(Golfer’s Elbow)
Medial epicondylitis – Definition
Medial epicondylitis is pain over the bone on the inner side of the elbow. The piece of bone that can be felt on the inner side of the elbow is called the medial epicondyle. When the tendons attached to this bone are overstretched or torn, they can become painful. This is called tendinopathy.
Medial epicondylitis is commonly called golfer’s elbow, but it is not restricted to people who play golf. It can occur in tennis players and other people who repeatedly grip objects tightly.
Medial epicondylitis – Causes
Golfer’s elbow is caused by overusing the flexor muscles of the forearms. Overusing these muscles can stretch or tear the tendons attached to the medial epicondyle.
Causes include:
- Improper golf swing technique or grip of golf clubs
- Wrong model of golf clubs
- Improper technique for hitting a tennis ball
- Improper size of tennis racquet or tension of racquet strings
- Doing certain arm motions too much, such as:
- Golf swings
- Tennis strokes (forehand or serve)
- Painting
- Raking
- Pitching
- Rowing
- Using a hammer or screwdriver
Medial epicondylitis – Risk Factors
A risk factor is something that increases your chance of getting a disease, condition, or injury. Risk factors for medial epicondylitis include:
- Playing golf or tennis
- Work that requires repetitive gripping or clenching of the fingers (especially when the hand is bent up or down at the wrist)
- Muscle imbalance
- Decreased flexibility
- Advancing age
Medial epicondylitis – Symptoms
Symptoms include:
- Pain or tenderness on the inner side of the elbow
- Pain increases when:
- Shaking hands
- Turning doorknobs
- Picking up objects with your palm down
- Hitting a forehand in tennis
- Swinging a golf club
- Applying pressure to this area
- Possibly pain extending down the forearm
- Tightness of forearm muscles
- Stiffness or trouble moving the elbow or hand
Medial epicondylitis – Diagnosis
The doctor will ask about your symptoms and medical history, your recent physical activity, and how the injury occurred. You may not remember the event that caused the injury because golfer’s elbow pain develops over time. The doctor will examine your elbow for:
- Pain on the inner side of the elbow when:
- Doing certain arm motions
- Pressing on the medial epicondyle
- Stiffness of elbow and pain with wrist movement
X-rays are not usually necessary, but the doctor may decide to x-ray your elbow to:
- Make sure the bones of the elbow are normal
- Look for a calcium deposit in the injured tendons
Magnetic resonance imagery (MRI) is occasionally used for diagnosis, but there is only limited evidence supporting this use.
Medial epicondylitis – Treatment
Treatment includes:
Rest
Do not do activities that cause pain. Do not play sports, especially golf and tennis, until the pain is gone.
Cold
Apply ice or a cold pack to the inner side of the elbow for 15-20 minutes, four times a day for several days after the injury. Wrap the ice or cold pack in a towel. Do not apply the ice directly to your skin.
Medication
The following drugs can help to reduce inflammation and pain:
- Aspirin
- Ibuprofen (Motrin, Advil)
- Naproxen (Aleve, Naprosyn)
- Acetaminophen (Tylenol)
- Topical pain medicines (eg, creams, patches) applied to the skin
If you still have tenderness in the elbow while taking these drugs, do not return to physical activity. Check with your doctor.
Compression
Wear a counter-force brace on your forearm if recommended by your healthcare professional. This brace limits the force generated by your forearm muscles when you use them.
Heat
Apply heat to the elbow only when you are returning to physical activity. Then use it before stretching or getting ready to play sports.
Stretching
When the acute pain is gone, start gentle stretching as recommended by a healthcare professional. Stay within pain limits. Hold each stretch for about 10 seconds and repeat six times.
Strengthening
Begin strengthening exercises for the flexor muscles of the forearm as recommended.
Gradual Return to Your Sport
Begin arm motions of your sport or activity (eg, golf swings, tennis strokes, painting) as recommended.
Cortisone Injection
The doctor may inject cortisone into the elbow near the medial epicondyle to reduce pain and inflammation.
Medial epicondylitis – Prevention
Take these steps to reduce your risk of getting golfer’s elbow:
- Keep your arm muscles strong so they can absorb the energy of sudden physical stress.
- After a short warm-up period, stretch your arm muscles before physical activity.
- Learn the proper technique for activities that require forearm motion.
- If you play golf, ask a golf specialist to check your:
- Swing technique
- Grip
- Model of golf clubs
- If you play tennis, ask a tennis specialist to check your:
- Technique for hitting a forehand
- Racket size and tension of racket strings
