Golfer's Elbow (Medial Epicondylitis)

What is golfer's elbow?

Golfer's elbow, medically known as medial epicondylitis, is a condition that causes pain and tenderness on the inside of your elbow. It happens when the tendons that bend your wrist and fingers become strained from overuse, and despite the name, it affects far more than just golfers.

What are the symptoms of golfer's elbow?

Golfer's elbow can come on suddenly or build up gradually over weeks or months. Pain is usually felt on the inside of your elbow and can spread down your forearm, and it's often worse first thing in the morning or when you grip something.

• Pain and tenderness on the inside of your elbow, over a bony bump called the medial epicondyle
• A dull ache or burning feeling that can radiate down your forearm
• Weakness in your grip, or pain when making a fist
• Stiffness in your elbow
• Numbness or tingling in your ring and little finger, if a nearby nerve is affected.

What are the causes of golfer's elbow and who is at risk?

Golfer's elbow happens when the tendons attaching your forearm muscles to the inside of your elbow become overloaded, usually from repeated gripping, wrist bending, or turning your forearm inwards. Over time, this causes tiny tears and changes within the tendon.

Despite the name, most cases have nothing to do with golf. More than 90% are linked to work rather than sport, particularly jobs involving repeated forceful gripping, lifting loads over 20kg, or using vibrating tools, such as carpentry, plumbing and construction.

It's most common in people aged 45–64and usually affects your dominant arm. Men are affected roughly twice as often as women. Smoking, diabetes, obesity and spending 2 or more hours a day on repetitive hand tasks can all increase your risk.

Are there different types of golfer's elbow?

Golfer's elbow affects the tendons on the inside of your elbow. A closely related condition, tennis elbow, affects the tendons on the outside of your elbow instead, though the underlying problem in the tendon is much the same. Golfer's elbow is the less common of the two, making up around 10–20% of all epicondylitis cases.

How is golfer's elbow diagnosed?

Golfer's elbow is usually diagnosed clinically, meaning your doctor or physiotherapist can identify it from your symptoms and a physical examination, without needing any scans. They'll check for tenderness over the inside of your elbow and see if your pain gets worse when you bend your wrist against resistance or turn your forearm inwards.

Imaging isn't usually needed, but an X-ray, ultrasound or MRI scan may be used if the diagnosis is unclear, your symptoms are unusual, or your doctor wants to rule out other causes of elbow pain, such as arthritis or a nerve problem.

How is golfer's elbow treated?

Most people recover from golfer's elbow without surgery, often within several months, although it can take longer. The right combination of self-care and physiotherapy is usually enough.

Self-help and non-surgical options

• rest and modify your activities, changing how you lift, grip or carry things for a while
• painkillers, such as paracetamol, or an anti-inflammatory such as ibuprofen (avoid ibuprofen for the first 48 hours after a new injury, as it may slow healing)
• ice or heat, such as an ice pack for up to 20 minutes at a time, or a hot water bottle to help relax the muscles before exercises
• stretching and strengthening exercises for your forearm, which research shows are the most important part of recovery
• a forearm brace or splint, sometimes called an epiclasp, which may help in the short term, though the evidence for it is limited
• physiotherapy, if you're not improving on your own.

Exercises can take around 6–12 weeks to make a noticeable difference, and it's worth continuing them for 6–8 weeks after your pain has gone to help stop it coming back.

If these measures aren't controlling your pain, your doctor may discuss a corticosteroid injection (a steroid medicine injected to ease inflammation). However, this isn't routinely offered any more, as evidence suggests it may only help in the short term and could be worse for your tendon's health in the long run. Other options some clinics offer include platelet-rich plasma (PRP) injections, which use a concentrated sample of your own blood to try to speed up healing, or shockwave therapy, though evidence for these varies.

Surgery

Surgery is rarely needed for golfer's elbow. It's usually only considered if your symptoms haven't improved after 6 to 12 months of non-surgical treatment. The operation removes the damaged part of the tendon and cleans away any scar tissue, and is usually done as a day case under general anaesthetic, meaning you go home the same day.

When should I see a doctor?

See your GP or physiotherapist if your elbow pain doesn't improve with rest, self-care and exercises, or if it's affecting your daily activities or getting worse.

Golfer's elbow doesn't usually need emergency care, but get immediate medical attention if your elbow looks an unusual shape, if it's hot, swollen and you have a fever, or if you think you may have broken a bone.