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What Is Golfer's Elbow

Pain from golfer's elbow - Is it a tendonitis or tendinopathy?

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Updated February 26, 2011

Golfer's Elbow, also called medial epicondylitis, is similar to tennis elbow and is considered a cumulative trauma injury. It is thought that over time 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. The muscles that are used to pull the hand down (wrist flexors) are located on the palm side of the forearm. These muscles attach to the common flexor tendon, which attaches to the medial epicondyle (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, which 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 Causes

It is thought that overuse of the wrist extensors creates cumulative stress, and small tears in the tendon, which causes the inflammation and pain of tendinitis. Tendinopathy results when long-term overuse to the tendons continues and teh tissues begin to breakdown.

Golfer's Elbow Symptoms

Pain on the inside of the elbow, usually 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.

Golfer's Elbow Treatment

The first step an athlete 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 for injury first aid (rest, ice, compression and elevation). This method helps decrease inflammation and swelling as well as providing temporary pain relief. Using conservative treatment often allows the athlete to recover without any 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.

If your elbow pain lasts more than a few days despite rest and conservative treatment, 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. The general rehab protocol for medial epicondylitis will depend upon the specific diagnosis and cause of the injury but the most common rehab methods include: ultrasound, medications, massage, bracing or splinting.

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 rehab 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.

As you begin using your arm and elbow for activities, continuing to use the R.I.C.E. method is often recommended 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 of this condition is common, return to activity should not occur too quickly, and preventive exercises that strengthen the muscles should be done consistently, even after your pain resolves.

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.

Lastly, keep in mind that whether you 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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