What are the diagnosis and treatment options for golfer's elbow (medial epicondylitis)?

From the Guidelines

Golfer's elbow (medial epicondylitis) is diagnosed through physical examination and patient history, with treatment focusing on conservative measures before considering invasive options. The condition results from repetitive wrist flexion and forearm pronation causing microtears in the tendon attachment at the medial epicondyle 1. Initial treatment includes:

• Rest to prevent further damage and promote healing
• Ice application for 15-20 minutes several times daily to reduce pain and inflammation
• Over-the-counter NSAIDs like ibuprofen (400-800mg three times daily) or naproxen (220-500mg twice daily) for pain and inflammation 1
• Physical therapy exercises to strengthen forearm flexor muscles, including wrist curls, reverse wrist curls, and grip strengthening, performed in sets of 10-15 repetitions daily
• A counterforce brace worn just below the elbow to reduce strain during activities

For persistent cases, a corticosteroid injection (typically methylprednisolone 40mg with lidocaine) may provide temporary relief, though limited to 2-3 injections due to potential tendon weakening 1. More severe or chronic cases might require platelet-rich plasma injections or surgery to remove damaged tissue. Most patients recover with conservative treatment within 3-6 months, but proper technique modification in activities is crucial to prevent recurrence. Imaging studies, such as radiographs, ultrasonography, or MRI, may be used to assess chronic elbow pain and guide treatment decisions 1.

Key considerations in treatment include:

• Relative rest and reduced activity to prevent further damage and promote healing 1
• Cryotherapy for acute relief of tendinopathy pain 1
• Eccentric strengthening to reverse degenerative changes 1
• Topical NSAIDs for pain relief with fewer systemic side effects 1
• Orthotics and braces to reduce strain and promote healing, although their effectiveness is uncertain 1

From the Research

Diagnosis of Golfer's Elbow

• Medial epicondylitis, also known as golfer's elbow, typically presents as medial elbow pain 2, 3, 4, 5
• The condition affects 1% of the general population, with a higher incidence in the 40 to 60-year-old age group 2
• Women and men alike can suffer from golfer's elbow, with microtrauma and attritional changes in the common flexor tendon origin at the medial aspect of the elbow being the primary causes 2
• Accurate diagnosis requires a thorough understanding of the anatomic, epidemiologic, and pathophysiologic factors 4

Treatment Options for Golfer's Elbow

• The first line of treatment is conservative therapy, which includes rest, ice, nonsteroidal anti-inflammatory agents, and possibly corticosteroid injection, followed by guided rehabilitation and return to sport 2, 4, 5
• New approaches to treating golfer's elbow include the use of Extra Corporeal Shock Wave therapy and injectable blood derivatives 2
• Surgical treatment is typically reserved for patients with persistent symptoms, involving excision of the pathologic portion of the tendon, repair of the resulting defect, and reattachment of the origin of the flexor pronator muscle group to the medial epicondyle 4, 5
• Surgical treatment results in a high degree of subjective relief, although objective strength deficits may persist 4
• Nonsurgical supportive care includes activity modification, NSAIDs, and corticosteroid injections, with a focus on flexor-pronator mass rehabilitation and injury prevention once the acute symptomology is alleviated 5