Medial Epicondylitis

ELBOW ANATOMY

DISEASE EXPLAINED

SYMPTOMS

Pain and tenderness. Usually felt on the inner side of your elbow, the pain sometimes extends along the inner side of your forearm. Pain typically worsens with certain movements.

Stiffness. Your elbow may feel stiff, and making a fist might hurt.

Weakness. You may have weakness in your hands and wrists.

Numbness or tingling. These sensations might radiate into one or more fingers — usually the ring and little fingers.

The pain of golfer’s elbow can come on suddenly or gradually. The pain might worsen with certain movements, such as swinging a golf club.

CAUSES

Golfer’s elbow, also known as medial epicondylitis, is caused by damage to the muscles and tendons that control your wrist and fingers. The damage is typically related to excess or repeated stress — especially forceful wrist and finger motions. Improper lifting, throwing or hitting, as well as too little warmup or poor conditioning, also can contribute to golfer’s elbow.

Besides golf, many activities and occupations can lead to golfer’s elbow, including:

Racket sports. Improper technique with tennis strokes, especially the backhand, can cause injury to the tendon. Excessive use of topspin and using a racket that’s too small or heavy also can lead to injury.

Throwing sports. Improper pitching technique in baseball or softball can be another culprit. Football, archery and javelin throwing also can cause golfer’s elbow.

Weight training. Lifting weights using improper technique, such as curling the wrists during a biceps exercise, can overload the elbow muscles and tendons.

Forceful, repetitive occupational movements. These occur in fields such as construction, plumbing and carpentry.

To cause golfer’s elbow, the activity generally needs to be done for more than an hour a day on many days.

TREATMENT OPTIONS

TREATMENT OPTIONS

NON-SURGICAL OPTIONS

MEDICATION
You can take an over-the-counter pain reliever. Try ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve) or acetaminophen (Tylenol, others).

INJECTION
Corticosteroid injections are not commonly given because they haven’t been shown to be effective long-term. A newer treatment being tried is platelet-rich plasma. This involves drawing a small amount of your blood and injecting a concentrated amount of platelets and other anti-inflammatory factors into the tender area. More studies are needed to evaluate the effectiveness of this treatment.

REST.
Put your golf game or other repetitive activities on hold until the pain is gone. If you return to activity too soon, you can worsen your condition.

ICE
Ice the affected area. Apply ice packs to your elbow for 15 to 20 minutes at a time, three to four times a day for several days. To protect your skin, wrap the ice packs in a thin towel. It might help to massage your inner elbow with ice for five minutes at a time, two to three times a day.

BRACE
Use a brace. Your doctor might recommend that you wear a counterforce brace on your affected arm, which might reduce tendon and muscle strain.

Stretch and strengthen the affected area. Your doctor might suggest exercises for stretching and strengthening. Progressive loading of the tendon with specific strength training exercises has been shown to be especially effective. Other physical or occupational therapy practices can be helpful too.

Gradually return to your usual activities. When your pain is gone, practice the arm motions of your sport or activity. Review your golf or tennis swing with an instructor to ensure that your technique is correct, and make adjustments if needed.

SURGERY
Surgery is seldom necessary. But if your signs and symptoms don’t respond to conservative treatment in six to 12 months, surgery might be an option. A new approach called the TENEX procedure involves minimally invasive, ultrasound-guided removal of scar tissue in the region of the tendon pain. More study is needed.

Most people will get better with rest, ice and pain relievers. Depending on the severity of your condition, the pain might linger for months to years — even if you take it easy and follow instructions on exercising your arm. Sometimes the pain returns or becomes chronic.