Golfer's Elbow

Golf injuries are seldom as dramatic as those sustained in contact sports, but can be just as serious in terms of pain, and can cause prolonged periods of absence from play.  In this monthly article I’ll be focusing on common golf injuries, and touching on the not so common injuries that can be a consequence of playing the game we love.

I invite you to write, email or tweet any injuries that you are suffering with and each month I’ll explore a selection of topics, explaining why they happen, how to prevent them, and the best treatment options available.

I’ll start with overuse injuries.  Golf is challenging enough without a niggling injury putting you off your swing.  Overuse injuries are often not so severe to stop us from playing, but painful enough to warrant the occasional rant to our playing partners (usually after a shank into the trees!).  A lot of amateur players dose themselves with painkillers prior to teeing off, but the pain usually persists, worsening with each hole played.

One of the commonest of these injuries is medial epicondylitis, more frequently referred to as “Golfer’s Elbow”.

Golfer’s Elbow is a condition caused by repetitive contraction of muscles that attach onto to a bony prominence on the inside of the elbow.  Microscopic tears develop where the muscle attaches, causing pain when using the muscles.  This pain can be felt at the top of the backswing and throughout the downswing.

Golfer’s elbow comes on gradually and can worsen if not given time to heal.  Various studies have looked at the muscles involved under a microscope. They have shown that repeated micro-tears can lead to an abnormal form of healing. Symptoms can be quite mild initially, so people continue to play, which leads to more tearing and heightened pain. The pain can become so severe that it prevents a normal swing, and can also affect everyday activities.

Golfer’s Elbow is not an inflammatory condition; therefore anti-inflammatory medications (ibuprofen and diclofenac) may not be effective in reducing pain.  Other treatment options need to be explored.

Specialists agree that non-surgical methods should be tried initially, with rest being the first step recommended.  By taking away the repetitive action of swinging a club, the muscles are allowed to heal in a normal way.  If symptoms continue, then physiotherapy is advised.  Various physio techniques are advocated, including eccentrically loading exercises.  Eccentric loading refers to muscles being held under tension whilst stretched, eg. holding a dumbbell with the wrist facing upwards, then slowly allowing the wrist to fall towards the floor in a controlled action, this stretches the muscles but keeps them under constant tension.

If rest and physiotherapy don’t help, then some specialists recommend steroid injections.  There are mixed reports regarding steroid injections.  Injections can provide short-term relief, but longer term results are less predictable.  In fact, steroid injections can lead to worse outcomes, when compared to simple rest and physiotherapy.  They can also cause local side effects, especially multiple injections, e.g. skin changes and numbness at the injection site. 

Persistant symptoms may warrant a session with your local golf pro.  Swing technique errors can increase the tension on the inside of the elbow, swing analysis and minor modifications to your swing may help.

If the pain has not resolved after 12 months, I suggest the opinion of an orthopaedic specialist, this can be arranged through your General Practitioner.  The specialist can confirm the diagnosis and rule out other problems; sometimes a nerve running down the inside of the elbow can be compressed, this can cause pins and needles and shooting pains to the little and ring fingers, this is called “ulna nerve neuropathy”, up to two thirds of people with Golfer’s Elbow suffer from this.  If this is the case, it can be addressed at the same time as surgery for Golfer’s Elbow, by releasing the nerve.

Depending on the severity, an operation may be advised.  Surgery can be performed arthroscopically (keyhole) in some centres.  Results of surgery for long standing Golfer’s Elbow have been reported as good to excellent in over 90% of patients.  It is important to realise though, surgery is not entirely predictable and symptoms can still remain.  There are risks of surgery eg. infection, nerve damage, and painful scars, which are low risk but must be taken into account.

Have you got an injury query? Or are you trying to find the quickest way back to full fitness? Send us your questions to editorial@todaysgolfer.co.uk or on Facebook and Twitter and the answers could appear in next month's blog.

Mr D J Murray MBChB, MRCS, FRCS(Tr&Orth)

David Murray is an Orthopaedic & Trauma Surgeon with an interest in sports medicine.  He has spoken at national and international conferences on the subject of sports injuries, including being an invited speaker at the recent World Sports Trauma Congress in London in 2012.

David has published articles in well-respected scientific journals, and continues to be actively involved in research in the field of sports medicine. He is also an avid golfer himself, and regularly plays courses around the Northwest of England in his spare time.