Golfer's Elbow (Medial Epicondylitis)

CONDITION

Golfer's elbow occurs when the tendons that attach forearm muscles to the bony projection on the inside of the elbow (the medial epicondyle) break down, become inflamed or are torn. These tendons and muscles (Figure 1 below) allow you to bend your wrist forward or down, as you do when you swing a golf club or grip things.

Figure 1.

CAUSES

Overuse, repetitive motion, a single lifting event or a direct blow to the tendon attachment can cause this injury. Other risk factors include:

• being over 30 years old
• using poor sports technique, such as improper grip or swing with a golf club, improper string tension on a tennis racket or improper pitching technique in baseball
• using a lot of topspin with forehand shots in tennis
• abruptly becoming a lot more active.

SYMPTOMS AND SIGNS

• You will have aching and, sometimes, sharp pain over the inside of the elbow.
• The pain can sometimes go down the inside and front of the upper forearm.
• Pain is worse during and shortly after activities that cause the problem.
• You may feel pain when you open a door, pick up a coffee cup, type, shake hands, garden or use a hammer or other tools.
• There may be swelling over the inside of the elbow.
• If you have weakness and numbness or problems feeling your forearm or hand, you may have a pinched nerve instead of golfer's elbow.
• If you have a lot of swelling, bruising and pain on the inside of your elbow, and if you can't bend or straighten your elbow completely, especially after a fall on an outstretched hand, you may have an elbow fracture.

WHEN TO CALL YOUR DOCTOR

Call your doctor right away (day or night) if:

• You have severe pain, swelling and/or numbness over your elbow and forearm after a fall or injury.
• You can't fully straighten or bend your arm after a fall or injury.

Call your doctor during regular office hours if:

• You have mild to moderate pain after a fall or injury, but don't have problems feeling your forearm or hand and can bend and straighten your elbow completely.
• You have had pain and swelling that have been getting worse over time.

SELF-CARE AT HOME

• Rest your arm and hand from activities that cause pain.
  • Avoid bending the wrist forward or down if it hurts, especially with repetitive activities.
  • Avoid picking up objects that are heavy enough to cause pain.
  • Take a break from golf, baseball or racquet sports until your symptoms are minimal or go away, which usually takes from one to four weeks.
• For swelling and pain control, apply a cold pack or an ice pack to your elbow three times a day for 20 minutes at a time. Hold the pack in place with plastic wrap or an elastic wrap. You may do this for up to 20 minutes every hour if you need to. If you use an ice pack, consider placing a washcloth between the pack and your skin to avoid frostbite.
  • Ice massage can help. Freeze water in a paper cup, peel the top of the cup back so the ice is sticking out, then rub the ice over the painful area for three to five minutes at a time. Let your elbow get warm between massages.
  • You can use ice massage anytime you are having pain or after arm activities that will probably cause pain.
• You may take ibuprofen (Advil® or Motrin®) if you can tolerate it. (See the labels for dose and risks.) Take this only briefly for swelling and pain.
• Braces or straps, particularly the kind with a built-in air pad http://www.aircast.com/index.asp/fuseaction/patient.main), can help decrease pain and increase function.
  • Wrap a tennis elbow strap snugly over your forearm, with the air pad positioned right in front of where the tendons attach to the inside of your elbow.
  • If you still have a lot of pain after trying the tennis elbow strap, wear a wrist splint (Figure 2 below) that holds your hand in a neutral position to rest your forearm tendons.

Figure 2.

Most sports stores, drug stores and some convenience stores stock braces and straps.

You may start doing certain stretching and strengthening exercises before you see your doctor:

• Straighten your injured arm out fully with the palm down. Push up the front of that hand using your other hand while keeping your elbow straight (Figure 3 below) so that you feel a stretch across the palm side of your forearms. Hold the stretch for 30 seconds, rest briefly and repeat three times. Do this exercise once or twice a day.

Figure 3.

• Make a strengthening tool out of a dowel or a broomstick, a piece of rope, some athletic tape and a weight (Figure 4, pictured below). Cut a dowel or broomstick 18 to 24 inches long. Tie a small rope to the center of the handle. Secure the rope in place with the athletic tape and then wrap the tape to each end of the handle. The rope should be long enough to reach the ground when you are holding the handle at waist level. Attach a light weight, usually one to five pounds, to the other end of the rope. A barbell weight, can of soup, hammer or rock will all work well.
  • Wrap the rope around the center of the handle so that the weight is at the center of the handle. Grasp the handle, palms up, with both hands.
  • Stand with your upper arms at your side, your elbows bent 90 degrees at your waist and your forearms straight out in front of your body. Alternately using one hand and then the other, slowly unwind the rope by rolling your wrists backward or down until the weight reaches the floor.
  • DO NOT bring the weight back up in a similar manner. Rather, kneel down and wrap the rope completely back around the handle, stand up and repeat the above exercise.
  • Lower the weight to the ground five to 10 times once daily. It is okay to have mild discomfort over the inside of the elbow during the exercise, but the discomfort should gradually improve over weeks and should not get worse.

Figure 4.

• You can massage your injured tendons a few times daily. Using two fingers, apply firm pressure with a back-and-forth rubbing motion for two to three minutes. This may stimulate healing.
• If you have severe pain, problems bending your arm or numbness in your forearm or elbow, do not do any exercises or use any braces. Put your arm in a sling and see your doctor.