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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 muscles which flex and rotate the forearm originate over the medial epicondyle, the bony prominence on the inside of the elbow, with the tendon anchored into the bone by the tendinous insertion. The pain occurs close to this and may be due to a degenerative process occurring in the tendon, as little inflammation has been noted in these cases.

The flexor tendons are put under stress by activities which force the forearm outwards away from the body and these stresses occur as the wrist is cocked prior to throwing, in the early acceleration of the throw and in the golf swing from high backswing to just before the ball is hit. The dominant hand is affected in golfers and in tennis players those who impart a heavy topspin to the ball are more likely to suffer.

Golfer’s elbow is not as common as tennis elbow but is the commonest cause of medial elbow pain with about half as many women affected as men. The third to fifth decades of life are the commonest periods for pain onset and 60% of golfer’s elbow occurs in the dominant hand. An acute onset of pain is reported in a third of patients, with the other two-thirds developing over a period of time.

Pain and ache over the front of the medial epicondyle is the typical symptom, worse with repeated flexion of the wrist and improved with resting. Shoulder, elbow, forearm or hand pain can occur, with weakness or pins and needles in the lower arm. Physiotherapy examination includes the bony tendon insertions, the elbow joints and the muscles, with palpation of the “funny bone” area behind the elbow where the ulnar nerve lies. Nerve involvement can give weakness in the forearm muscles and sensory symptoms, so an exclusion neurological examination is performed by the physio.

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.

In the acute phase of golfer’s elbow the physiotherapist’s aim is to reduce any pain and inflammation using ice treatment, stretching gently, deep frictions, ultrasound and anti-inflammatory medication. Progression into the sub acute phase changes treatment to increasing flexibility, strength and returning to normal activities in a paced manner. Counterforce forearm bracing can help realign the tendon stresses, or a wrist brace can give the muscles a rest. For a chronic syndrome the treatment is similar with reducing splint use and returning to sporting activities.

Scientific work shows that steroid injections can be useful in the early stages of golfer’s elbow to reduce pain and the time to recovery, but they are also used in chronic situations. There is no evidence that shockwave or laser therapy has any effectiveness and surgery is contemplated when a significant period of physiotherapy has been attempted without success. The surgeon removes the abnormal tendinous tissue and if the ulnar nerve is involved he may move it around to the front of the elbow from its posterior groove.

A professional instructor will allow correction of golf swing technique. Overall fitness including strengthening exercises, aerobic work and stretching is another aim of treatment. Proper sporting technique and equipment usage is vital in athletes, with a good warm up prior to performance and good stretching afterwards. Patients may need to be strictly monitored and treated by the physiotherapist as many sports people ignore pain during activity, worsening or prolonging their symptoms.

Tags: Health & Fitness //