What is Golfer’s Elbow?
Most people have heard of Tennis Elbow, but fewer know of Golfer’s Elbow, the common term for medial epicondylitis. While it is very similar to Tennis Elbow, or lateral epicondylitis, Golfer’s Elbow affects the bony bump on the inside of the elbow. It is not caused by inflammation of the tendons as often thought but a build-up of scar tissue that has formed through excessive use. The tendons affected are those that connect the muscles of the forearm to the elbow joint. These muscles are responsible for flexing the wrist and fingers, gripping and pronating (rotating) the arm. Pain can be sharp, localised to the elbow and may radiate down the arm into the wrist and hand. Gripping and resisted movement is usually painful as well as some pain on muscle stretching, especially on wrist flexion, bending the hand towards the forearm. It can sometimes be accompanied by median nerve irritation with neck stiffness and tightness and there may be trigger points felt within the wrist flexor muscles. Patients often present with pain on shaking hands, a weak grip, tingling and pins and needles extending from the elbow to the ring and pinkie fingers.
Repetitive strain applied to the tendon causes tissue degeneration and microtears which can result in fibrosis and calcification as well as swelling and pain. Some referred pain (especially from the neck) can mimic Golfer’s Elbow. The most common vertebrae are C6/7 and the corresponding median nerve. A physiotherapist will complete a full assessment and test shoulder and neck joints to ascertain where the source of pain is.
A physical examination is usually all that is required to diagnose Golfer’s Elbow although it can also be confirmed via an ultrasound or MRI to identify any inflammation. X-rays are of no diagnostic benefit.
Who Suffers From It?
Golfers are the most obvious candidates; however, 90-95% of patients are not sportsmen. It more commonly affects tradesman who perform large amounts of gripping movements in their work. Other sports such as tennis, squash, weightlifting, rowing, baseball and cricket can also cause the condition as they all involve gripping rackets and bats for long periods of time. Ironically tennis players can also get Golfer’s Elbow and it is not unheard of to develop both Tennis and Golfer’s Elbow in the same arm.
Manual tasks such as those carried out by plumbers, builders, carpenters, butchers and cooks or patients who have suddenly performed a large amount of repetitive strain e.g. amateur DIY enthusiasts turning a screwdriver multiple times due to starting a home renovation project.
While it can strike at any age, it usually affects those between 35-50 years old and people are more at risk if they are obese, smokers, Type 2 diabetics and perform manual or repetitive tasks for two or more hours per day. Males and females are equally as affected, and it usually occurs in the dominant arm, but this is not always the case. In patients where the cause of symptoms is work related, it’s more likely to be due to forceful activities in men and repetitive strain in women.
Another factor that can increase the risk of developing Golfer’s Elbow is those athletes who spend too little time warming up or those with poor conditioning e.g. a sudden increase in the amount of time playing golf or doing manual tasks around the home such as people who enthusiastically start home renovations.
How Is Golfer’s Elbow Treated?
Initial treatment should focus on rest and avoidance of aggravating and problematic activities. Over the counter anti-inflammatories and analgesia can be helpful as well as applying ice to the region.
If it does not settle with the above treatment, then it’s best to seek the advice of a physiotherapist. Assessment will involve a thorough subjective interview, establishing aggravating factors and relevant medical history then a physical examination assessing range of movement and muscle strength as well as looking at the adjacent joints to rule out other possible sources of the pain.
To determine a positive test, while the elbow is kept in extension, patients will have pain on passive wrist extension and resisted wrist flexion. Treatment may consist of manual joint glides and the teaching of similar self-glides that the patient can perform themselves.
Similarly, they can be taught self-massage, specifically cross fibre friction massage. This technique may feel quite tender initially as the body has laid down some scar tissue and the massage is trying to break this down.
Some adjunct treatment techniques include:
- Taping to offload the joint and the tendon. If effective, patients can be taught to self-tape, making this a great choice for independent management
- Elbow brace for extra support during aggravating activities
- Anti-inflammatory gels and creams
- Ultrasound application
- Night splinting
- Steroid injections can have a short term (2-6 weeks) effect on pain when conservative management has been unsuccessful
- Strengthen the muscles of the forearm by squeezing a ball, using light hand weights
- Ensure correct technique with any sports, ask a coach to review your form
- Adequate stretching of muscles before and after activity
- Make sure you use correct lifting technique when picking up an object, keep your wrist rigid, this reduces the force on the elbow
- Adequate rest, listen to your body and try not to continue an activity beyond the point of pain
If your elbow is hot and swollen and you are suffering from a temperature, then seek medical advice from a doctor immediately as this can indicate the presence of an infection.