GOLFER'S ELBOW: CAUSES, SYMPTOMS, DIAGNOSIS, AND TREATMENT

Golfer’s elbow, or medial epicondylitis, is a condition that develops when you overload the tendons that attach your forearm muscles to the bony bulge on the inside of your elbow. It mostly occurs in your dominant arm and typically affects men and women aged between 45 – 64 years.

Golfer’s elbow occurs due to the excessive use of your tendons leading to their tearing, irritation, and inflammation. Despite its name, golfer’s elbow is not exclusive to golfers. It is pretty common in tennis players, weight lifters, and several occupations (e.g. construction workers, plumbers, and carpenters, etc.).

Medial epicondylitis starts as abrupt or gradual pain that is mainly located on the inner side of your elbow. The pain might travel down to your forearm and wrist.

The treatment of golfer’s elbow is simple and straightforward. It is generally managed conservatively (e.g. resting, brace, exercises, etc.). However, If your pain persists despite treatment, you might be referred for surgery.

What is golfer’s elbow and what are its causes?

Golfer’s elbow is an overuse injury related to the constant, repetitive, and forceful straining of the tendons responsible for your wrist flexion (i.e. bending your wrist towards your palm). These movements result in the tearing and damage of your forearm tendons as they attach to the inner part of your elbow.

It is caused by activities that demand vigorous rhythmic wrist flexion, swinging, and finger clenching, such as racquet sports, weightlifting, and bowling.

However, more than 90% of golfer’s elbow cases are in fact work-related, not sports-related. Occupations that require heavy recurring wrist movements and are strongly associated with golfer’s elbow include carpentry, construction, plumbing, painting, etc.

If left untreated, golfer’s elbow could lead to permanent debility:

• Persistent elbow pain
• Weakened hand grip
• A stiff, inflexible, and deformed elbow

What are the symptoms of golfer’s elbow?

The symptoms of golfer’s elbow might be felt suddenly (in case of trauma) or gradually over time (in case of overuse):

• Pain
• Weakness
• Elbow stiffness and inflexibility
• Finger numbness and tingling (especially the ring and pinky fingers)

Pain is mainly felt on the inner part of your elbow. Sometimes, the pain might extend down to the inner part of your forearm and your wrist. You might also experience weakness in your wrist and hand.

Activities or movements that might worsen your pain:

• Clenching your fist
• Bending your wrist toward the palm, particularly if against resistance
• Shaking your hands
• Squeezing a rubber ball
• Swinging a golf club

What are the risk factors for golfer’s elbow?

Factors that might increase your likelihood of developing golfer’s elbow:

• Smoking
• Obesity
• Age: ≥ 40 years
• Direct trauma to your elbow
• Occupations: Work-related activities that demand forceful repetitive wrist and arm movements tend to exert a lot of stress on your tendons and are thus associated with golfer’s elbow (e.g. carpenters, plumbers, construction workers, gardeners, chefs, etc.).
• Sports: Athletes are at an increased risk for developing golfer’s elbow due to inadequate training, bad technique, and wrong equipment use, in addition to heavy physical work (e.g. tennis, golf, bowling, weight training, archery, etc.)

How is golfer’s elbow diagnosed?

Golfer’s elbow is almost always diagnosed clinically, without the need for confirmatory tests. Your doctor will ask you about your symptoms, the characteristics, and location of your symptoms, your work, and your recreational activities.

He/she will then examine you. You will be asked to rest your forearm on the examination table, with your palm facing upwards. Then, your doctor will apply gentle pressure to your hand and ask you to bend your hand towards your wrist. If this reproduces the pain you usually feel on your inner elbow when flexing your wrist, then you have golfer’s elbow.

Your doctor might recommend further testing if he/she is still not sure about the diagnosis or to rule out other conditions:

• X-ray: to rule out arthritis (i.e. inflammation of the joints) and fractures
• MRI scan: to check for the extent of tendon damage

How to fix your golfer’s elbow?

The first and foremost effective measure to improve golfer’s elbow symptoms is avoiding the activity that caused your condition in the first place. Besides resting, treatment may include:

Conservative Management

• Applying ice to the painful area can help reduce inflammation and pain.
• Off the counter pain and anti-inflammatory medications might help relieve the pain.
• You can wear a wrist brace to support your muscles and tendons.
• A physiotherapist could help you perform stretching and strengthening exercises to relieve your elbow pain.
• Seek professional guidance when it comes to the equipment you use and your technique if you’re into sports like golf, tennis, or weightlifting.
• Your doctor might recommend steroid injections for short-term pain relief.
• Your doctor might also use platelet-rich plasma (PRP) injections to aid the healing process of your tendons.

Surgical management

• Surgery to treat golfer’s elbow is rarely indicated.
• If 6-12 months of simple conservative therapy fail to control your symptoms, you might be referred for surgery.
• The success rate of golfer’s elbow release surgery exceeds 90%.
•  Your doctor will remove the damaged tissue and repair your tendons to restore the normal function of your forearm and hand.

What are the risks of golfer’s elbow release surgery?

The risks of golfer’s elbow release surgery include:

• Pain
• Bleeding
• Infection
• Stiffness
• Tendon healing failure
• Damage to nearby surrounding structures (nerves and vessels)

After surgery, your doctor will briefly observe you for potential complications before sending you home.

What to expect after your golfer’s elbow release surgery?

• The splint and sutures are removed 7-10 days after your surgery.
• At this point, you will be advised to start physiotherapy.
  • You will start off with gentle hand, wrist, and elbow exercises.
  • More resistive exercises are postponed till 6 weeks after your surgery.
• The optimal time to return to work depends on the nature of your work.
  • Professions that require light deskwork: 1-2 weeks after surgery
  • Professions that demand heavy lifting and vigorous manual work: > 3 months after surgery
• You can return to your regular activities 3-6 months after your golfer’s elbow surgery.

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Sources:

• https://www.ncbi.nlm.nih.gov/books/NBK551506/figure/article-21196.image.f3/
• https://www.ncbi.nlm.nih.gov/books/NBK519000/
• https://www.choosept.com/symptomsconditionsdetail/physical-therapy-guide-to-medial-epicondylitis-golfers-elbow
• https://www.medicalnewstoday.com/articles/320949
• https://www.hopkinsmedicine.org/health/conditions-and-diseases/medial-epicondylitis-golfers-and-baseball-elbow
• https://www.physio-pedia.com/Medial_Epicondyle_Tendinopathy
• https://www.webmd.com/fitness-exercise/golfers-elbow-basics#1
• https://www.healthline.com/health/exercises-for-golfers-elbow-2
• https://www.mayoclinic.org/diseases-conditions/golfers-elbow/diagnosis-treatment/drc-20372872
• https://www.oamkg.com/uploads/pdfs_forms/Patient%20Ed-Medial%20Epicondylitis%20(Golfer’s%20Elbow)%20Surgery.pdf

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