Golfer's elbow is also known as medial epicondylitis and is the less common sister condition of tennis elbow, both conditions sharing the tendon degenerative nature without inflammation. They are referred to as tendinopathies due to the pathological changes which occur inside the tendon without an inflammatory process. Not just occurring in golfers, golfer's elbow also appears in racquet sports, cricket bowling, weightlifting and archery.
The medial epicondyle is the bone prominence on the inside of the elbow where the forearm and rotatory muscle originate from. The muscles become tendinous near the bone and the tendon inserts into the bone to anchor the muscles. This area is where the pain occurs but there is no inflammatory process, rather a degenerative one. As the elbow is stressed by forces which would tend to push the elbow out into "knock elbow", the tendon takes a lot of stress and changes occur.
The throwing the ball action brings these factors into play, especially cocking the wrist at the start of the movement and the acceleration which follows. Golfers, whose dominant hand is typically affected, engage these stresses from the top of the backswing down to just before ball strike. Heavy topspin tennis players are also more susceptible.
Tennis elbow is more common but golfer's elbow remains the most reported pain problem over the inner elbow. Men are more likely to be sufferers than women in a 2:1 proportion, with most people affected in their early adult or middle years. The dominant hand is typically affected in two-thirds of cases, a third report a sudden pain onset with pain coming on slowly over time in the rest.
Patients complain of aching pain over the front of the inner epicondyle, worse with repeated wrist flexion and better with rest. Pain can occur in the shoulder, elbow, forearm or hand, with weakness in the lower arm and hand also. The physiotherapist will examine the bony areas and joints of the elbow, check the muscles and their tendinous insertions. The physio palpates the ulnar nerve in the groove behind the elbow, called the "funny bone" when it's hit. The nerve can give pins and needles or weakness in the forearm and a neurological examination excludes other causes of pain or weakness.
Most golfer's elbow treatment is conservative, not surgical. Treatment involves activity modification, forearm or wrist splinting, anti-inflammatory drugs, steroid injections and physiotherapy. Modification of the use of the arm is vital to prevent ongoing stimulation of the condition, so altering the mechanics of swinging the golf club or other sporting equipment is essential. Patient education continues with the identification of aggravating activities and postures and the patient is taught to avoid them.
Non-steroidal anti-inflammatory drugs are used by physios in the initial acute phase to reduce pain and inflammation along with avoiding painful movements, use of ice, gentle stretches, friction massage and ultrasound. As the problem settles and becomes sub acute the aims change to improving flexibility by stretching, increasing strength and normal activities. A forearm brace may also be used or a wrist brace to rest the wrist muscles. Once the problem is chronic the programme continues with reduced use of the splint and re-introduction of sporting activities.
Doctors inject corticosteroid medication into the sites of chronic golfer's elbow but this treatment appears to be more useful in the earlier, acute cases. Other therapies, such as shockwave or laser, have been used but do not seem to be effective. Once physio has been attempted for some time without improvement then a surgical approach may be considered, cutting out the abnormal tissue from the tendon. The ulnar nerve can be transposed around to the front of the joint from its position in the groove posteriorly.
Advice from a professional instructor is well worthwhile as they can instruct on technique of the golf swing, aerobic fitness, muscle strength work and flexibility. Warming up prior to activity and stretching afterwards, with good sporting technique and sound choice of equipment are the basic requirements. Monitoring of patients by the physiotherapist, especially if they are sports people, may be essential to avoid overdoing and training or performing through pain. - 16004
The medial epicondyle is the bone prominence on the inside of the elbow where the forearm and rotatory muscle originate from. The muscles become tendinous near the bone and the tendon inserts into the bone to anchor the muscles. This area is where the pain occurs but there is no inflammatory process, rather a degenerative one. As the elbow is stressed by forces which would tend to push the elbow out into "knock elbow", the tendon takes a lot of stress and changes occur.
The throwing the ball action brings these factors into play, especially cocking the wrist at the start of the movement and the acceleration which follows. Golfers, whose dominant hand is typically affected, engage these stresses from the top of the backswing down to just before ball strike. Heavy topspin tennis players are also more susceptible.
Tennis elbow is more common but golfer's elbow remains the most reported pain problem over the inner elbow. Men are more likely to be sufferers than women in a 2:1 proportion, with most people affected in their early adult or middle years. The dominant hand is typically affected in two-thirds of cases, a third report a sudden pain onset with pain coming on slowly over time in the rest.
Patients complain of aching pain over the front of the inner epicondyle, worse with repeated wrist flexion and better with rest. Pain can occur in the shoulder, elbow, forearm or hand, with weakness in the lower arm and hand also. The physiotherapist will examine the bony areas and joints of the elbow, check the muscles and their tendinous insertions. The physio palpates the ulnar nerve in the groove behind the elbow, called the "funny bone" when it's hit. The nerve can give pins and needles or weakness in the forearm and a neurological examination excludes other causes of pain or weakness.
Most golfer's elbow treatment is conservative, not surgical. Treatment involves activity modification, forearm or wrist splinting, anti-inflammatory drugs, steroid injections and physiotherapy. Modification of the use of the arm is vital to prevent ongoing stimulation of the condition, so altering the mechanics of swinging the golf club or other sporting equipment is essential. Patient education continues with the identification of aggravating activities and postures and the patient is taught to avoid them.
Non-steroidal anti-inflammatory drugs are used by physios in the initial acute phase to reduce pain and inflammation along with avoiding painful movements, use of ice, gentle stretches, friction massage and ultrasound. As the problem settles and becomes sub acute the aims change to improving flexibility by stretching, increasing strength and normal activities. A forearm brace may also be used or a wrist brace to rest the wrist muscles. Once the problem is chronic the programme continues with reduced use of the splint and re-introduction of sporting activities.
Doctors inject corticosteroid medication into the sites of chronic golfer's elbow but this treatment appears to be more useful in the earlier, acute cases. Other therapies, such as shockwave or laser, have been used but do not seem to be effective. Once physio has been attempted for some time without improvement then a surgical approach may be considered, cutting out the abnormal tissue from the tendon. The ulnar nerve can be transposed around to the front of the joint from its position in the groove posteriorly.
Advice from a professional instructor is well worthwhile as they can instruct on technique of the golf swing, aerobic fitness, muscle strength work and flexibility. Warming up prior to activity and stretching afterwards, with good sporting technique and sound choice of equipment are the basic requirements. Monitoring of patients by the physiotherapist, especially if they are sports people, may be essential to avoid overdoing and training or performing through pain. - 16004
About the Author:
Jonathan Blood Smyth is a Superintendent Physiotherapist at an NHS hospital in the South-West of the UK. He specialises in orthopaedic conditions and looking after joint replacements as well as managing chronic pain. Visit the website he edits if you are looking for physiotherapists in Manchester.
