GETTING RID OF GOLFER'S ELBOW
Earlier this spring, I developed pain in my wrist and on the inside of my elbow after a long weekend of golf. I iced the area for a few days, but the pain is still there when I move a certain way or try to lift anything heavy. Is it possible that I tore something in my elbow while golfing? At what point should I see a doctor?
The condition you're describing sounds like golfer's elbow. It's a common injury typically associated with overuse, and it isn't limited to golfers. Self-care measures often are enough to take care of the problem. But, because you still have symptoms after icing it for several days, it would be a good idea to see your health care provider for an evaluation. He or she can then determine if you need additional treatment.
The medical term for golfer's elbow is medial epicondylitis. It happens when muscles and tendons that control flexing of your wrist and fingers are damaged, often by too much stress or repeated stress due to forceful wrist and finger motions. Golfers may develop this condition when they repeatedly hit the ball incorrectly or use improper swing techniques.
In many cases, golfer's elbow requires only self-care at home. Rest from golf and other repetitive wrist and hand activities. Ice the painful area for 15 to 20 minutes at a time, three to four times a day, for several days. Take an over-the-counter nonsteroidal anti-inflammatory drug, such as ibuprofen or naproxen sodium.
When those measures aren't enough to relieve the pain, then it's time to see your health care provider. He or she may recommend that you wear a type of brace called a counter-force brace on the painful arm. That can reduce strain on your muscles and tendons. Your provider also may refer you to a physical or occupational therapy program that can teach you techniques to help ease your symptoms, as well as stretching and strengthening exercises. In the majority of cases, no further evaluation or treatment is needed beyond that point.
If pain is persistent, though, imaging tests may be necessary to assess the injury. A musculoskeletal ultrasound study or MRI can be used to evaluate if there's a tear in one of your muscles or tendons.
Additional treatment may include corticosteroid injections. Although they can help ease pain for a while, in general, these injections are not effective long-term. Another newer treatment is platelet-rich plasma injections. The goal of this approach is to help heal tendon damage and promote the growth of new, healthy tissue.
When pain lasts despite other treatments, more invasive approaches may be necessary. One option is called ultrasonic percutaneous tenotomy, or TENEX. In this procedure, under ultrasound guidance, a doctor inserts a needle into the damaged portion of the tendon. Ultrasonic energy vibrates the needle so swiftly that the damaged tissue liquefies and is suctioned away. If symptoms don't improve after thorough use of other treatments, then surgery may be an option to remove the damaged tissue.
Once your symptoms go away, take steps to prevent golfer's elbow from returning. Use weight training to strengthen your forearm muscles, and do stretching exercises before you go golfing to help avoid injuries. If you use older golfing irons, consider upgrading to lighter graphite clubs to reduce stress and strain on your wrists.
Don't play through pain. If you notice discomfort in your elbow or forearm, take a break. Finally, work on your golf form and swing. If you play frequently, ask a golf instructor to evaluate your form and correct any improper habits. Repeating a swing that has poor mechanics puts you at higher risk for another injury.
Bryan Ganter, M.D., Physical Medicine and Rehabilitation, Mayo Clinic, Scottsdale, Ariz.
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