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Golfer’s Elbow (Medial Epicondylitis)

Dr. Nadheer K M (AIIMS)MBBS

February 11, 2020

March 06, 2020

Golfer’s Elbow
Golfer’s Elbow

You don’t have to be a tennis player to suffer a tennis elbow - inflammation of the tendons that connect the muscles of the forearm to the outer part of the elbow joint. Similarly, you don't have to be a golfer to get golfer’s elbow.

Also known as medial epicondylitis, tendinosis, thrower's elbow and pitcher’s elbow, golfer's elbow causes pain and stiffness on the inside part of the elbow joint.

Golfer’s elbow occurs as a result of damage to the epicondyle - the bony bump on the inside of the elbow that attaches to the tendons and muscles in the forearms, wrists and fingers. Overuse of these muscles and tendons can result in the symptoms of golfer's elbow. This usually occurs in people who perform throwing actions or an exaggerated movement of the arm repeatedly.

While the pain of golfer's elbow can occur suddenly, injuries related to the tendons are usually caused by the repetitive movement of the same set of muscles, ligaments and tendons over a long time. It is usually not considered to be serious, as one can make a full recovery with proper rest and therapy.

To diagnose the condition, your doctor will perform a thorough physical examination and may also recommend an X-ray to rule out arthritis or fractured bone. The treatment protocol involves resting the area, wearing elbow support and eventually strengthening it through physiotherapy. In rare cases, surgery may be recommended for people who don't recover even after six months to a year.

Read more: Repetitive strain injury (RSI)

Symptoms of golfer’s elbow

Medial epicondylitis usually affects those who engage in repetitive movements of the lower arm muscles - you can feel these muscles while gripping something, moving the wrists up towards the elbow or wriggling your fingers. Here are some of the symptoms of golfer's elbow:

  • Pain: Repeated movement of the injured hand means there is going to be mild to severe pain in the inside of the elbow joint. The pain may also travel up or down the inside of the arm.
  • Tenderness: The bony part on the inside of the elbow joint is usually tender to the touch in people with this condition.
  • Loss of strength: People with this condition find it difficult to hold things or bear weight on the elbow. They may also have difficulty gripping things.
  • Stiffness: Movement in the affected elbow will become limited as a result of the injury. You can experience joint stiffness in the wrist as well.
  • Tingling: An uneasy, tingling sensation could catch you off guard as well, as it can travel all the way from the elbows down to the smaller fingers of the hands.

Read more: Bone pain: symptoms, causes, risk factors, prevention, diagnosis and treatment

Golfer’s elbow causes

Flexor muscles enable us to bend joints like the wrists. Tendons are connective tissues that link our bones to our muscles. Intense repetitive movements of the arm - such as using heavy machinery in a factory, repeated throwing in sports, weight training in the gym or even while playing racquet sports - can overwork these muscles and tendons, resulting in pain and tenderness in the inner portion of the elbow. Some of the most common causes for golfer's elbow are:

  • Occupational: Those who work in construction, carpentry, professions involving the use of heavy equipment like drills, factory workers or even butchers can be at risk of suffering from golfer’s elbow. Not to forget the profession it is named after: golf, even if it is played as a hobby.
  • Throwing actions: People who play sports that involve throwing - like cricket, baseball, or even javelin in track and field - can experience golfer’s elbow problems.
  • Racquet sports: People who play any racquet sport - including squash, tennis, badminton and even table tennis - can suffer from golfer’s elbow injuries.
  • Weight training: Gym-goers who repeatedly use their arm muscles to perform various weight training exercises are also at the risk of experiencing golfer’s elbow due to weak arm muscles.

The wrist flexor muscles attach at the elbow on the inside part of the joint. Wear and tear involving these muscles can also add to the pain of golfer's elbow. Acute inflammation is rare in such cases as golfer's elbow usually develops over time, causing little tears in the tendons.

Golfer’s elbow injuries are degenerative in nature but most people make a recovery with relatively conservative treatment methods.

