Golfer’s elbow may also be referred to as medial epicondylitis. It causes pain on the inside of your elbow. This pain is made worse in several situations:
People also notice a tender spot around the inside of the elbow, usually around the prominent part of bone known as the medial epicondyle. This is where the muscles that are involved in making a fist and bending your wrist start.
Some people also get numbness or tingling in their little finger due to irritation of a nerve that runs down the inside of the elbow. This is called cubital tunnel syndrome.
Anyone can get golfer’s elbow. Interestingly, golfers are actually more likely to get tennis elbow then golfer’s elbow! It is most common in people who make repetitive wrist movements as part of their job, such as painters and carpenters. It can also happen as a result of racket sports, throwing sports and weight training. This overuse of the muscles is thought to cause tiny areas of damage in the tendons that bend your wrist and fingers which are not given a chance to heal properly.
This starts with a conversation with your doctor to describe the problems you are experiencing with your elbow. You will then be examined, with some specialised tests, paying careful attention to where the pain is coming from. The diagnosis is usually clear by this point. If there is any suspicion that the pain is instead due to arthritis around the outside of your elbow, you may be sent for an X-ray. If there is any doubt, or initial treatments have not worked, you may be sent for an MRI scan to look in more detail at the area. If you have pins and needles or any changes in sensation in your fingers, you may be sent for nerve conduction studies to check whether you have a trapped nerve around your elbow.
For some people, just knowing what the problem is, and having the reassurance that there is no major damage to the elbow is enough. The pain can be controlled with simple painkillers, such as paracetamol and anti-inflammatories (if you can take them). This may be coupled with simple changes to your lifestyle to rest your elbow while it recovers.
Most people make a full recovery within a year.
There are several commercially-available braces for golfer's elbow. These are usually straps or plastic clips that go around your elbow near the source of pain. They put gentle pressure on the tendons in your forearm. Some people find these very beneficial at relieving the pain in your elbow. There are relatively inexpensive and safe treatments and, although they do not work for everyone, they are often worth a try.
A course of physiotherapy is the first line of treatment that most people are offered. The goal of physiotherapy is to stimulate the tendon to heal by itself, without causing further damage. The main exercises for golfer's elbow are controlled stretching exercises. Your physiotherapist will show you these. It is normal for these exercises to be painful and you may need to build up from doing the exercises only once every 2-3 days to eventually doing them 3 times per day. It can take several months to get the full benefit of physiotherapy, so it is important to work hard early on, even if you do not feel an immediate benefit.
Another effective treatment is a PRP injection. PRP stands for Platelet-rich plasma. This involves taking some blood from your arm and putting it into a machine that separates the liquid and different types of cells in your blood. Special cells called platelets are then extracted from this mixture and injected around the painful area in your tendon. These platelets contain important proteins that stimulate healing and are thought to kick-start the healing process. It is important to rest your elbow for a few weeks after the injection and avoid anti-inflammatory drugs for 4 weeks to allow the healing process to start.
It can take up to 3 months to improve after this injection, and it is important to continue with the physiotherapy during this period. At least 50% of people notice a marked improvement, although many still have a tender spot on the bone which does not fully resolve.
Very occasionally for golfer's elbow, you may be offered a low-dose steroid injection into the painful area. This is sometimes referred to as a cortisone injection. Although this can bring about rapid relief of the pain, its effect is not always permanent. Mr. Davies prefers to avoid steroid injections for golfer's elbow because they can make it even more difficult to permanently rid you of the pain. They may be thought of as "short-term gain for long-term pain".
The purpose of this injection is to settle down any inflammation in your tendon. It is important that you start physiotherapy straight away after an injection. There are several rare risks of steroid injections:
If the above treatments are not successful, surgery may be helpful to treat golfer's elbow. This is usually performed through a 3-4cm cut around the inside of your elbow and is often called a golfer's elbow release. It involves removing any unhealthy tendon tissue and releasing a little bit of the tendon from the bone to reduce the tension on the muscle. If you have numbness or tingling in your little finger, you may also be offered a cubital tunnel release to take the pressure off a trapped nerve at the same time. Around 80% of patients report 80% relief from this operation.