Golfer's elbow (medial epicondylitis)

Regain elbow movement with specialised individual therapy

Although golfer's elbow can indeed develop from playing golf, in most of the cases the cause is not related to this sport. Pain can also occur for any person while bending the wrist or simply squeezing something in the hand.

At Schoen Clinic, you will receive comprehensive advice from our shoulder and elbow specialists and together with you, we will discuss which treatment is best for your symptoms.

How does golfer's elbow develop?

Golfer’s elbow is due to chronic degeneration of the tendon insertions on the inside of the elbow. It is a painful condition caused by repetitive use and sprains of the tendons.

Golfer’s elbow can be associated with compression of the ulnar nerve and in these cases, abnormal sensation, tingling or burning might affect the ring and little fingers. Therefore, an ulnar nerve decompression may be required in addition to the standard surgical treatment.

Rarely, golfer’s elbow can be also associated with elbow instability. This is usually seen in throwing athletes, where the elbow feels unstable and may clunk on movement. Instability is caused by insufficiency of the ulnar collateral ligament on the inside of the elbow. This might also require surgical repair.

Golfer's elbow symptoms

Symptoms of golfer’s elbow include pain and weakness when performing movements such as bending the wrist, making a fist or squeezing something in the hand. These are common movements in many sports and activities including golf, throwing and manual labour.

Causes of golfer's elbow

A golfer’s elbow injury occurs when the tendons and muscles used to control your wrist become damaged. You often see this injury in golfers due to the repeated strain imposed on the wrist and fingers. Damage typically occurs when repetitive actions create small tears in the tendon that connects the wrist and the elbow, which in turn can become swollen and painful.

There are several contributing factors that can lead to a golfer’s elbow injury occurring. Inadequate warm-up prior to sport, poor conditioning and technique, as well as regular repetitive strain which can all have an impact.

This is how we diagnose golfer's elbow

Diagnosis is usually confirmed by clinical examination. However, an X-ray may be requested to exclude other causes of elbow pain. Often an ultrasound scan is performed if an acute tendon tear or calcium deposits within the tendon are suspected. Nerve conduction studies might be required if ulnar nerve compression is suspected. MRI can help diagnose elbow instability and tendon degeneration. 

Regain function and strength in your elbow

Approximately 90% of golfer’s elbow resolves without surgery. Recommended treatment often includes activity-modification, physiotherapy, injections or shockwave therapy.

Activity-modification and physiotherapy

This is usually the first-line treatment. Avoiding repetitive and painful movement, or modifying activities to use other muscle groups will provide symptom relief. Physiotherapy aims to combine stretching exercises with exercises to strengthen the flexor muscles. This is usually effective in the long-term.  Splinting can be useful to reduce the strain on the insertion of the tendon on the bone.

Injections

Steroid can be injected locally into the affected area. This may provide short-term pain relief and is very helpful in acute phases. Up to three injections can be given but, despite good short-term relief, recent studies show no change of the condition or sometimes an even longer recovery time after steroid injections.

Shockwave therapy

A machine delivers sound waves into the affected area. Reported rates of success are extremely variable and therapy can sometimes be considered an experimental treatment, but new evidence is coming out about its efficacy. However, whilst it is not possible to guarantee that it will work, it is very safe. 

PRP injection

This is a new treatment used for some common orthopaedic conditions in your elbow like lateral epicondylitis (tennis elbow) or medial epicondylitis (golfer’s elbow).

Platelet rich plasma (PRP) is blood plasma with concentrated platelets (the body’s repair for damaged tissue). The concentrated platelets found in PRP contain growth factors that are vital to initiate and accelerate tissue repair and regeneration. These bioactive proteins initiate connective tissue healing and repair, promote development of new blood vessels, and stimulate the healing process.

The treatment involves obtaining a blood sample, centrifuging (spinning) it to retrieve the growth factors and reinject it in the tendon area, often under local anaesthesia.

Scientific evidence of this treatment is mild to moderate. There are no long-term studies but when it works this treatment may eliminate the need for more aggressive treatments, such as long-term medication or surgery. A major advantage is the patient’s own growth factors are used rather than a foreign substance, therefore there is no risk of disease transmission.

Golfer's elbow surgery

Surgery for golfer’s elbow is usually performed as a day-case and can be open or keyhole. Open surgery is usually very successful with more than 90% of patients improving significantly. Keyhole surgery is still new in this particular condition, but it is showing promising results.

Rare complications of surgery include:

  • Infection
  • Nerve or blood vessel damage
  • Weakness
  • Stiffness
  • Growth of islands of bone
  • Prolonged rehabilitation
  • Need for further surgery

Aftercare

Pain: During surgery local anaesthetic is injected around the wound and the elbow is numb for a few hours. After this you will be given painkillers to take whilst in hospital and at home. Ice packs may also help reduce pain. Ice can be wrapped in a damp tea towel and applied to the elbow for up to 20 minutes.

Wearing a sling: At the end of the operation you will be placed into a bandage dressing and a sling. These are for comfort and can be removed after 48 hours.

The wound: Keyhole surgery is usually performed through small 5-10mm wounds. With open surgery, the wound will be a few centimetres in length. You may have dissolvable stitches or sticky strips over the wounds. You must keep the wounds dry and covered with a small dressing until they have healed. This usually takes 7-10 days.

Returning to work: This will depend on your job and your surgeon will advise you. You may be able to return to a desk job within a few days. However, manual labourers may need 8-12 weeks off work.

Driving: You will not be able to drive for about a week.

Leisure activities: You will not be allowed to lift anything heavy or do anything very active for approximately 6-12 weeks. Contact or high-risk sports may need to be avoided for six months.

Follow-up appointment: You will be seen in outpatients by your surgeon two to three weeks after surgery.

Physiotherapy: Before you go home your physiotherapist will teach you some exercises for you to practise several times every day. You should continue these exercises until you see the physiotherapist in outpatients. Recovery time can be slow due to poor blood supply in the area and slow healing of the tendons. Whilst some improvement can be seen after four weeks, it often takes between four and six months to regain good/full function and strength within the elbow.

Golfer’s elbow: Our specialists

Our specialist Consultant Orthopaedic Surgeons diagnose and treat all upper limb conditions including the shoulder and elbow.

Golfer’s elbow: Our specialised hospital

Whether you are a golfer or not, our specialised orthopaedic & spinal hospital in the heart of London is home to the specialists who can assist in resolving your condition. As a patient at Schoen Clinic London, your safety and care is paramount in order to provide you with the best possible outcome and a quick return to your everyday life.