Golfer’s Elbow

Golfer’s elbow, or medial epicondylitis, is a painful condition of the elbow caused by overuse. Not surprisingly, playing golf can cause this condition. But several other sports and activities can also put you at risk, especially baseball.

Golfer’s elbow is pain in the tendons that join the forearm muscles on the inside of the elbow. The forearm muscles and tendons become damaged from overuse — repeating the same motions again and again. This leads to pain, scarring, and tenderness on the inside of the elbow. Golfer’s elbow is 5x less common than tennis elbow, or lateral epicondylitis, which causes pain on the outside of the elbow.

Elbow Anatomy

Your elbow joint is a joint made up of three bones: your upper arm bone (humerus) and the two bones in your forearm (radius and ulna). There are bony bumps at the bottom of the humerus called epicondyles. The bony bump on the inside (medial side) of the elbow is called the medial epicondyle. Muscles, ligaments, and tendons hold the elbow joint together.  

Medial epicondylitis, or golfer’s elbow, involves the muscles and tendons of your forearm. Your forearm muscles flex (bend) and pronate (rotate your wrist palm down), and flex your fingers. Your forearm tendons -- often called flexor-pronator mass -- attach the muscles to the bone. They attach to the medial epicondyle.  

What Causes Golfer’s Elbow?

Overuse

Recent studies show that golfer’s elbow is often due to damage to a specific forearm muscle. The pronator teres (PT) and flexor carpi radialis (FCR) muscles help stabilize the wrist when the elbow is bent. When the flexor-pronator mass is weakened from overuse, microscopic tears form in the tendon where it attaches to the medial epicondyle. This leads to scarring and pain. Despite the name of the condition ending in –itis, this is not an inflammatory condition.

Activities

Golfers and pitchers are the most common athletes who develop medial epicondylitis. For pitchers, this involves pain usually during the late cocking phase. Athletes are not the only people who get golfer’s elbow. Many people with golfer’s elbow participate in work or recreational activities that require repetitive, vigorous use of the forearm muscles.

Painters, plumbers, and carpenters are particularly prone to developing golfer’s elbow. Studies have shown that auto workers, cooks, and even butchers get golfer’s elbow more often than the rest of the population. It is thought that the repetition and weight lifting required in these occupations lead to injury, particularly lifting things in a palm-up position (supination).

Age

Most people who get golfer’s elbow are between 30 and 50, though anyone can get it if they have risk factors. In sports like golf, improper grip or stroke technique and improper equipment may be risk factors.

Unknown

Medial epicondylitis can occur without any recognized repetitive injury. This occurrence is called "insidious" or “idiopathic”, meaning of an unknown cause.

Symptoms

The symptoms of golfer’s elbow develop gradually. In most cases, the pain begins as mild and slowly worsens over weeks and months. There is usually no specific injury associated with the start of symptoms.

Common signs and symptoms of golfer’s elbow include:

• Pain and tenderness on the inside of your elbow
• Weakness in the hand or wrist
• Stiffness
• Numbness or tingling – these can radiate to one or more fingers, usually the ring and little finger

The symptoms are often worsened with forearm activity, such as swinging a golf club, squeezing or pitching a ball, shaking hands, turning a doorknob, lifting weights (especially biceps curls), picking something up with the palm facing up, or flexing your wrist. Your dominant arm is most often affected; however, both arms can be affected.

Treatment

• Nonsurgical Treatment - Approximately 80% to 95% of patients have success with nonsurgical treatment. However, at times it can be a frustrating process because, on average, it takes 9 months for symptoms to improve. Treatment can help shorten the course of symptoms to 4-6 months.
• Rest - The first step toward recovery is to give your arm proper rest. This means you will have to stop participating in sports or other strenuous activities for several weeks. This includes any activities that worsen your symptoms.
• Non-steroidal anti-inflammatory medicines - Drugs like aspirin or ibuprofen do not reduce pain because this is not an inflammatory problem.
• Equipment/Form check - Getting your equipment checked for proper fit is crucial. Stiffer clubs often increase the stress on the forearm. One of the best ways to avoid elbow problems is to strengthen your forearm muscles and slow your golf swing so that there will be less shock in the arm when the ball is hit. A golf stroke analysis can also identify mechanical problems that are leading to injury.
• Stretching - Wrist-stretching exercises are done with the elbow extended. Do both of these exercises once every hour, holding each for 3 seconds (total of 6 seconds of stretching per hour).