Golfer's Elbow

Golfers elbow or medial epicondylosis is very similar to the much more prevalent tennis elbow, but occurs on the inside rather than the outside of the elbow joint. Much like tennis elbow, golfers elbow gains its name as this can be a common activity that results in the injury, however there are a number of other non-golf related activities that can result in medial epicondylosis.

The injury generally occurs as a result of repetitive use of the wrist flexor muscles on the underside of the forearm, which have a common tendon attachment at the medial epicondyle (bony point on the inside of the elbow). Micro-tears usually form in the tendon over time as a result of repetitive lower grade forces but can occur with one larger traumatic force such as driving a golf club into the ground with a golf swing.

Golfers elbow is equally common in men and women and peaks in prevalence between the ages of 35 and 45.

Symptoms Of Golfers Elbow

Golfers elbow is characterised by;

• Pain and tenderness over the medial epicondyle often radiating down into the forearm.
• Pain, which is aggravated with, resisted wrist flexion (pushing the palm downwards), pronation (turning the palm down) and gripping activities.
• Pain with lifting or bending the arm.
• Difficulty with extending the arm fully.

Due to its close proximity to the medial epicondyle, the ulnar nerve may become trapped in scar tissue, resulting in decreased sensation and/or tingling in the fourth and fifth fingers.

Pain in the elbow can be referred from a source in either the shoulder or the neck and these areas should be assessed and cleared by a qualified physiotherapist before a diagnosis of Golfers elbow is made.

Management of Golfers Elbow

Management of Golfers elbow can be broken down into two phases. The first phase involves rest from activity causing the irritation where possible or activity modification if complete rest is not an option. If the patient is unable to completely rest from aggravating activities, a compression strap can be a useful way off reducing strain on the painful area and allowing continued function. Physiotherapy aimed at appropriate stretching and tissue release is usually employed at this time in order to offload the effected tissue and decrease pain. Acupuncture has also been shown to be effective in reducing pain and improving functioning of the arm (1).

The second phase in management of Golfers elbow involves a program of graduated eccentric loading of the effected tissue, which has been shown to give the best effect in stimulating the body to repair and strengthen the damaged tendon (2). This phase of treatment will also normally looking at correcting the abhorrent biomechanics or work postures, which resulted in the injury as part of a return to full functional activity.

Physiotherapy combining elbow manipulation and exercise has been shown to give superior results to a wait and see approach in the first six weeks and to corticosteroid injections after six weeks (3).

This article is not intended as a resource for self management of injury. Definitive diagnosis and correct rehabilitation should always be guided by a qualified practitioner.

1. Fink, M., Wolkenstein, E., Karst, M. et al. Acupuncture in chronic epicondylitis: a randomized controlled trial. Rheumatology, 2002. 41(2); 205-209.

2. Norregaard, J., Larson, CC., Beitler, T and Langberg, H. Eccentric exercises in the treatment of Achilles tendonopathy. Scandinavian Journal of Medical Sports Science, 2007. 17(2) 133-138.

3. Bisset, L., Beller, E., Jull, G. et al. Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: Randomised trial. British Medical Journal, 2006 Sept 29 [abstract].