Golfer's Elbow

Golfer's Elbow

  The term “golfer’s elbow” is a lay-term for a condition whose medical name is medial epicondylitis of the elbow.  Although often found in golfers, it can occur in individuals who never play golf.  It is usually an overuse injury to the tendons on the inside aspect of the elbow.  These are the same tendons that allow one to actively bend the wrist forward.  If you lay your forearm on a counter with the palm facing up and then lift the clenched fist off the counter, you are using the muscles that we are talking about.  These muscles originate as tendons from a small area of bone on the inside aspect of the elbow.  If you extend your arm in front of you so that the palm is facing up to the ceiling, this is the part of the elbow on the same side as your little finger.  In golfer's elbow this inside aspect of the elbow is the area of maximum pain.  The pain can sometimes radiate down the forearm a little bit.  There is usually no numbness or tingling involved with this condition. 
  What causes golfer’s elbow?  The start of golfer’s elbow is thought to be an injury that causes a small tear in the origin of these muscles.  Sometimes this is a one-time injury.  More commonly, however, it is a repetitive overuse injury.  Once the injury occurs, instead of a normal healing response, the body sometimes creates an ongoing process in which the tissue is not repaired but actually partially degenerates.  This is why this problem can be so persistent.
  Most of the time, this can be treated without surgical intervention.  However, it can take up to two years in order for this to occur.  In order to treat this successfully, we need to avoid the offending activity.  If you are a golfer, you may need to modify your grip and/or correct abnormal mechanics in order to take the stress off the injured area.  Some players might even need to restrict playing for a time, and then slowly return to those activities which do not cause them discomfort.  Also, the way we grasp or lift things may need to be modified in order to decrease discomfort in this area.
  Unlike lateral epicondylitis (tennis elbow), bracing is not typically used to decrease stress on the injured area.  The reason for this is that medial epicondylitis occurs next to an important nerve (the ulnar nerve).  Trying to take stress off the injured tendons by applying a brace here risks compressing this nerve.
  The mainstay of treatment for golfer’s elbow consists of an exercise program.  The exercises are designed to stretch and strengthen the injured area in order to stimulate a correct healing response.  These exercises are done with high repetitions of about 20-25 per set and about 3-5 sets per workout.  These should be done daily, and one should use very light weight.  The average individual should use no more than 2 to 3 lbs.  A very strong individual should use no more than 5 to 10 lbs.
  Also unlike tennis elbow, injection of corticosteroids into the inflamed area is usually not undertaken.  Again, the nearby ulnar nerve makes injections into this area of the elbow risky.
  Very rarely, conservative treatment fails and painful golfer’s elbow persists causing discomfort and limited function.  In these cases, surgical procedures can be performed.   However, it can take many months to recover from this surgical intervention.  During this time, activities performed with that arm are restricted.
Exercises for golfer's elbow and tennis elbow. The upper two figures demonstrates stretches that should each be held for one minute. The lower two figures depict strengthening exercises (reverse wrist curls and wrist curls, respectively). These should be done slowly and with control, using a light and very thin weight, aiming for a high number of repetitions, as described above. In severely symptomatic patients, these strengthening exercises should be initially performed with either no weight, or gripping a pencil.