What is the treatment for golfer's elbow (medial epicondylitis)?

Treatment for Golfer's Elbow (Medial Epicondylitis)

The first-line treatment for golfer's elbow includes rest, ice, NSAIDs, and eccentric strengthening exercises, with progression to other therapies if symptoms persist. 1

Initial Treatment Phase (0-6 weeks)

Conservative Management

• Relative rest rather than complete immobilization
  • Modify activities to minimize repetitive stress on the medial elbow
  • Avoid activities that aggravate symptoms

Pain Management

• Ice application: Apply through a wet towel for 10-minute periods to reduce pain and swelling 1
• Medications:
  • Acetaminophen (up to 4g/day) as first-line analgesic
  • NSAIDs (oral or topical) at lowest effective dose for shortest duration 1

Exercise Therapy

• Eccentric strengthening exercises: Begin early and continue for at least 12 weeks 1
  • Focus on wrist flexors and pronators
  • Start with light resistance and gradually increase

Supportive Devices

• Medial counterforce bracing: Helps unload the affected tendon during activity 2
• Larger club grips and graphite shafts for golfers to reduce stress on the medial elbow 2

Intermediate Phase (6-12 weeks)

If symptoms persist after 6 weeks of conservative treatment:

Injection Therapy

• Corticosteroid injections: Consider if no improvement with conservative measures
  • Limit to 1-2 injections to avoid potential tendon weakening 1
  • More effective than NSAIDs for short-term pain relief

Physical Therapy Modalities

• Ultrasound therapy: May decrease pain and increase collagen synthesis 1
• Extracorporeal shock wave therapy (ESWT): Consider for persistent cases, though evidence shows mixed results 1

Continued Exercise

• Progress eccentric strengthening program
• Add functional exercises specific to patient's activities or sport

Advanced Phase (>12 weeks)

For persistent symptoms beyond 3 months:

Diagnostic Reassessment

• Imaging: Consider radiographs initially, followed by MRI if needed 3, 1
• Rule out other causes of medial elbow pain (ulnar neuropathy, medial collateral ligament injury)

Specialist Referral

• Consider referral to orthopedic surgeon or sports medicine specialist for evaluation

Surgical Consideration

• Surgery is reserved for cases that fail 6+ months of conservative management 1, 4
• Typically involves excision of abnormal tendon tissue and reattachment of the origin to the medial epicondyle 4

Prevention Strategies

• Technique modification: Proper golf swing mechanics to reduce stress on the medial elbow 5, 6
• Equipment adjustments: Larger grips, softer grips, graphite shafts 2
• Strength and flexibility program: Focus on forearm flexors and pronators 5
• Proper warm-up before activities 5

Prognosis

Most cases (approximately 80%) resolve within 3-6 months with conservative treatment 1. However, symptoms may persist or recur in some patients, particularly with return to aggravating activities without proper technique or equipment modifications 4.

Common Pitfalls to Avoid

• Overuse of corticosteroid injections: Can lead to tendon weakening and rupture
• Premature return to aggravating activities: May cause symptom recurrence
• Neglecting eccentric exercises: These are crucial for tendon healing and strengthening
• Misdiagnosis: Ensure proper differentiation from other causes of medial elbow pain 7
• Focusing only on symptom relief: Address underlying biomechanical issues and technique problems to prevent recurrence