What is “golfers’ elbow”?

Medial epicondylitis (golfers’ elbow) is less common that its counterpart on the lateral (outside) and occurs more frequently in sports that place stresses on the medial aspect of the elbow. Affected structures include the muscle-tendon structures at and just below the attachment site on the medial epicondyle (bony prominence on the inside of the elbow). These muscles are responsible for flexing your wrist and pronating (turning the palm down) your forearm. This condition occurs not only in golfers, but also in anyone who performs repeated resisted motions of the wrist.

Examples include golf, tennis and bowling. Despite its name “tendonitis,” which literally refers to inflammation (“itis”) of the tendon, there is no inflammatory component. The true pathology is what is now referred to as “tendinosis,” referring to degenerative changes in the tendon at the attachment site.

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How does golfers’ elbow occur?

Chronic, repetitive stress and strain to the muscles and tendons of the wrist and forearm to the elbow may cause this condition; alternatively, a sudden strain on the forearm, including wrist snap when serving balls with racket sports or throwing a baseball

What increases the risk?

• Sports or jobs that require repetitive and/or strenuous forearm and wrist movements (tennis, squash, racquetball, carpentry)
• Poor physical conditioning (strength and flexibility)
• Inadequate warm-up before practice or play
• Resumption of activity before healing and rehabilitation and conditioning are complete

What are the symptoms of golfers’ elbow?

• Pain and tenderness on the inside of the elbow
• Pain or weakness with gripping activities
• Pain with twisting motions of the wrist (playing golf, using a screwdriver, or bowling)

How is golfers’ elbow diagnosed?

Diagnosis is established by the history of medial elbow pain, focal tenderness over the bony prominence on the inside of the elbow (the medial epicondyle). There may be pain with wrist flexion (bending wrist towards the palm) against resistance or pain with forearm pronation (turning palm down) against resistance.

Are there any special tests?

• X-rays are usually normal

• MRI is unnecessary except in cases that are atypical (i.e., history of prior surgery, significant trauma, swelling, difficulty with elbow motion).

How is golfers’ elbow treated?

Non-operative treatment is effective for most patients. Initial treatment consists of activity modification to minimize provocative activities that cause the pain. Anti-inflammatory medications and ice may be of value.

Brace or splint

Use of a “counterforce” (tennis elbow brace splints the muscle-tendon unit just distal to (below) the site of attachment) may be recommended. Gentle stretching and strengthening is helpful as the symptoms subside. Persistent symptoms may justify referral to physical therapy for further evaluation and treatment. Persistent symptoms are often treated with cortisone injection, which is effective for most patients, but may need to be repeated.

Operative treatment

Most patients respond to non-operative treatment, but for those who have persistent symptoms, surgery is indicated. Surgical treatment is open and involves surgical excision of the pathologic abnormal tissue responsible for the symptoms. The success rate with surgical treatment is better than 90 percent.

What are the complications of treatment?

Possible complications of non-operative treatment include:

• Persistent symptoms of pain and impairment in daily activities, vocation and/or athletics

Possible complications of operative treatment include:

• Persistent symptoms of pain/impairment
• Risks associated with any surgery, such as infection, stiffness, and inability to return to previous level of pre-injury activity

When can you return to your sport or activity?

In cases that have been present for a short period, improvement with simple measures may be effective quickly. Chronic cases may require three to six months to resolve, and may require referral to a physical therapist or athletic trainer.

How can “golfers’ elbow” be prevented?

• Appropriately warm up and stretch before practice or competition
• Maintain:
  • Wrist and forearm flexibility
  • Muscle strength and endurance
• Ensure proper equipment fit (e.g., racquet size/weight and grip)
• Maintain proper technique and have a coach correct improper technique
• Wear a tennis elbow (counterforce) brace