Treatment for Golfer's Elbow (Medial Epicondylitis)
The first-line treatment for medial epicondylitis includes rest, activity modification, NSAIDs for pain relief, and eccentric strengthening exercises for the wrist flexors. 1, 2
Diagnosis and Assessment
- Initial diagnosis is primarily clinical, based on pain at the medial epicondyle and pain with resisted wrist flexion 2
- Plain radiographs are recommended as the initial imaging to rule out other pathologies such as intra-articular bodies, heterotopic ossification, or occult fractures 1, 2
- MRI may be considered if radiographs are normal but tendon degeneration or tear is suspected 2
First-Line Treatment (Conservative Management)
- Rest and activity modification are essential, particularly avoiding activities that require repetitive wrist flexion and forearm pronation 1, 2
- NSAIDs can provide short-term pain relief, though they don't affect long-term outcomes 2
- Eccentric strengthening exercises for the wrist flexors help promote tendon healing and increase strength 1, 2
- Cryotherapy (ice application) for 10-minute periods can provide acute pain relief 2
- Deep transverse friction massage can help reduce pain and improve function 1, 2
- Stretching exercises for the wrist flexors are beneficial for recovery 2
Equipment and Technique Modifications
- Counterforce bracing/orthotics (medial counterforce bracing) may reduce strain on the affected tendon 2, 3
- Using larger club grips and graphite shafts can reduce stress on the medial elbow 3
- Proper swing technique modifications can help prevent recurrence 3, 4
Second-Line Treatment Options
- Corticosteroid injections may be considered for patients with persistent symptoms despite first-line treatment 1, 2
- Corticosteroid injections are more effective than NSAIDs in the acute phase but do not change long-term outcomes 2
- Extracorporeal shock wave therapy (ESWT) may be considered as an alternative therapy, though results are mixed 1
Physical Therapy Approach
- Progressive strengthening exercises focusing on the flexor-pronator muscle group 2
- A dynamic exercise program incorporating golf-specific functional rehabilitation has shown success in treating medial epicondylitis 4
- Comprehensive resistance-strength-training combined with functional activities specific to golf can be effective 4
Common Pitfalls and Caveats
- Overreliance on corticosteroid injections without addressing underlying biomechanical issues can lead to poor outcomes 1
- The condition is properly termed "epicondylosis" rather than "epicondylitis" as the pathophysiology demonstrates angiofibroblastic degeneration (tendinosis) rather than inflammation 5
- Conformity to the complete exercise regimen is crucial for recovery, though challenging for enthusiastic golfers 4
- Medial epicondylitis is less common than lateral epicondylitis but predominates in amateur athletes and patients over 40 years of age 6