Golfer Elbow or Joint Pain in Elbow

February 9, 2009 on 3:53 pm | In What is Tennis Elbow? |

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Golfer’s elbow, more technically called medial epicondylitis, is a similar type of condition to tennis elbow or lateral epicondylitis, but is less common. Since there is little or no inflammation present in these syndromes, they are known as tendinopathies, where degeneration of the tendon occurs and gives symptoms. Typical aggravating factors are racquet sports, golf and sports which involve throwing, although other sports people may be affected such as weight lifters, archers and cricket bowlers.

The medial epicondyle is the bone prominence on the inside of the elbow where the forearm and rotatory muscle originate from. The muscles become tendinous near the bone and the tendon inserts into the bone to anchor the muscles. This area is where the pain occurs but no inflammatory process, rather a degenerative one. As the elbow is stresses by forces which would tend to push the elbow out into "knock elbow", the tendon takes a lot of stress and changes occur.

High stresses occur in the cocking phase of a throw and during the subsequent acceleration, and in the golf swing from high backswing down to near the ball strike. Golfers are more likely to have their dominant hand affected and tennis players who use heavy topspin in their forehands are also more at risk.

The medial epicondyle is the bone prominence on the inside of the elbow where the forearm and rotatory muscle originate from. The muscles become tendinous near the bone and the tendon inserts into the bone to anchor the muscles. This area is where the pain occurs.and scientific work has not shown an inflammatory process but degenerative one. As the elbow is stresses by forces which would tend to push the elbow out into "knock elbow", the tendon takes a lot of stress and changes occur. High stresses occur in the cocking phase of a throw and during the subsequent acceleration, and in the golf swing from high backswing down to near the ball strike. Golfers are more likely to have their dominant hand affected and tennis players who use heavy topspin in their forehands are also more at risk.

golf or tennis elbow symptoms
Patients complain of aching pain over the front of the inner epicondyle, worse with repeated wrist flexion and better with rest. Pain can occur in the shoulder, elbow, forearm or hand, with weakness in the lower arm and hand also. The physiotherapist will examine the bony areas and joints of the elbow, check the muscles and their tendinous insertions. The physio palpates the ulnar nerve in the groove behind the elbow, called the "funny bone" when it’s hit. The nerve can give pins and needles or weakness in the forearm and a neurological examination excludes other causes of pain or weakness.

The main treatment of golfer’s elbow is conservative, including anti-inflammatories, wrist and forearm splinting, corticosteroid injection and physiotherapy. Modifying the provoking activity is a first line of management, making patient education about the condition and the eliciting factors vital. An example is modifying the golf swing mechanics to avoid setting the problem off continually. The patient is taught to avoid aggravating positions and activities, such as leaning on the elbow if there is nerve involvement.

Non-steroidal anti-inflammatory drugs are used in the initial acute phase to reduce pain and inflammation along with avoiding painful movements, use of ice, gentle stretches, friction massage and ultrasound. As the problem settles and becomes sub acute the aims change to improving flexibility by stretching, increasing strength and normal activities. A forearm brace may also be used or a wrist brace to rest the wrist muscles. Once the problem is chronic the programme continues with reduced use of the splint and re-introduction of sporting activities.

Scientific work shows that steroid injections can be useful in the early stages of golfer’s elbow to reduce pain and the time to recovery, but they are also used in chronic situations. There is no evidence that shockwave or laser therapy has any effectiveness and surgery is contemplated when a significant period of physiotherapy has been attempted without success. The surgeon removes the abnormal tendinous tissue and if the ulnar nerve is involved may move it around to the front of the elbow from its posterior groove.

By: Jonathan Blood-Smyth

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