Golfer's Elbow (Medial Epicondylitis)

Summary & Treatment

Golfer’s elbow (also called medial epicondylitis) refers to pain on the inner aspect (medial epicondyle) of the elbow. It is different from tennis’s elbow where the pain is on the outer aspect (lateral epicondyle) of the elbow.

The pain is situated at the bony bump on the inner aspect of the elbow where the flexor tendons of the forearm attaches. The pain might spread into the forearm and wrist.

It’s not limited to golfers. Tennis players and others who repeatedly use their wrists or clench their fingers also can develop golfer’s elbow.

Cause

The part of the muscle that attaches to a bone is called a tendon. Some of the muscles in the forearm attach to the bone on the inside of the elbow.

When these muscles are used over and over again, small tears develop in the tendons. Over time, this leads to irritation and pain where the tendon is attached to the bone.

The injury can occur from using poor form or overdoing certain sports, such as:

  • Golf
  • Baseball and other throwing sports, such as javelin
  • Racquet sports, such as tennis
  • Weight training

Repeated twisting of the wrist (such as when using a screwdriver) can lead to golfer’s elbow. People in certain jobs may be more likely to develop it, such as:

  • Painters
  • Plumbers
  • Construction workers
  • Cooks
  • Assembly-line workers
  • Computer users
  • Butchers

Signs & Symptoms

Golfer’s elbow is characterized by:

  • Elbow pain that runs along the inside of the forearm to the wrist, on the same side as the little/pinky finger
  • Pain when flexing wrist, palm down
  • Pain when shaking hands
  • Stiffness – elbow may feel stiff, and it may hurt to make a fist
  • Weak grasp
  • Numbness and tingling from elbow up and into little/pinky and ring fingers

Pain may occur gradually or suddenly. It gets worse when grasping things or flexing the wrist.

Diagnosis

Golfer’s elbow is usually diagnosed based on patient’s medical history and a physical examination. To evaluate pain and stiffness, the doctor may apply pressure to the affected area or have the patient move his/her elbow, wrist and fingers in various ways. The exam may show:

  • Pain or tenderness when the tendon is gently pressed where it attaches to the upper arm bone, over the inside of the elbow.
  • Pain near the elbow when the wrist is bent forward.
  • You may have x-rays to rule out other possible causes.

An X-ray can help the doctor rule out other causes of elbow pain, such as a fracture or arthritis. Rarely, more comprehensive imaging studies — such as MRI — are performed.

Treatment

The first step is to rest the arm and avoid the activity that causes the symptoms for at least 2 to 3 weeks or longer, until the pain goes away. Other measures include:

  • Put ice on the inside of the elbow 3 to 4 times a day for 15 to 20 minutes.
  • Take nonsteroidal anti-inflammatory medication. These include ibuprofen, naproxen, or aspirin.
  • Do stretching and strengthening exercises.
  • Gradually return to activity.

If the golfer’s elbow is due to a sports activity, the  patient may want to:

  • Ask about any changes to make in technique. If golf, have an instructor check the form.
  • Check any sports equipment used to see if any changes may help. For example, using lighter golf clubs may help.
  • Think about how often the sport is played and if should cut back amount of playing time.
  • If desk-bound, ask about making changes to work station. Look at how the chair, desk, and computer are set up.
  • Get a special brace for golfer’s elbow at most pharmacies. It wraps around the upper part of the forearm and takes some of the pressure off the muscles.

Cortisone injections and a numbing medicine around the area where the tendon attaches to the bone may be applied. This may help decrease the swelling and pain.

If the pain continues after 6 to 12 months of rest and treatment, surgery may be recommended. In these recalcitrant cases, surgery can provide long lasting pain relief. It involves an incision over the painful inner aspect of the elbow. The injured tendon is removed leaving normal tendon.