Golfer’s Elbow (Medial epicondylitis)

Golfer’s elbow, also known as medial epicondylitis, is less common than tennis elbow. It causes pain on the inside (medial side) of the elbow over the tip of the funny bone (medial epicondyle). It usually occurs after repetitive wrist flexion and pronation (forearm rotation) or it can develop after an injury. The flexor muscle attachment at the elbow develops small tears and becomes swollen. This disease process continues if the elbow isn’t rested properly. Amateur golfers are more prone to develop golfer’s elbow and it is the elbow of the trail arm that is commonly affected. Golfer’s elbow is not only seen amongst golfers. It also occurs in tennis players, throwing athletes and manual labourers.

Symptoms:

Pain usually develops gradually on the inside (medial side) of the elbow and may spread into the forearm. It is worsened by activity and throwing and often persists at rest. The hand grip may be weakened and a forceful hand grip may cause pain at the elbow. If the pain occurred suddenly after and elbow injury, a torn flexor muscle attachment and a torn elbow ligament should be ruled out. Throwers may have an injured elbow ligament (ulnar collateral ligament) as well as golfer’s elbow and should be examined for elbow instability.

Certain patients may have nerve-related symptoms such as pain, numbness or pins and needles over the inner aspect of the forearm, hand, little finger and ring finger due to irritation of the ulnar nerve.

Pain Management:

• Rest (probably most important) – throwers with an injured elbow ligament should avoid throwing for at least 6 weeks.
• Ice packs are helpful in the acute painful period.
• Anti-inflammatory medication and simple pain killers.
• Cortisone injections – provides good short term pain relief and improvement in grip strength.
• Platelet-rich plasma injection: this implies injection part of your own blood after spinning it in a special machine to isolate the plasma which is rich in growth factors. This is quite costly.
• Counterforce bracing and elbow taping – very little evidence to support its use.
• Shock wave therapy – conflicting evidence.

Further non-operative management:

• Physiotherapy: Stretching and strengthening exercises and commenced one pain allows.
• Prevention in golf: Consider altering swing technique and going for professional golf club fitment. The golf club length, type of shaft, club head weight and grip size could all be factors that need to be changed.
• Prevention in tennis: Consider changing racquet grip size, racquet weight, string tension and changing forehand technique.

Surgical Management:

When conservative treatment fails, surgery can be considered. A small incision is made over the inside of the elbow and the diseased part of the tendon is located and removed. If the unlar nerve is involved, it has to be released/decompressed. If there is a torn elbow ligament, it is repaired with a suture anchor (a small screw with suture threads attached to it). A few tiny holes may be drilled into the bone before the remainder of the flexor muscle origin is repaired. The skin is closed with dissolved sutures and a bulky dressing or soft cast (backslab) is applied.