What is it?
Golfer’s elbow (medial epicondylitis) is most frequent between 30 and 50 years of age. It is more common in men.The cause is poorly understood but it is thought to be due to micro-tears or degeneration at the origin of the flexor muscles (common flexor origin) on the inner side of the elbow. The damage is typically related to excess or repetitive stress, especially forceful wrist and finger motions (only 10% patients are golfers!).
Golfer’s elbow causes pain on the inner aspect of the elbow that often radiates down the forearm.There can be associated numbness in the hand (little and ring finger) due to irritability of the ulna (funny bone) nerve behind the epicondyle. A positive provocative test to help diagnose this, is pain on the inner aspect of the elbow when trying to flex the wrist against resistance. This is due to the usual function of these affected flexor muscles being to flex the wrist and fingers.
What can be done?
Many treatments have been described;
Steroid injections can result in short-term relief of symptoms but studies have questioned the success in the long term. A maximum of 2 injections is my limit as more can cause skin problems.Other treatments include anti-inflammatory drugs, physiotherapy techniques, and splints. Probably the most effective treatment is to stop/cut back on the activities which cause the symptoms. The natural history of golfer’s elbow is a slow (12-18 months) resolution of the problem.
Stem Cell is a technique where blood (bone marrow) is taken from the pelvic bone and injected around the site of pain. It is thought to work as an anti-inflammatory. This is a newish technique and the longterm results are not fully known, however success rates appear to be 60-70%.
Shockwave therapy is a non-invasive technique, which stimulates the bodies’ own healing process. Success appears to be at around 60-80%. This procedure is useful in selected patients. Further information can be sought at www.shockwavesouth.co.uk
Surgery is considered in patients with severe or chronic golfer’s elbow and little or no response to treatment. This involves release of the common flexor origin through a short incision on the side of the elbow, removal of damaged tissue and the prominent epicondyle bone. Occasionally the ulna nerve will also be released. This does not cause a long-term weakening of the arm once the muscle has healed.
The operation is usually performed under general anaesthetic as a day-case. The elbow will be dressed with a supportive dressing that permits movement and light hand use. Occasionally you will be put in a Plaster of Paris for 2 weeks.Your stitches will usually be dissolvable. Timing of your return to work is variable according to your occupation and you should discuss this.
Nerves running in the region can be bruised or damaged during the surgery and form a painful spot in the scar (neuroma) or numbness down the side of the forearm.
Any operation can be followed by infection and this would be treated with antibiotics.
You will have a scar on the elbow. This will be somewhat firm to touch and tender for 6-8 weeks. This can be helped by massaging the area firmly with the moisturizing cream.
The symptoms and your function will recover slowly and it will probably be six months before you will get your final result. Success rate of surgery is in the order of 60-80%.
About 5% of people are sensitive to upper limb surgery and their arm may become swollen, painful and stiff after an operation (Complex regional pain syndrome). This problem cannot be predicted but will be watched for afterwards and treated with physiotherapy.