Golfer's elbow (Medial epicondylitis)

Overview

Golfer's elbow, also known as medial epicondylitis, is a condition that causes pain on the inner elbow. It causes pain where the tendons from the forearm muscles attach to the bone. The pain also may spread down the forearm and into the wrist. Golfer's elbow is similar to tennis elbow, which affects the outside of the elbow. But golfer's elbow happens on the inside of the elbow, closer to the body.

Despite the name, golfer's elbow doesn’t happen only to golfers. Anyone who uses their wrists or grips things over and over can develop it. This includes tennis players, pickleball players and people whose jobs require certain repetitive movements.

The good news is that golfer's elbow typically gets better with rest, simple treatments and changes to how you use your wrist and arm. Most people return to their usual activities with the right care.

Symptoms

Golfer's elbow typically causes:

• Pain and tenderness on the inside of the elbow. The pain can spread down the forearm. It often gets worse with certain movements, such as gripping or lifting, especially when you use your wrist.
• Stiffness in the elbow. It may hurt to make a fist.
• Weakness in the hands or wrists.
• Numbness or tingling, which may travel into the fingers. This is more common in the ring and little fingers.

The pain can start suddenly or build up over time. It may feel worse when doing activities such as swinging a golf club, pitching a ball or playing a racquet sport. Shaking someone's hand, turning a doorknob, picking up something with your palm down, and flexing your wrist also may hurt.

When to see a doctor

See your healthcare professional if your pain doesn't improve with rest, ice and pain medicines you can buy without a prescription.

Get medical help right away if:

• Your elbow is swollen and warm to the touch and you have a fever.
• You can't bend your elbow.
• Your elbow looks odd or out of place.
• You think you may have broken a bone.

Causes

Golfer's elbow happens when the muscles and tendons that control the wrist and fingers get overused or injured. This typically comes from repeating the same motion too often, especially forceful wrist bending and finger bending movements.

Golfer's elbow can be caused by:

• Lifting, throwing or hitting the wrong way.
• Not warming up properly before activity.
• Having weak or poorly conditioned muscles.

You don't have to play golf to get golfer's elbow. Many sports and jobs can lead to this condition, including:

• Racket sports such as tennis and pickleball. Using poor technique, too much topspin, or a racket that's too small or heavy can strain your tendons.
• Throwing sports such as baseball, softball, football, archery or javelin. Improper pitching technique in baseball or softball is a common cause.
• Weight training. Lifting weights using improper technique, such as curling the wrists during the completion of a biceps curl, can overload the elbow muscles and tendons.
• Jobs with repeated arm movements. These include jobs in fields such as construction, plumbing and carpentry.

To cause golfer's elbow, the provoking activity generally needs to be done for a long period on many days.

Risk factors

You're more likely to get golfer's elbow if you:

• Are 40 or older.
• Do repetitive movements for two or more hours a day.
• Are overweight.
• Have diabetes.
• Smoke cigarettes, which may affect tendon health and healing.

Prevention

You can help prevent golfer's elbow by taking these steps:

• Strengthen your forearm muscles, especially those that flex the wrist. Use light weights or squeeze a tennis ball regularly to build strength and protect your tendons from sudden strain.
• Warm up and stretch. Walk or jog for a few minutes, then gently stretch your wrists before playing sports or working.
• Use good technique. Ask a coach or trainer to check your form during sports or workouts to avoid putting too much stress on your elbow. Try to keep your wrist stiff and rigid throughout your sports movement.
• Use the right equipment. If your golf clubs are old and heavy, try switching to lighter ones. If you play tennis or pickleball, make sure your racket grip fits your hand and isn't too heavy.
• Lift safely. Keep your wrist straight and firm when lifting anything — especially weights — to avoid straining the tendons attached to your elbow.
• Rest when needed. If your elbow starts to hurt, stop what you are doing and give it time to heal. Pushing through pain can make golfer's elbow worse.

Diagnosis

To diagnose golfer's elbow, also called medial epicondylitis, your healthcare professional typically starts by asking about your symptoms and medical history. Then, you'll have a physical exam to check for pain, stiffness or weakness. Your healthcare professional may press on the inside of your elbow or ask you to move your elbow, wrist and fingers in different ways to see what causes pain.

An X-ray can help rule out other causes of elbow pain, such as a broken bone or arthritis.

If your symptoms are serious or not getting better, your healthcare professional may suggest more-detailed tests, such as an ultrasound or an MRI, to get a closer look at the tendons and soft tissues.

