How does Golfer’s elbow develop?
The condition is believed to result from overuse. The tendons of the elbow suffer wear and tear over time. This results in degeneration of the tendons and occasionally there may be microscopic or partial tears in the tendon. Some natural healing may take place but often there is a process of repeated breakdown and incomplete healing which results in pain.
How is Golfer’s elbow diagnosed?
A diagnosis of Golfer’s elbow is made based on the history of pain localised to the inner aspect of the elbow and occasionally down the forearm. Pain is usually intermittent and often experienced with activities. Pain may be associated with weakness of grip. Examination shows localised tenderness on the inner aspect of the elbow and pain with certain provocative manoeuvres such as flexing the wrist or gripping hard against resistance. An X-ray may sometimes show bone spurs or calcium deposits. An ultrasound scan or MRI may be performed to examine the state of the tendons. If associated nerve pain is suspected, electromyography (EMG) or nerve conduction tests may be requested.
How is Golfer’s elbow treated?
In the early phase, pain may be controlled with activity modification and the use of pain relieving or anti-inflammatory medication. In most individuals, Golfer’s elbow is a self-limiting condition that often resolves slowly over a variable period of time ranging from 6-18 months.
Supervised physiotherapy: You may be advised to see a physiotherapist to start a regime of specific treatment that includes deep friction, stretching of the affected tendons and eccentric strengthening exercises. There is good evidence to suggest that supervised physiotherapy improves symptoms. Instructions on a therapeutic exercise program can be downloaded from the Orthoinfo website.
Clasp: Wearing an epicondylitis clasp on the forearm will often help ease symptoms particularly if worn during activities. It may also act as a reminder to modify activities.
Steroid injection: A steroid injection placed accurately into the tendon origin will often provide good short to medium term pain relief allowing progress to be made with physiotherapy. The injection will not cure the condition. It is not advisable to have multiple injections.
Platelet-rich-plasma (PRP) injection: A small amount of venous blood is withdrawn from the patient and spun in a special centrifuge for 5-15min. This yields a sample of Plasma rich in platelets, which are the blood cells that play an important role in healing. A small volume (approximately 2ml) is injected into the origin of the tendon using a multiple puncture technique. The procedure is painful and shows some benefit compared with steroid injections over the long term.
Surgery: In a small minority of patients, in whom symptoms have persisted despite adequate nonoperative treatment, it may be appropriate to undertake surgical treatment. Surgery is performed open. The origin of the affected flexor tendon is released from the bone and the bone may be drilled, abraded or treated with microfracture to promote healing. Following surgery symptoms will usually settle over a period of time. For further information on surgical treatment, please refer to the section on Surgery for golfer’s elbow.