In some cases, the pain you may be feeling in the elbow may be emanating from degenerative issues in the cervical spine (neck), which can extend to the joint through a compressed nerve.

Prevention of golfer’s elbow

While conditions like golfer’s elbow are treatable, taking precautionary steps to avoid the injury altogether is the ideal scenario. Here are some ways you can prevent this injury from occurring:

  • Ensure that you warm-up properly before beginning a sport, workout or even work. Stretching the muscles and warming them up will make the more intense movements you’re going to perform much easier and more efficient.
  • Strengthening the muscles you feel are weak in the body is an effective way to counter chronic problems in the future. Working on small exercises even while sitting down can be beneficial. Using a stress ball or hand grip strengtheners even while sitting at work are efficient ways to enhance and add strength to your wrists and fingers.
  • Move from heavy equipment to lighter, more efficient items while playing your favourite sport. Using oversized or heavier equipment can put more stress on your playing hand.
  • Always focus on the right technique and form while lifting weights in the gym. A majority of weight training exercises require your arms to do the heavy lifting, so ensure you are following the right lifting methods. Even bodyweight exercises like push-ups and pull-ups require the use of your forearms quite extensively.
  • Strengthen the bicep and shoulder muscles to take the load off your forearm muscles, making for more efficient, less strain-inducing movements.
  • Listen to your body when it is telling you to stop. Most of us tend to ignore the early signs of an injury which could be minor aches and pains. Rest frequently, hydrate often and change your routine.
  • For those who play sports as a hobby, it is advised to switch your games and training methods often to avoid using the same set of muscles every day and keep the body healthy.

Diagnosis of golfer’s elbow

The symptoms of pain and tenderness on the inside of the elbow may be enough to understand if you have golfer’s elbow. Still, getting it examined by a medical professional is a good practice:

  • A doctor will perform a physical exam to locate the pain by asking you to perform various movements.
  • An X-ray will be performed to rule out other possible reasons such as an elbow fracture or other causes.
  • An MRI may be performed to ascertain the exact location of the injury as well as the degree of its damage to the muscle or the tendons.
  • In extreme cases, where the torn tendons or muscle tissues cannot be repaired on their own even after six months or longer, surgery is recommended to remove the scar tissue.

Treatment for golfer’s elbow

Recovering from golfer’s elbow begins with the person taking a break from the activity that caused it in the first place, which is followed by home-based care:

  • RICE therapy is the first line of defence against such an injury. The combination of rest, ice, compression and elevation (RICE) is recommended to keep the inflammation from flaring up.
  • An elbow brace or shoulder support may be used to keep the elbow raised and reduce the strain on the affected elbow.
  • Over-the-counter pain medication such as ibuprofen or pain-relief ointments is also advised to bring the inflammation down.
  • Corticosteroids are sometimes used if the pain or swelling is too intense and hasn’t come down even after trying out more conservative methods. However, more research needs to be done on the long-term effectiveness of corticosteroids for treatment.
  • Sports injury specialists or physical therapists can also be consulted if the problem hasn’t subsided even after trying out other treatment methods.
  • If the pain or swelling do not come down even after a long period, more invasive methods like surgery may be performed to remove the torn tissues and repair the affected part.

With proper rest, treatment and aftercare through physical therapy and strengthening exercises, a person can make a full recovery. It is a good idea to take things slow if you are going to resume the activity that caused the problem in the first place.

Risks factors of golfer’s elbow

Although anyone can suffer an injury like golfer’s elbow, some people are more prone to it than others. There are:

  • People between the ages of 35 and 50.
  • Obese or overweight people: people with a BMI over 40 are more prone to ailments related to tendinopathy (chronic pain linked to the tendons) of the elbow, according to studies. BMI or body mass index is the ratio of weight to height. A BMI of 18.5 to 24.9 is considered healthy. People with a BMI of 25-29.9 are considered overweight. And BMI over 30 indicates obesity
  • Smokers are more prone to this injury as well.
  • Repeated and intense arm movements over a long period of time make one more susceptible to this injury.

