What is it?
Less common than tennis elbow, and otherwise known as medial epicondylitis, golfer’s elbow is a painful condition affecting the inner or medial aspect of the joint. This bony lump acts as the attachment site for a group of forearm muscles, which are responsible for flexing the wrist and fingers. These muscles converge to form a common flexor tendon.
Why does it occur?
This condition is often associated with tendon overuse, and subsequent microtrauma within the tissue where it attaches to the outer aspect of the elbow. The normal healing process is altered, and the formation of fibrous tissue ensues. This painful, altered tissue within the tendon makes repeated attempts to heal, leaving further scar tissue.
What are the symptoms?
Irritation of the tendon can cause pain or tenderness around the inner surface of the elbow, or more commonly, at the bony attachment site. This is aggravated during certain movements, such as flexing the forearm or wrist, or repetitive movements involving the tendons, such as using a screwdriver.
How is it diagnosed?
A diagnosis of golfer’s elbow is often confirmed following a thorough medical history and physical examination. Further imaging, such as x-rays, ultrasound or MRI scans, may be used to rule out an alternative diagnosis.
How is it treated?
Most commonly, treatment involves rest, ice and painkillers in the form of anti-inflammatory medications. Arm braces or splints are also known to be effective, particularly alongside physiotherapy. The brace or splint acts to reduce microtrauma at the attachment site, through stretching the forearm flexors.
Steroid injections may be considered, as they are successful in relieving symptoms by reducing local inflammation. They must be followed by a course of physiotherapy in order to reduce the chance of recurrence.
Platelet Rich Plasma (PRP) injections are increasingly being used where other non-invasive treatments have proved ineffective. The solution is extracted from the patient’s own blood, rich in growth factors which act locally to help the tendon to heal.
Surgery is rare, and will be considered only if all other options have been exhausted and there has been no improvement in the condition over a 6 month period. Further imaging and potentially arthroscopy (keyhole surgery) may be needed to rule out any other type of diagnosis.
If it is discovered that the problems you experience are secondary to golfer’s elbow, surgical removal and reattachment of the flexor tendons may be considered. The skin incision will be closed using absorbable stitches and painkillers will be required as you recover. utures and regular analgesia will be required post-operatively. Bandages may be removed after 5 days, but the sticky dressing underneath remains for 2 weeks, until the skin has healed.
The One Orthopaedics team specialists
Consultant Orthopaedic Specialist FRCS (Tr & Orth)