Medial Epicondylitis (Golfer’s Elbow)
Medial epicondylitis or golfer’s elbow is a common condition that affects the medial side of the elbow in athletes and non-athletes alike. It is, like lateral epicondylitis or tennis elbow, typically due to repetitive overuse. While the name implies that it only affects golfers, again, this can happen to any person involved in repetitive motions of their forearm. Ironically, high level tennis players are more prone to get medial epicondylitis than lateral epicondylitis. With regards to golfers, this typically occurs simply due to playing too much, however, other factors such as poor mechanics may hasten the development of this condition.
Patients with medial epicondylitis complain of localized pain over the medial epicondyle, which is on the inner aspect of the elbow. Pain and weakness with resisted wrist flexion and forearm pronation are common physical exam findings. Even everyday activities, such as shaking hands or pouring juice can bother the elbow. It is always important to rule out other conditions that can cause similar symptoms such as ulnar neuritis, cubital tunnel syndrome, ulnar collateral ligament injury or even lacertus syndrome.
Conservative treatment is usually successful and starts with activity modification. Physical therapy and anti-inflammatory medications can help as well.
About 90% of the time, medial epicondylitis will resolve with conservative treatment. The initial step towards recovery involves complete cessation of the offending activity. In the case of a golfer, no golf should be played and that includes no practicing at the range. Based on studies in the literature, the gold standard to improve the condition is a structured physical therapy program that focuses on stretching and strengthening of the elbow and forearm muscles. In severe, acute cases, Cortisone injections may alleviate the pain, however, the lasting benefits of these injections is variable. Cortisone injections, while potentially beneficial in the short term, should be limited because they do have negative side effects with regards to the tendon and may even predispose the tendon to more tearing if repeated injections are administered.
When the athlete or patient is pain free, it is at this point that we typically allow them to return to sports. Again, the key is not overusing the elbow, so one should gradually ease back into sports. If this is the result of a golf injury, then one should work up through their bag starting with pitching wedges, eventually hitting longer irons and then woods prior to playing 18 holes.
In more chronic cases and for those who failed to respond to the above mentioned treatments of rest, physical therapy and injections, two other options remain that are commonly used. One is platelet rich plasma and this has shown promising results for overuse tendon injuries. One benefit of platelet rich plasma is that it isn’t associated with the same risks as Cortisone injections. If PRP or platelet rich plasma injections do not alleviate the symptoms, surgery provides successful outcomes. The surgery is done through a very small incision and involves removing the degenerated or torn tissue and repairing the healthy appearing tendon back to its insertion on the medial epicondyle.
This surgery is done on an out-patient basis, meaning the patient goes home that day. They are typically kept in a splint for the first week and then start physical therapy the following week. Typically, the patients or athletes can return to sports by about three months after the surgery.