Read more: Disadvantages of smoking and benefits of quitting

Golfer's elbow exercises

After the initial period of rest and treatment, people are advised to begin moving the injured elbow to regain strength and flexibility. Here are some exercises that can be performed without putting too much stress on the injured elbow:

1. Wrist stretch

  • Sit or stand comfortably.
  • Bend the wrist of the injured arm down, so the fingers of this hand are pointing towards the floor. Use your other hand to press the back of this hand down gently. You should feel a stretch in your wrist. 
  • Hold for 15-20 seconds.
  • Now turn the wrist of the injured hand up, so the fingers are pointing towards the ceiling. Use your other hand to press the fingers back towards the elbow gently.
  • Hold for 15-20 seconds.

2. Golfer’s elbow stretch

  • Extend your injured arm out in front of you with the wrist pointing outwards and fingers pointing down.
  • With the other hand, pull the fingers towards you while keeping the affected arm straight to feel a stretch in the elbow.
  • Hold for a few seconds
  • Now, turn the wrist. Hold the hand of the injured arm up, as if you are trying to stop someone from moving ahead.
  • Using the other hand, grab the fingers of this hand and lightly bend them towards the elbow. Hold for 15-20 seconds.

3. Ball squeeze

  • Sit comfortably.
  • Squeeze a sponge ball lightly in the hand of the affected arm.
  • Repeat this a few times.

4. Wrist flexion

  • Pick up a light-weight dumbbell, an old fashioned paperweight, or even a bottle of water.
  • Place your affected arm’s forearm on the edge of a raised surface like a table or the arm of a couch, keeping your wrist suspended.
  • Lower your hand and raise it slowly repeatedly for a few seconds.
  • You can turn your arm over to point your palms down, and perform the same movement over 10-15 repetitions.

Difference between tennis elbow and golfer's elbow

The most obvious difference between tennis elbow and golfer's elbow is that tennis elbow causes pain and swelling in the outer part of the elbow while golfer's elbow affects the inside of the elbow.

Apart from this, both are caused by repetitive movements. Both can involve tendon injury or tendinopathy - a partial or complete tear in the tendon. Both can involve tendinosis or pain in the tendons as a result of wear and tear and loss of collagen (the most abundant protein in the body. The treatment for both mostly involves rest, icing the area and painkillers.

Takeaways for golfer’s elbow

Injuries affecting the muscle tissue, ligaments or tendons usually have similar, overuse-related causes and are chronic in nature, but they can be treated and cured, allowing the injured person to return to their favourite activity with the same intensity.

Problems like golfer’s elbow are also extremely preventable and understanding your body’s limitations is the key to avoiding such injuries. Knowing when to stop when your elbow begins to hurt and getting it checked by a doctor at the earliest can go a long way to make sure it doesn’t flare up and become worse with time.



References

  1. Franceschi, F et al. Obesity as a Risk Factor for Tendinopathy: A Systematic Review. International Journal of Endocrinology. 2014 Aug; 2014: 670262.
  2. Ciccotti MC et al. Diagnosis and treatment of medial epicondylitis of the elbow. Clinics in Sports Medicine. 2004 Oct;23(4):693-705, xi. PMID: 15474230.
  3. Stanford Health Care [Internet]. Stanford Medicine, Stanford University; Golfer's Elbow.
  4. Matthews P and Leyshon R. ACUTE CALCIFICATION IN TENNIS AND GOLFER'S ELBOW. Rheumatology. 1980 Aug; 19(3):151–153.
  5. Amin, NH et al. Medial epicondylitis: evaluation and management. The Journal of the American Academy of Orthopaedic Surgeons. 2015; 23:348-355.
  6. Informed Health [Internet] Institute for Quality and Efficiency in Health Care, Germany. Golfer’s elbow: Strengthening and stretching exercises

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