity related pain (particularly involving repetitive use of forearm)
-Pain often resolves once the activity is ceased
Clinical findings:
-Tenderness over the medial epicondyle with potential swelling
-Pain at this location during resisted wrist flexion and/or forearm pronation
-Reduced grip strength
*Imaging (ultrasound and MRI) is not often required.
What else could it be?
At Elite Physio, we pride ourselves on delivering an accurate diagnosis.
While golfer’s elbow is the most common injury of the medial elbow, it is important to rule out other possible causes such as:
-C6/7 radiculopathy (referred from neck)
-Cubital tunnel syndrome
-Ulnar or median neuropathy
-Ulnar neuritis
-Anterior interosseous nerve entrapment
-Ligamentous injury
-Arthritis
Prognosis
Prognosis for golfer’s elbow is generally favourable.
Most patients with golfer’s elbow will have a full return to activities, work, or sport, particularly if they seek help from a physiotherapist and are diligent with their acute management, rest and a progressive exercise program.
Treatment
Phase one: Settling the symptoms
Following an acute golfer’s elbow, it is important to rest and offload the elbow. This will help reduce the stress placed on and around the medial epicondyle and allow a quicker recovery of the injured tissue. Cessation of aggravating activities is important to allow the injured site to repair and for swelling to subside, however this may be difficult for certain occupations. For these scenarios, taping or bracing the elbow may be of benefit. While anti-inflammatory medication may also help.
Phase two: Rehabilitation through loading and strengthening
Tendon rehabilitation takes time!
Unlike other injuries such as a muscle strain or ligament sprains, tendons can take 12 weeks of progressive loading to change from being pathological and painful to functioning normally. Throughout this process, there are lots of treatment modalities we use to reduce the pain and promote loading/exercise.
It is important to note that a “flare-up” of pain is not uncommon and not necessarily detrimental to your progress. Settle the symptoms and continue with your rehab exercises!
Phase three: return to sport/activity
During the final phase of rehabilitating, it is important to put the elbow through exercises that simulate specific sport/activity as well as test its ability to transmit load.
This is done via heavy, fast, and repetitive exercises.
Other treatments
Pharmacology
Primarily used for pain control, a short course of NSAIDs may be indicated to increase comfort for clients and allow them to perform the prescribed exercises.
Corticosteroid injection
Studies have demonstrated short term pain benefits of CSI for epicondylitis (up to 8 weeks).
Autologous blood and platelet-rich plasma (PRP) injections
The results from these types of injections have been promising but inconsistent. There is some research supporting the use of PRP injections.
The bottom line
Golfer’s elbow can be a frustrating, stubborn, and debilitating condition. It can impact your ability to work, play sport and even enjoy basic daily activities.
Call us 89418555 for a comprehensive assessment, accurate diagnosis, and thorough treatment for your medial elbow pain.
