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Golfer's Elbow

What is Golfer's elbow?

Golfer's elbow, also known as medial epicondylitis, is a condition that causes pain in the inner aspect of the elbow joint. Golfer’s elbow is caused by overuse of the muscles and tendons that flex (bend) the wrist and fingers, that attach to the inner aspect of the elbow.

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Who is affected by golfer's elbow?

Golfer's elbow can affect people of all ages, but it is most common in adults between the ages of 30 and 50. It is also more common in people who participate in activities that require repetitive movements of the wrist and forearm, such as golf, tennis, and DIY.

Other risk factors for golfer's elbow include:

  • carpentry, plumbing, and assembly line work

  • Age-related changes in the tendons

  • Certain medical conditions, such as diabetes and arthritis

What are the main symptoms of golfer's elbow?

 

The main symptom of golfer's elbow is pain on the inside of the elbow. The pain may be worse with activity, especially activities that involve flexing of the wrist or gripping objects.

Other symptoms of golfer's elbow may include:

Tenderness on the inside of the elbow

Weakness in the wrist and forearm

Reduced range of motion in the elbow

How is golfer's elbow diagnosed?

The diagnosis of golfer's elbow is usually made based on the patient's medical history and physical examination. The doctor will ask about the patient's symptoms and activities. The doctor will also examine the elbow for pain, tenderness, and range of motion limitations. Imaging tests, such as X-rays, ultrasound or MRI scans, may be ordered to clarify the diagnosis. Under ultrasound assessment the clinician will be looking for structural changes in the Common Flexor Origin, the tendon in the forearm that attaches to the inner side of the elbow. They will also assess for abnormally high blood flow into the tendon, a hallmark of tendon overload associated with Golfer’s elbow.

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How is golfer's elbow treated?

 

Treatment for golfer's elbow typically focuses on relieving pain and strengthening the muscle and tendon to be able to tolerate the loads that the individual requires. Non-surgical treatments are often effective. Non-surgical treatments may include:

  • Rest:

    Avoiding activities that aggravate the pain is important for healing.
  • Ice:

    Applying ice to the elbow for 10-15 minutes at a time can help to reduce inflammation and pain.
  • Over-the-counter pain relievers:

    Over-the-counter pain relievers, such as ibuprofen, paracetamol or naproxen, can help to relieve mild to moderate pain.
  • Physiotherapy:

    Physiotherapy can help to improve range of motion and strengthen the muscles around the elbow.
  • Injections:

    The two main injection options include Corticosteroid injection and Platelet Rich Plasma (PRP) Injection.
  • Steroid Injection

At The Joint Injection Clinic, these injections are performed after a thorough consent process, whereby the risk and benefits of the procedure are discussed in detail with your doctor.  The experienced medical doctor will then place you seated in a chair, across the couch with your elbow bent to 90 degrees and resting on the bed. The elbow is cleaned using a cleaning solution to ensure that the procedure is performed under sterile conditions.  Local anaesthetic is often then injected from the skin to the tendon under ultrasound guidance.  After giving the local anaesthetic a few minutes to take effect, the tendon injection is performed with a small dose of steroid and local anaesthetic.

The steroid injection itself is normally completed within 30-60 seconds, after which a plaster is applied and post-injection advice is given.  The patient is advised to look out for any signs of infection, specifically to check whether the local area becomes red, hot, tender, swollen or if they develop a fever.  If this occurs then the patient is asked to contact the clinic immediately at which time a formal reassessment will occur and if needed oral antibiotics can be prescribed.  The patient is also warned that following any injection they may notice a short-term worsening or flare in their symptoms after the local anaesthetic has worn off (4-5 hours).  This may last for 3-5 days and the patient is advised to consider icing of the area using an ice pack for 10-15 minutes every hour as required.

  • PRP injection

    A PRP injection involves taking 10mls blood from the elbow as per a normal blood test.  The blood is then centrifuged (spun down) to separate the platelet-rich part from the red blood cells.  The platelet-rich part contains growth factors and signalling molecules that can help to increase tendon cell proliferation and reduce tendon inflammation.  3-5 mls of PRP is then injected under ultrasound guidance to the tendon.

If non-surgical treatments are not effective, surgery may be an option. A Tennis elbow release describes the minimally invasive surgery that involves releasing of the tightened tendons that are causing the pain in the outer part of the elbow.

The best treatment option for you will depend on the severity of your tennis elbow, your overall health, and your activity level.

Additional tips for managing tennis elbow pain:

  • Use a brace or splint to support the elbow and limit movement.
  • Avoid activities that aggravate the pain, such as gripping objects tightly and twisting the wrist.

If you are experiencing pain and stiffness in your elbow, it is important to see a doctor to get a diagnosis and discuss treatment options. With early diagnosis and treatment, most people with tennis elbow can recover fully and return to their normal activities.