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 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 at the attachment point on the outer aspect of the elbow. The normal healing process is altered, and formation of fibrous tissue ensues. This painful altered tissue within the tendon repeatedly makes attempts at healing 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 against resistance or repetitive movements involving these movements, such as using a screwdriver.
How is it diagnosed?
A diagnosis of Golfer's elbow is often confirmed following a thorough history and physical examination. Further imaging such as X-ray, ultrasound or MRI may be utilised to rule out an alternative diagnosis.
How is it treated?
1. Non-surgical treatment
Most commonly, treatment involves rest, ice and analgesics in the form of anti-inflammatory medications. Arm braces or splints are also known to be effective, particularly alongside physiotherapy. This acts to reduce microtrauma at the attachment site through stretching the forearm flexors.
Steroid injections may be considered as next line in those where simple measures have not worked over a course of several months. This is successful in relieving symptoms through reducing local inflammation but when used alone there is a high chance of recurrence, therefore must be followed with a course of physiotherapy.
Platelet Rich Plasma (PRP) injections are increasingly being utilized where the initial mainstays of conservative treatment aren’t effective. The solution is extracted from the patient’s own blood and is rich in growth factors which act locally to aid tendon healing.
2. Surgical treatment
This is required in rare cases following a failure of non-surgical methods after at least 6 months and exclusion of other possible pathologies. Further imaging and potentially arthroscopy may be needed if other diagnoses are suspected.
If confirmed that the problems are secondary to Golfer's elbow, surgical debridement and reattachment of the flexor tendons may be considered. The skin incision will be often be closed using absorbable sutures and regular analgesia will be required post-operatively.
Afterwards, the heavy bandage may be removed after 5 days with the sticky dressing underneath remaining until the skin has healed at approximately 2 weeks.