Introduction
Golfer’s elbow or medial (inner) epicondylitis is a condition of inner elbow pain. It is similar to tennis elbow but occurs less frequently than tennis elbow.
However, these two conditions are not limited to only golfers or tennis players.
This condition is mainly caused by stress overload on the tendons of the forearm muscles which control the wrist. These tendons attach to the inner elbow joint and are a source of pain if they are affected.
Symptoms
Symptoms may develop suddenly or gradually over time. Pain and tenderness may be felt over the inner elbow and may radiate up and down to the forearm, with movement, while carrying objects, or even at rest if the condition is severe. Stiffness and weakness may occur in the hand and wrist.
Common Causes
- Forceful or repetitive wrist/finger motions
- Improper stroke techniques
in sports - Improper techniques for
throwing sports - Improper weight lifting
techniques - Excessive practice leading
to overload
Risk Factors
- Smokers
- Occupations or sports demanding forceful activities for the elbow and wrist
- Obesity (in women) (Shiri et al. 2006)
Physiotherapy and Rehabilitation
Recovery goals
- Relieve pain
- Reduce inflammation
- Education and lifestyle advice (ergonomics, posture)
- Strengthen the affected muscles
- Safe return to daily activities or sport
Physiotherapy will approach rehabilitation of Golfer’s elbow in 3 structured phases:
Phase 1
- Education and lifestyle advice to avoid/reduce/modify the painful activities
- Splinting or bracing the elbow and wrist
- Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain control and inflammation
- Application of ice, ultrasound, and other modalities – research suggests potential effectiveness (Dingemanse et al. 2012)
- Extracorporeal shock wave therapy – significant improvements in pain (Sang et al. 2012)
Phase 2
Once pain is not so prominent, a guided rehabilitation program will be initiated to regain pain-free, full wrist and elbow range of motion and strength. This will include:
- Simple muscle activation exercises
- Progressively challenging exercises to build up resilience
- Maintaining the strength and flexibility of the shoulder and elbow muscles
Physiotherapy will advance to the next phase once you are able to perform sprint repetitions to fatigue without discomfort (Ciccotti et al. 2004).
Phase 3
This final step of rehabilitation is mainly for athletes to return to sports and address more advanced moves. Physiotherapy will focus on:
- Identifying deficiencies in equipment or techniques that may contribute to the condition
- Conditioning of the entire body (muscle strength, endurance, flexibility)
- Minimizing the future risk of injury
Surgical Intervention
If conservative measures are not effective, and the condition is chronic, surgery or injections for pain relief are options. These can include:
- Mini-open muscle resection procedure under local anesthesia
- Fascial elevation and tendon origin resection (FETOR)
- Steroid injections
