Golfer's Elbow — Symptoms, Causes & Treatment

Golfer's elbow or medial epicondylitis is an overuse injury that occurs when the tendons on the inner side of the forearm become irritated, inflamed, and painful.

Golfer's elbow or medial epicondylitis is caused by damage to the muscles and tendons that control the wrist and fingers. This usually occurs in golf players and others who repeatedly use their hands, wrists, forearms, and elbows. Other causes can be:

• Degenerative changes.
• Excess or repeated stress.
• Improper lifting, throwing or hitting.
• Too little warmup or poor conditioning.
• Improper technique with tennis strokes, especially the backhand or excessive use of topspin.
• Using too small or heavy rackets.
• Improper pitching technique in baseball or softball, football, archery, and javelin throwing.
• Lifting weights while using improper techniques.
• Forceful, repetitive occupational movements such as plumbing, construction, and carpentry.

Pain in the golfer's elbow can occur suddenly or gradually.

• Pain on the inner side of the elbow.
• Tenderness in the elbow.
• Radiating pain to the inner side of the forearm.
• Pain aggravates with certain movements like gripping or squeezing.
• Elbow stiffness.
• Weakness in the hands and wrists.
• Numbness or tingling in one or more fingers.

Pathology:

The group of muscles that bend and turn the wrist, fingers, and thumb, stabilize the elbow, and allow for wrist movement are affected. Inflammation occurs in the tendon when the load exceeds the tissue's capacity, causing the tendon to become tender and irritated with continuous overuse and insufficient recovery and repair time.

Physical examination:

Golfer's elbow is usually diagnosed based on the physical examination and medical history. The examiner evaluates the pain and stiffness, applies pressure to the affected area, or asks to move the elbow, wrist, and fingers in various ways. With the elbow fully extended, the patient feels points of tenderness over the affected area on the elbow. Passive wrist flexion and resistive wrist extension (Cozen's test) are also painful which means Cozen's test is positive.

X-rays:

An x-ray can help to confirm and distinguish the possible causes of elbow pain such as fracture or arthritis.

MRI:

Magnetic resonance imaging can confirm the presence of excess fluid and swell in the affected region of the elbow.

Medication: Ibuprofen, naproxen sodium or acetaminophen, corticosteroid injections

etc.

Note: Medication should not be taken without the doctor's prescription.

Surgery:

Surgery is not usually required but if the signs and symptoms don't respond to conservative treatment in 6 to 12 months, then surgery might be recommended.

Rest:

Rest from repetitive activities is recommended until the pain is gone, as movement can worsen the condition.

Cryotherapy:

Cryotherapy or ice packs can be applied to the elbow for 15 to 20 minutes, 3 to 4 times a day for several days. To protect the skin, wrap the ice pack in a thin towel and use it to massage the inner elbow with ice for 5 minutes at a time, 2 to 3 times a day.

Brace:

The physiotherapist recommends wearing a brace on the affected arm, which might reduce tendon and muscle strain.

Taping:

Taping has a good effect on pain and enables pain-free grip strength in patients with chronic golfer's elbow. Physiotherapists usually suggest Kinesio tape and exercise, which are found to be very effective.

Manual therapy:

Manual therapy is a hands-on treatment that involves techniques like mobilization with movement that can reduce pain and facilitate exercise e.g Mulligan's mobilization, etc. Manual therapy uses soft tissue massage and joint mobilization techniques to regain full movement in the affected area. Transverse massage is effective in breaking the adhesions that finally help in pain-free movement.

Ultrasound therapy:

Ultrasound therapy is found to be effective to relieve pain and spasm.

TENS:

The TENS unit helps alleviate pain in the golfer's elbow. It is used 2-3 times per day or as needed to reduce pain and inflammation.

Laser therapy:

Laser with intensity 1-4 joule energy with power 905NM in pulse/continuous with 1 m exposer at each point to the medial epicondyle 3-4 days weekly treatment for 3-4 weeks decreases pain and swelling.

Stretching Exercises:

Stretching exercises are considered to be an effective measure for tendon overuse injuries. Stretching can be done on the elbow, forearm, wrist, shoulder, and thoracic spine increasing movement.

Strengthening Exercises:

Strengthening exercises of the forearm, elbow, and hand are incorporated by using weights and resistance bands to strengthen the weak muscles. Isometric exercises can be used during the acute phase of the golfer's elbow. These exercises generate force without changing the length of the muscle. Eccentric exercises cause muscles to elongate in response to a greater opposing force and build muscle flexibility. These exercises strengthen the muscles, tendons, and ligaments and can help reduce the risk of muscle strains and tears. Eccentric exercises involve progressive loading on the tendon, which helps the tendon gradually adapt to tolerate the demands placed on it.

Patients are educated to modify specific movement patterns to lessen the stress on the tendons, forearm, elbow, and wrist and also reduce the risk of injury, such as adjusting the golf swing and throwing techniques or altering work tasks to reduce the pressure placed on the tendons of the forearm.