Treatment

The first step in treating golfer's elbow is to stop doing activities that cause pain. Giving your arm a break helps the tendons heal.

Most people get better with rest, ice and pain relief. But healing can take time — sometimes several months or even longer. Even with treatment, some people may have ongoing pain or flare-ups that come and go.

Medication and procedures

You can take a pain reliever that you can buy without a prescription to lessen pain from golfer's elbow. Try ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve) or acetaminophen (Tylenol, others). Talk with your healthcare professional if you are not sure which one is right for you.

Cortisone shots are not often used to treat golfer's elbow because they don't seem to help long-term and they have been found to weaken the tissue. Rarely, they may be used for short-term pain relief.

There are other treatments being studied to treat golfer's elbow. If rest, ice and pain relievers haven't helped, talk with your healthcare professional about whether these treatments may benefit you:

• Dry needling, also called tenotomy. A healthcare professional uses a small needle to poke the sore tendon to help it heal. Sometimes, ultrasound is used to guide the needle.
• Shockwave therapy. This treatment uses sound waves on the elbow to help it heal.

A newer treatment being studied is called platelet-rich plasma (PRP). For this treatment, your healthcare professional draws a small amount of your blood, concentrates the platelets, and then injects them into the sore area. The shots typically are guided by ultrasound. Researchers are still studying how well this treatment works.

Therapy and self-care

These steps can help you recover:

• Rest your arm. Stop playing golf or doing other activities that strain your elbow until the pain goes away. Going back to activities too soon can make the injury worse.
• Apply ice. Put an ice pack on your elbow for 15 to 20 minutes at a time, 3 to 4 times a day, for a few days. Wrap the ice in a thin towel to protect your skin. You also can gently massage the inside of your elbow with an ice cube for five minutes, 2 to 3 times a day.
• Wear a brace. Your healthcare professional may suggest a special strap or brace for your forearm. This can reduce strain on the tendons that attach to your elbow.
• Stretch and strengthen. Your healthcare professional may recommend exercises to gently stretch and then strengthen your wrist and forearm muscles. Building strength gradually is important and has been shown to help tendon healing. Physical or occupational therapy also may be helpful.

Once your pain improves, slowly return to your usual activities. Practice the motions of your sport or job first. If needed, work with a therapist, trainer or other sports professional, such as a golf pro, to improve your technique and avoid injuring your elbow again.

Surgery

Surgery is rarely needed to treat golfer's elbow. But if your symptoms don't improve after 6 to 12 months of other treatments, your healthcare professional may recommend a surgical procedure.

One newer option is the Tenex procedure. The medical term for this treatment is percutaneous ultrasonic tenotomy (PUT). It uses a tiny tool that goes through the skin and removes damaged tissue. Ultrasound imaging guides the tool to the exact spot where the tendon is injured. A similar device called TenJet uses water to remove damaged tissue. More research is needed, but these surgeries may help some people recover.

Preparing for an appointment

You'll probably start by seeing your primary healthcare professional. If your symptoms don’t get better with rest, ice and pain medicine, they may refer you to a sports medicine specialist or a doctor who treats muscle, bone and joint issues.

Here's how to prepare so you can get the most out of your visit.

What you can do

Before your appointment, write down:

• Your symptoms and when they started.
• Any health conditions you have and a list of all medicines and supplements you take, including doses.
• Details about your daily routine, including how often and how hard you play sports or do other activities that may strain your elbow. Note if you recently changed your workout or how you use your arm.
• Any recent injuries that may have affected your elbow.
• A list of questions you want to ask.

You may want to ask:

• What's the most likely cause of my elbow pain?
• Could anything else be causing it?
• Do I need any tests?
• What treatment do you recommend?
• Will I be able to go back to the sport or activity that caused the pain?
• How long should I avoid that activity?
• What kinds of exercises are safe while I'm healing?
• Will I need surgery?
• How often will I need follow-up visits?

Don't hesitate to ask other questions you have.

What to expect from your doctor

Your healthcare professional may ask:

• Is your pain constant? How bad is it?
• Do activities make the pain worse — such as lifting, gripping, typing or shaking hands?
• Is the pain making it hard to do everyday tasks or sleep?
• What is your exercise routine?
• Have you changed your training style or equipment recently, such as using a new racket or trying new techniques?
• What kinds of physical tasks do you do for work?
• What are your hobbies and recreational activities?
• Have you tried any home treatments? Did they help?