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Golfer's Elbow

Article
Bone, Muscle, & Joint
Sports Medicine
+1
Contributed byKrish Tangella MD, MBAOct 19, 2018

What are the other Names for this Condition? (Also known as/Synonyms)

  • Baseball Elbow
  • Medial Epicondylitis
  • Thrower’s Elbow

What is Golfer's Elbow? (Definition/Background Information)

  • Golfer’s Elbow is a painful condition involving the tendons that attach forearm muscles to the inner elbow prominence; the rounded bony protrusion (called epicondyle) seen along the line of the little finger, traced along the palm
  • Golfer’s Elbow predominantly occurs when the tendons are overworked and become inflamed. Overuse of the elbow from throwing or hitting action results in damage to the tendons that does not heal
  • The condition usually develops in golfers and baseball pitchers due to a combination of repetitive motion causing elbow overuse. Most of the cases are reported in young and middle-aged adults; a slight male predilection is reported
  • Golfer’s Elbow is also termed as Medial Epicondylitis, as the medial epicondyle is affected. It is less common than tennis elbow, a condition that involves the lateral epicondyle (or the outer elbow prominence)
  • Rest, physical therapy, or over-the-counter medications, are typically the initial recommended steps in treating Golfer’s Elbow. However, surgery is an option, if these aforementioned treatments are unsuccessful
  • The prognosis of Golfer’s Elbow depends on the severity of the condition; but, it is generally good with adequate treatment. However, severe cases of tendon injury may take several months of physical therapy and treatment to completely heal

Who gets Golfer's Elbow? (Age and Sex Distribution)

  • Golfer’s Elbow may occur in individuals of all ages; although, individuals between the ages of 20-50 years have a higher risk
  • A male-female ratio of 2:1 is observed
  • No specific racial or ethnic group preference is observed

What are the Risk Factors for Golfer's Elbow? (Predisposing Factors)

Common factors that increase the risk for Golfer’s Elbow include:

  • Any sport that involves a repetitive overuse of the wrist or arm (lifting or swinging motion), such as with golf, tennis, or baseball
  • Certain occupations that cause a repetitive stress on the elbow joint, such as with farming, carpentry, painting, or even excess work using a computer
  • Regular use of certain vibratory tools such as a jackhammer or power saw

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Golfer's Elbow? (Etiology)

Golfer’s Elbow is caused by muscle strain and repetitive tendon injury, from a set of repetitive motions. The tremendous amount of stress on the elbow tissue can result in chronic episodes of inflammation, building up within the elbow region. Some of the causes associated with Golfer’s Elbow include:

  • Participating in certain sports activities that involve a set of repetitive actions, leading to overuse of the wrist or arm, such as in baseball or tennis
  • Use of poor throwing techniques that involves lifting one’s arm over the head
  • Certain occupations that cause stress on the elbow joints, due to its repetitive overuse, such as while working on a computer, carpentry, or painting
  • Poor fitness level of an individual

What are the Signs and Symptoms of Golfer's Elbow?

The signs and symptoms of Golfer’s Elbow usually develop over time. Most individuals with the condition start to feel mild pain, as the condition gradually progresses over many months. The signs and symptoms of Golfer’s Elbow include:

  • Slow progressive pain within the elbow; pain that worsens with use of the wrist or elbow
  • Weakness in the arm, which makes it difficult to grip or hold on to objects, such holding a ball or gripping a door knob, or even while shaking hands
  • Tenderness and warmth around the elbow
  • Decreased range of motion in the affected arm/elbow
  • Weakness of the arm
  • Localized numbness and tingling sensation, in some cases

How is Golfer's Elbow Diagnosed?

