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Mr. Mark Falworth, Consultant Orthopaedic Shoulder & Elbow Surgeon, London, Watford, Stanmore, UK / Elbow / Golfers Elbow / Medial Epicondylitis

Golfers Elbow / Medial Epicondylitis

Golfers elbow, also known as medial epicondylitis, is a degenerative condition affecting the tendons which insert into the bony prominence on the inside (medial) aspect of the elbow. It is almost identical to a tennis elbow however unlike a tennis elbow, it affects the inside aspect of the elbow.

Causes & Risk factors

Golfers elbow most often affects individuals aged between 30 and 50 years. It is believed that the condition is caused by the repetitive use of the tendons involved in flexing the wrist and fingers. These tendons, which travel up the forearm from the fingers and wrist, converge and insert into the bony prominence on the inside of the elbow, the medial epicondyle. Justa s in a tennis elbow, the symptoms of a golfers elbow can occur secondary to inflammation (neovascularity) of the tendons, the presence of small tears within the substance of the tendon and even an avulsion of the tendon form the medial epicondyle. Whilst golfers are classically susceptible to the condition, any individual who performs activities that require the repetitive use of the forearm muscles can be affected.

Symptoms

The most common symptoms are usually pain and tenderness on the inside aspect of the elbow however the pain can sometimes radiate down the forearm. The pain is usually intermittent but with repetitive use it can result in a continuous pain. The pain is often worse when gripping or lifting objects.  In more severe cases the pain can occur during simple elbow movements or at night thereby disturbing sleep.

Diagnosis

The diagnosis is based on clinical examination. Ultrasound scans and occasionally MRI scans, can be helpful to exclude alternative diagnosis or indeed confirm degenerative changes at the medial epicondyle. Radiographs may also be used to exclude other causes of pain from the elbow.

Treatment

In most cases non-operative treatments are successful. These include;

  • Rest, activity modification and anti-inflammatory medication can be used in the first instance.
  • Physiotherapy treatments, which include stretching and range of motion exercise regimes can be utilised.
  • Tennis / golfers elbow splints can also be used to aid recovery.
  • Injections can be utilised to address the symptoms. Corticosteroid injections to the medial epicondyle can be used to improve the pain. Usually no more than two or three injections are used as they can cause further degeneration of the tendon and cause wasting of the fatty tissue below the skin. Platelet Rich Plasma (PRP) injections can also be undertaken and these are particularly helpful in managing interstitial tears of the common flexor origin where they can stimulate the healing of any degenerative lesions.
  • Surgery, in the form of a golfers elbow release, can be used where non-operative measures have failed. The aim of surgery is to excise the diseased tendon tissue, which is the perceived source of the pain, and then create an environment for the normal tendon to heal back to the bone. This is done through a small incision, measuring approximately 3-4 cm over the bony prominence on the inner aspect of the elbow. The surgery is usually performed as a day case procedure and you are discharged from hospital in an elbow bandage with a physiotherapy programme which slowly encourages the elbow back to full function over a three month period. Failing to complete the physiotherapy programme, or indeed trying to return to full activity too soon, increases the risk of residual symptoms. Golfers elbow surgery is usually successful in 85 -90% of patients.