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Golfer’s Elbow – Overview

January 21, 2021
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"Golfer's elbow, or medial epicondylitis, is a common overuse condition that causes elbow pain. While golfer's elbow most often affects people in middle age, it can affect patients of any age. Golfer's elbow is somewhat common. It is significantly less common than tennis elbow. Golfer's elbow is not always caused by playing golf, but it can be seen in people who play racket sports. Throwing athletes are also prone to golfer's elbow. The classic hallmark symptom of golfer's elbow is pain on the medial, or inside, portion of the elbow. The pain is sometimes described as achy, sharp, or sore. The pain is usually worse with gripping. It sometimes feels like it radiates up toward the shoulder or down toward the wrist. The symptoms of golfer's elbow can present differently in some patients than others. Some patients get an acute episode with their symptoms coming on suddenly after an injury while others see their symptoms come on gradually over time. Some patients notice their symptoms more in the morning. Others have it worse in the evenings. Some patients can also have irritation of their own or nerve, which can cause dullness or numbness in the ring finger and little finger. A doctor should be consulted for golfer's elbow whenever the patient feels that they cannot adequately care for the condition at home, or if they are uncertain of the diagnosis. A doctor can help determine whether golfer's elbow is the culprit or perhaps something else. And what would be the appropriate treatment? Golfer's elbow is primarily caused by inflammation and repetitive injury where the wrist flexor pronator tendons originate at the inside or medial portion of the elbow. Heavy manual labor, repetitive gripping activity, overhead throwing sports golfing, and middle-age are all risk factors for golfer's elbow. Throwing athletes are considered to be at high risk. Medications that may be recommended for golfer's elbow primarily include the NSAID family of anti-inflammatory medications, which includes medications like ibuprofen, Naproxen, and also diclofenac, which is the only one that is available as a topical cream. These medications can often be used for a few weeks to help combat the longstanding inflammation that is present. Though caution should be used, especially in cases where the patient has a history of gastric ulcers or kidney disease, as NSAID medications can affect these systems. Patients who are on a blood thinner also must be careful using these medications. Anybody with a potential interaction or problem with an NSAID medication should ask their own doctor prior to taking them. A brace such as the popular counterforce brace, which is used for tennis elbow, can also be helpful in golfer's elbow. It is typically worn on the forearm a bit farther down than the site of the actual pain by about three finger breadths, with the pressure on the inside portion of the forearm over the flexor pronator muscles. This brace in this location can shield the injured tendon from further injury and allow it to heal. Do not over-tighten the counterforce brace. It should just fit snugly. Patients who are prone to golfer's elbow do not need to necessarily stop playing certain sports, but they may need to modify their grip or wear a brace during sport. Physiotherapy is not necessary, but can be very helpful in treating golfer's elbow. A therapist can help stretch tight muscles and strengthen the weak ones to better balance the affected arm. They can also assess the patient's use in the arm and potentially instruct them on postures to avoid, or ways to improve their biomechanics. They may also design a custom home exercise program. Thankfully, surgery is rarely indicated for golfer's elbow. Most cases of golfer's elbow resolve with non-surgical treatment, including rest, medications, bracing, therapy, and/or improvement in biomechanics. Injections are sometimes offered for golfer's elbow, but they have not been shown to alter the long-term course of the disease, only to provide short term relief and thus are not always the preferred option. They also carry a risk of injury to the ulnar nerve. If surgery is considered for golfer's elbow, it should be as a last resort after trying multiple other non-surgical treatments. Since most of the time, those are successful. Surgery, while it can be effective, also carries with it the risk of complications, which can be avoided with non-surgical treatment."

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