Mike Nicholls, B.Sc., M.D., C.F.P.C., Diploma Sport Medicine
“Dear Doctor, I have heard of Tennis Elbow, but lately my elbow has hurt when golfing. I asked a friend who suggested I might have Golfers’ Elbow (Medial Epicondylitis). Is there such a thing, and if so why does it hurt during golf?
Golfers’ Elbow or medial epicondylitis is a painful inflammation of the flexor retinaculum (musculotendinous insertion of the flexor muscles of the forearm). It presents as pain over the inner or medial aspect of the elbow. It presents most commonly as the result of a chronic overuse injury such as in the repetitive stress associated with turning a wrench, hammering or swinging a golf club. It usually affects the dominant arm. It is similar to but less common than “Tennis Elbow” which affects the insertion of the extensor muscles of the forearm on the lateral aspect of the elbow.
A history of a weak grasp associated with pain (and occasionally numbness in the little and ring fingers) after activities like golf or carpentry would be highly suggestive. The examination would reveal tenderness anterior and distal to the medial epicondyle worse with resisted wrist flexion and forearm pronation. The diagnosis is clinical and x-rays are not usually helpful. Occasionally an EMG (electromyogram) is indicated if there are any neurological symptoms present. It is also important to rule out a cervical disc or elbow joint problem and on occasion a CT or MRI scan is indicated.
Treatment depends on the duration of the symptoms, the activities that have caused the problem and the motivation of the patient. Generally the longer symptoms have been present the slower the recovery. Initial treatment is aimed at diminishing inflammation through activity modification and rest, ice, anti-inflammatory medications and occasionally splinting. The next phase involves stretching and strengthening and can include modalities such as electrical stimulation, ultrasonography, phonophoresis and acupuncture. Strengthening progresses from elastic “therabands” to hand weights. Occasionally steroid injection is a reasonable treatment option. Surgical release is usually done only after 6 to 12 months of failed conservative treatment. The final phase of treatment consists of functional rehabilitation through close attention to correct swing mechanics, retraining and prevention. Medial counterforce braces and larger club grips can be used for golf. The advice of a golf pro could save you a lot of grief and might be well worth the expense.
Don’t let golfers’ elbow keep you off the green.