Golfers Elbow (medial epicondylitis)

What is Golfers Elbow (medial epicondylitis)

Golfers Elbow, also called medial epicondylitis, is a condition that results from inflammation of the strong bands of tissue (tendons) that attach your forearm muscles to the inside of your bone at the elbow.

These tendons affect the muscles that bend the palm toward the wrist (flexion).

This condition is called golfers elbow because it is more common among people who constantly bend and twist their wrists, such as golfers. This injury usually results from overuse. Tendons also become less flexible with age.

This condition causes elbow pain that may spread to your forearm and upper arm. The pain may get worse when you bend your wrist downward.

What are the causes?

This condition is an overuse injury that is caused by:

• Repeatedly flexing, turning, or twisting your wrist.
• Constantly gripping objects with your hands.

What increases the risk?

This condition is more likely to develop in people who play golf or tennis or have jobs that require the constant use of their hands. This injury is more common among:

• Carpenters.
• Gardeners.
• Musicians.
• Bricklayers.
• Typists.

What are the signs or symptoms?

Symptoms of this condition include:

• Pain near the inner elbow or forearm.
• Reduced grip strength.

How is this diagnosed?

This condition is diagnosed based on your symptoms, medical history, and physical exam. During the exam, your health care provider may test your grip strength and move your wrist to check for pain. You may also have an MRI to confirm the diagnosis, look for other issues, and check for tears in the ligaments, muscles, or tendons.

How is this treated?

Treatment for this condition includes:

• Stopping all activities that make you bend or twist your wrist until your pain and other symptoms go away.
• Icing your wrist to relieve pain.
• Taking NSAIDs or getting corticosteroid injections to reduce pain and swelling.
• Doing stretches, range-of-motion, and strengthening exercises (physical therapy) as told by your health care provider.

In rare cases, surgery may be needed if your condition does not improve.

Follow these instructions at home:

• If directed, apply ice to the injured area.
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.
• Move your fingers often to avoid stiffness.
• Raise (elevate) the injured area above the level of your heart while you are sitting or lying down.
• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do exercises as told by your health care provider.
• Do notuse tobacco products, including cigarettes, chewing tobacco, or e-cigarettes. If you need help quitting, ask your health care provider.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

How is this prevented?

• Warm up and stretch before being active.
• Cool down and stretch after being active.
• Give your body time to rest between periods of activity.
• Make sure to use equipment that fits you.
• Be safe and responsible while being active to avoid falls.
• Do at least 150 minutes of moderate-intensity exercise each week, such as brisk walking or water aerobics.
• Maintain physical fitness, including:
  • Strength.
  • Flexibility.
  • Cardiovascular fitness.
  • Endurance.
• Perform exercises to strengthen the forearm muscles.
• Slow your golf swing to reduce shock in the arm when making contact with the ball, if you play golf.

Contact a health care provider if:

• Your pain does not improve or it gets worse.
• You notice numbness in your hand.

Get help right away if:

• Your pain is severe.
• You cannot move your wrist.

Golfers Elbow Rehabilitation

Ask your health care provider which exercises are safe for you. Do exercises exactly as told by your health care provider and adjust them as directed. It is normal to feel mild stretching, pulling, tightness, or discomfort as you do these exercises, but you should stop right away if you feel sudden pain or your pain gets worse. Do notbegin these exercises until told by your health care provider.

Stretching and range of motion exercises

These exercises warm up your muscles and joints and improve the movement and flexibility of your elbow.

Exercise A: Wrist flexors

1. Straighten your left / right elbow in front of you with your palm up. If told by your health care provider, do this stretch with your elbow bent rather than straight.
2. With your other hand, gently pull your left / right hand and fingers toward you until you feel a gentle stretch on the top of your forearm.
3. Hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times a day.

Strengthening exercises

These exercises build strength and endurance in your elbow. Endurance is the ability to use your muscles for a long time, even after several repetitions.

Exercise B: Wrist flexion

1. Sit with your left / right forearm palm-up and supported on a table or other surface.
2. Let your left / right wrist extend over the edge of the surface.
3. Hold a __________ weight or a piece of rubber exercise band or tubing. Slowly curl your hand up toward your forearm. Try to only move your hand and keep the rest of your arm still.
4. Hold this position for __________ seconds.
5. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise C: Eccentric wrist flexion

1. Sit with your left / right forearm palm-up and supported on a table or other surface.
2. Let your left / right wrist extend over the edge of the surface.
3. Hold a __________ weight or a piece of rubber exercise band or tubing.
4. Use your other hand to move your left / right hand up toward your forearm.
5. Slowly return to the starting position using only your left / right hand.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise D: Hand turns, pronation i

1. Sit with your left / right forearm supported on a table or other surface.
2. Move your wrist so your pinkie travels toward your forearm and your thumb moves away from your forearm.
3. Hold this position for __________ seconds.
4. Slowly return to the starting position.

Exercise E: Hand turns, pronation ii

1. Sit with your left / right forearm supported on a table or other surface.
2. Hold a hammer in your left / right hand.
   • The exercise will be easier if you hold on near the head of the hammer.
   • If you hold on toward the end of the handle, the exercise will be harder.
3. Rest your left / right hand over the edge of the table with your palm facing up.
4. Without moving your elbow, slowly turn your palm and your hand down toward the table.
5. Hold this position for __________ seconds.
6. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise F: Shoulder blade squeeze

1. Sit in a stable chair with good posture. Do notlet your back touch the back of the chair.
2. Your arms should be at your sides with your elbows bent. You can rest your forearms on a pillow.
3. Squeeze your shoulder blades together. Keep your shoulders level. Do notlift your shoulders up toward your ears.
4. Hold this position for __________ seconds.
5. Slowly release.

Repeat __________ times. Complete this exercise __________ times a day.