Epicondylitis, Medial (Golfer’s Elbow)

Description

Medial epicondylitis is characterized by inflammation and pain on the inner side of the elbow, where muscles and tendons attach to the bone. The structures involved are the muscles and tendons of the forearm that bring your wrist down, flexing the wrist. This occurs not only in golfers but in anyone who performs repeated resisted motions of the wrist. Without proper intervention, this condition may develop into a chronic problem.

Common signs and symptoms

• Pain and tenderness on the inner side of the elbow

• Pain or weakness with gripping activities

• Pain with twisting motions of the wrist, such as using a screwdriver, playing golf, or bowling

Causes

• Chronic, repetitive stress and strain to the muscles and tendons of the wrist and forearm

• Sudden strain on the forearm, including the wrist snap when serving balls in racket sports or when throwing a baseball

Factors that increase risk

• Sports or occupations that require repetitive and strenuous forearm and wrist movements, such as pitching a baseball, golfing, or carpentry

• Poor physical conditioning (strength, flexibility)

• Inadequate warm-up before practice or play

• Resumption of activity before healing, rehabilitation, and conditioning are complete

Preventive measures

• Appropriately warm up and stretch before practice or competition.

• Maintain appropriate conditioning that includes wrist and forearm flexibility, muscle strength and endurance, and cardiovascular fitness.

• Ensure proper equipment fit.

• Use proper technique, and have a coach correct improper technique.

• Wear an elbow (counterforce) brace.

Expected outcome

• Acute cases, in which symptoms are present for less than 4 weeks, are usually resolvable in 2 to 6 weeks.

• Chronic (repetitive) cases, in which symptoms have been present for more than 8 weeks, may require 3 to 6 months to resolve and often require referral to a physical therapist or athletic trainer.

Possible complications

• Frequent recurrence of symptoms may result in a chronic problem; appropriately addressing the problem the first time decreases the frequency of recurrence.

• Chronic inflammation, scarring, and partial tendon tear may require surgery.

• Delayed healing or delayed resolution of symptoms may occur.

General treatment considerations

Initial treatment consists of medications and ice to relieve pain, stretching and strengthening exercises, and modification of the activity that initially caused the problem. These can all be carried out at home in acute cases. Chronic cases often require referral to a physical therapist or athletic trainer for further evaluation and treatment. A counterforce (tennis elbow) brace may be recommended to reduce the forces to the damaged tendon. If symptoms persist, an injection of cortisone and anesthetics may be required, and surgery is occasionally necessary to excise the damaged tissue. Surgery is done on an outpatient basis (you go home the same day), with resumption of sports at 3 to 6 months.

Medication

• Nonsteroidal antiinflammatory medications, such as aspirin and ibuprofen (do not take for 7 days before surgery), or other minor pain relievers, such as acetaminophen, are often recommended. Take these as directed by your physician, and contact your doctor immediately if any bleeding, stomach upset, or signs of an allergic reaction occur.

• Cortisone injections reduce inflammation, but they are used only in extreme cases. The number of times cortisone may be given is limited, because it weakens muscle and tendon tissue. Cortisone may also cause skin and subcutaneous fat atrophy (shrinking and thinning) and lightening of skin (depigmentation). Anesthetics temporarily relieve pain.

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