Diagnostic methods that a physician may use to help diagnose Golfer’s Elbow include:

  • Physical examination: A physician will perform a thorough physical examination of the elbow. During this exam, a physician may apply pressure to the affected area and examine the elbow, wrist, and fingers, range of motion. Individuals are also expected to provide an explanation of the circumstances that caused the injury. In addition to this, a complete medical history can aid in arriving at a definitive diagnosis
  • X-ray of elbow: X-rays use radiation to produce images of the elbow. It can also help the physician rule out other possible causes of elbow discomfort, such as a fracture
  • Magnetic resonance imaging (MRI) of affected elbow region: An MRI scan is a more detailed scan that uses a magnetic field to produce images that allow a physician to view any damage to the bones and soft tissue that surrounds the elbow joint
  • Electromyography (EMG): An EMG shows the electrical activity of the muscle during rest and during contraction. Examining the electrical activity may help a physician rule out possible nerve compression, which presents signs and symptoms similar to Golfer’s Elbow

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Golfer's Elbow?

The complications of Golfer’s Elbow may include:

  • Inability to fully straighten the elbow
  • Sometimes, atrophy of the muscles in the region
  • Prolonged and chronic elbow pain, if the condition is left untreated
  • Recurrence of the injury

How is Golfer's Elbow Treated?

A treatment of Golfer’s Elbow includes the use of both nonsurgical and surgical methods.

  • Any activity that aggravates the elbow condition further should be avoided. The physician may advise the individual to refrain from participating in physical activities, till the pain or symptoms get better
  • Applying ice to the elbow can help reduce pain and swelling
  • Non-steroidal anti-inflammatory oral medications, such as ibuprofen and naproxen, can help reduce the pain and swelling, in the elbow
  • Corticosteroid injections help provide temporary relief of symptoms and in improving the range of motion. It is important to note that corticosteroid injections may only give temporary relief. Prolonged episodes of such injections can injure the joints in the long-run
  • The individual may be advised to wear a forearm strap or brace, to decrease stress on the elbow
  • After the signs and symptoms have abated, it is important to begin some light motion exercises. Physical therapy may help restore strength, as well as improve flexibility in the muscles
  • Extracorporeal shock wave therapy (ESWT) is an increasingly popular (US FDA-approved) therapeutic approach in which high-energy sound waves are sent to the elbow. However, this therapy is still considered experimental by many physicians; even though research has shown that it may be effective

Surgical treatment:

  • Arthroscopy of elbow joint: Arthroscopic surgery is a minimally-invasive surgical procedure that helps visualize (through a fiber-optic scope connected to a television camera), diagnose, and repair the elbow joint using small instruments. These instruments are inserted through a small incision within the elbow and guided using a video monitor
  • Open surgery of elbow joint: Open surgery is a surgical procedure in which an incision is made over the elbow, allowing repair of the damaged tissue under direct visualization

How can Golfer's Elbow be Prevented?

A daily stretching program can help reduce the chance of the injury recurring for individuals with a history of Golfer’s Elbow. It is also important to incorporate a strength exercise program, to help strengthen the elbow. Other methods to help prevent Golfer’s Elbow include:

  • Warming up prior to the event, such as through light aerobic exercise including jogging
  • Stretching the muscles before and after exercising/sports activity
  • Minimizing physical activity that involves repetitive shoulder/elbow movements for prolonged periods
  • Avoiding any repetitive lifting or pulling (especially overhead) of objects that are heavy
  • In sports, learning the correct techniques and avoiding poor (overhead) throwing techniques that may cause unstable elbow joints

What is the Prognosis of Golfer's Elbow? (Outcomes/Resolutions)

  • The long-term prognosis of Golfer’s Elbow is usually good in a majority of the individuals
  • Some individuals with severe Golfer’s Elbow may experience recurring symptoms, leading to a prolonged recovery period
  • When properly treated, a high percentage of individuals regain their full strength and range of motion in their affected elbow

Additional and Relevant Useful Information for Golfer's Elbow:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/health-topics/orthopedc-disorders/

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Krish Tangella MD, MBA

Pathology, Medical Editorial Board, DoveMed Team

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