What Is Golfer's Elbow

Tendonitis or tendinopathy? Either way, it painful

Golf Swing. Michael Cohen/Getty Images

Golfer's Elbow, also called medial epicondylitis, is similar to tennis elbow and, if you play a lot of golf, you may suffer from this cumulative trauma injury. 

What is Golfer's Elbow?

Over time the repeated use of the muscles of the arm and forearm may lead to small tears in the tendons which results in elbow pain and weakness.

Specifically, the wrist flexors, which are the muscles that are used to pull the hand down, are located on the palm side of the forearm and attach to the common flexor tendon, which attaches to the medial epicondyle — located on the inside of the elbow.

When the wrist flexors are overused, the common flexor tendon becomes inflammation and painful. Such inflammation in a tendon is termed "tendinitis."

Tendonitis or Tendinopathy

More frequently, physicians are using the term tendinopathy to describe the typical pain of tennis elbow and golfer's elbow. These are more often injuries caused by long-term overuse rather than an acute injury causing inflammation of the tendon.

The distinction is important because the inflammation of tendinitis is treated differently than tendinopathy. Inflammation from acute injury often responds quickly to medications and anti-inflammatory treatment. However, if the injury is due to of tendon tissue degeneration, treatment may be quite lengthy and will be focused on improving the strength of the tendon and rebuilding tissues.

Golfer's Elbow Symptoms

Pain on the inside of the elbow during or after intense use usually indicates medial epicondylitis.

Pain increases during wrist flexion and often radiates to the forearm. Because this frequently occurs in golfers, it has become known as 'golfer's elbow'.

Other symptoms of golfer's elbow include:

  • Specific pain on inside of the elbow, particularly while grasping objects.
  • Wrist weakness and pain during wrist flexion.
  • Weakness and/or pain while resisting wrist pronation.

Treating Golfer's Elbow

The first step you should take if tendinitis is suspected is to stop the activities that cause the pain, rest the arm, and follow the R.I.C.E. method (rest, ice, compression and elevation). This will help decrease inflammation and swelling as well as provide temporary pain relief. This often facilitates recovery without it becoming a chronic problem. Tendinitis usually resolves in a few days to a few weeks.

Unfortunately, it takes far longer — from two to six months — to recover from tendinopathy. Many cases of medial epicondylitis become chronic problems that gradually get worse because the athlete continues activity despite nagging elbow pain.

When to See a Doctor

If your elbow pain lasts more than a few days despite rest and doing the R.I.C.E. method, you should see a sports medicine specialist for an evaluation and, possibly, a physical therapist.

A physical therapist may use ultrasound or other modalities to help heal tendinopathy.

In some cases, a splint or brace may be recommended. Your course of rehab for medial epicondylitis depends upon the specific diagnosis and cause of the injury. The most common treatments include: ultrasound, medications, massage, bracing or splinting.

Anti-inflammatory medications may help reduce inflammation and pain during acute phases of injury, and in chronic or intense cases, your physician may consider using cortisone injections to help relieve the discomfort.

If nonsurgical forms of treatment do not eliminate the pain of this condition, surgery may be recommended as a final option. A hand specialist may offer advice regarding potential treatments and the possible outcomes for surgery.

The final stage of rehab for tendinitis includes strengthening and flexibility exercises. There is some question regarding the benefit of stretching exercises for tendinopathy. Your therapist will help determine the best path for you, but it's important to understand that beginning any exercises before the tendon has healed may make the problem worse, so it's essential to follow your therapist or physician's recommendations.

Getting Back Into the Swing of Things (Pun Intended)

As you begin using your arm and elbow for activities, continue to use the R.I.C.E. method  to manage both pain and swelling. Icing the elbow for 10-15 minutes at a time will decrease the inflammation and swelling, and relieve pain. Wrapping the forearm near the elbow may help protect the injured muscles as they are healing.

Because recurrence is common, don't return to activity too quickly. Do your preventive exercises that strengthen the muscles consistently, even after your pain resolves.

Lastly, keep in mind that whether your elbow pain is from tendonitis or tendinopathy the immediate treatment should include rest. Next, see if you can determine the cause of the injury and make a correction. If your elbow pain came from overuse, reduce or stop that activity, and find a substitute activity. If the pain is from poor technique or poor ergonomics, consult a coach or trainer for skills training. If you can eliminate the offending factors, you have a much greater likelihood of a full recovery.

Sources

Coombes, et al. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. The Lancet, Volume 376, Issue 9754, Pages 1751 - 1767, 20 November 2010

Jobe, et al. "Lateral and Medial Epicondylitis of the Elbow" J. Am. Acad. Ortho. Surg., Jan 1994; 2: 1 - 8.

Regan, et al. Tendinopathies around the elbow. DeLee and Drez's Orthopaedic Sports Medicine. 3rd ed. Philadelphia, Pa.: Saunders Elsevier; 2009. Accessed Jan, 2011

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