Golfer’s Elbow

Elbow Anatomy

The elbow joint is made of three bones: the two forearm bones (the radius and ulna) that connect with your upper arm (the humerus) to create the elbow joint. The forearm muscles, ligaments and tendons hold the elbow joint together and control movement of the elbow, wrist and hand.

The forearm muscles run down to and operate the wrist and fingers. Forearm tendons attach the forearm muscles to the bone at the lateral epicondyle at the outside of the elbow and the medial epicondyle at the inside of the elbow. Tendons carry the force of muscle action to the bone, creating movements.

What is golfer’s elbow?

Golfer’s Elbow (medial epicondylitis) is tendonitis of the inner part of the elbow where the muscles that bend the wrist and fingers attach. Cumulative and on-going repetitive trauma from overuse strains the tendons causing pain, inflammation, and muscle tenderness on the inside of the elbow and forearm. It can occur at any age and affects men and women alike.

Golfer’s elbow is considered the most common cause of elbow pain affecting 1-2% of the population. It results in significant activity restriction and chronic symptoms are associated with tendon degeneration from repetitive microtrauma. Most patients respond well to conservative measures but about 10-15% will need surgery.

What causes golfer’s elbow?

The most common cause is overuse of the forearm muscles that results from grasping and gripping activities.  Overuse can occur at work and in sports including golf, baseball, rowing, tennis and racquet ball, and occupational activities that require the use of a screwdriver hammer, rake or painting.

Symptoms

Overuse is repetitive trauma that creates microscopic tears in the tendons that cause inflammation, swelling and pain.

• Pain when flexing the wrist.
• Pain that runs from the inside of the elbow down to the pinky finger.
• Painful handshakes.
• Numbness and tingling in the elbow that can run down to the ring and pinky fingers.
• Stiffness and difficulty moving the elbow.
• Wrist weakness.
• Weak grip.

Symptoms build slowly and range from mild to severe but can eventually signal tendon degeneration which makes the grip weak and the elbow more vulnerable to injury.

How is it diagnosed?

Your Ortho Illinois orthopedic surgeon can often diagnose the condition by listening to your symptoms and conducting a physical exam. They will ask you to perform a simple test that involves laying your forearm on a table, palm up and when pressure is applied you will be asked to flex the hand toward the wrist. If you have pain from this test it confirms golfer’s elbow. However, x-rays will be ordered to rule out other conditions such as a fracture and confirm the diagnosis.

Treatment

Conservative treatments are initially recommended. In many cases stopping the activities that caused the condition and activity modification can improve pain, restore arm and wrist motion and strength, and even recover.

Conservative treatment includes:

• Rest
• Icing
• Anti-inflammatory medications for pain
• Bracing to reduce tension on the tendon can help it heal
• Steroid injections
• Physical therapy with stretching and strengthening exercises, heat and ultrasound treatments, or ASTYM therapy
• Platelet Rich Plasma (PRP)
• A nighttime splint

Additional nonsurgical options include:

Platelet Rich Plasma (PRP)

PRP helps to enhance soft tissue regeneration by releasing growth factors that modulate the inflammatory response. It is safe and effective to stimulate tendon and ligament healing which may provide long-term pain relief and function improvement.  PRP is created from your own blood so there is no risk of complications and no side effects, unlike steroid injections that can further degenerate the tendon.

Extracorporeal Shockwave therapy (ESWT)

ESWT is noninvasive and has been reported to provide good recovery of grip strength and pain relief.

Surgery

Surgery is reserved for patients whose pain has lasted 3-6 months without significant relief from conservative treatments. Surgical options range from open, arthroscopic and percutaneous procedures. The goal of surgery is to remove the damaged tendon tissues and stimulate a healing response.

Percutaneous golfer’s elbow release (tenotomy)

This is surgery to release the tendon. It is outpatient, minimally invasive, ultrasound- guided surgery under local anesthetic. During the procedure diseased tissue is removed, the tendon released, the attachment is reinforced, and multiple holes are drilled into the bone to stimulate healing. This procedure is safe and effective and produces sustainable improvements in pain and function at low risk. Physical therapy after surgery is imperative to restore strength and mobility.

At Ortho Illinois we provide an unsurpassed continuum of care by a team of specialized surgeons, physiatrists and physical and occupational therapists focused on your successful surgery and recovery. Ortho Illinois has offices in Algonquin, Elgin, Rockford/Riverside, and Rockford/Roxbury for your convenience. Contact us to schedule a consultation at 815-398-9491 and the get right diagnosis and treatment.