Golfers elbow is an inflammation of tendons that flex the wrist and fingers. This inflammation usually comes from overuse or repeating the same motions consistently. Unlike acute injuries, where a specific cause of pain can be identified, overuse injuries are subtle and occur over a period of time. They occur as the result of repetitive microtrauma to tendons, bones and joints.
The wrist flexors are the muscles on the palm side of the forearm that pull the hand forward. Most wrist flexors attach to one main tendon (the “common flexor tendon”) on a bony bump on the inside of the elbow called the medial epicondyle. They then travel down the forearm and attach again to the wrist and hand. Repetitive wrist motion may cause the common flexor tendon to become irritated and inflamed. The wrist flexors may also be at increased risk for damage because of its position. As the elbow bends and straightens, the tendon rubs against the epicondyle. This can cause gradual wear and tear of the muscles over time.
Symptoms of golfer’s elbow are pain on the inside of the elbow and weak grip strength. Sensations such as elbow pain and numbness and tingling can also travel down the forearm, typically into the ring and little fingers. Though this injury is traditionally called “golfer’s elbow”, symptoms can begin from performing many different activities. This injury is very similar to tennis elbow. Tennis players and others who repeatedly use their wrists or clench their fingers also can develop golfer’s elbow. Pain and discomfort will typically occur with tasks such as swinging a golf club, turning a doorknob, shaking hands, or frequently using tools such as a screwdriver or hammer.
Physical therapy can be very beneficial for people with this injury. Golfer’s elbow is diagnosed through a description of the history of the symptoms and a physical examination. During the examination, a physical therapist will try to reproduce the symptoms in order to make a correct diagnosis. Range of motion and strength tests of the arm and wrist will be performed. Once a diagnosis is made then therapy will begin and a plan of care will be determined. Typical physical therapy sessions will include range of motion, exercise, manual therapy (such as deep friction massage), and neuromuscular reeducation. Rest, heat and ice are important and will help with pain relief. A strap may also be worn around the forearm near the elbow to provide some tension relief for the muscles.
Most people with golfer’s elbow will make a full recovery, provided that they attend physical therapy and follow instructions that are suggested by the therapist. If golfer’s elbow is not addressed early, it can continue to be painful for years. Golfer’s elbow is also prone to reoccurrence. Therefore the earlier one gets the proper medical attention, the faster the rate of return to activity. Once returning to activity, it is important to continue to stretch and perform exercises given by the physical therapist.
If conservative treatment is not successful new medical treatments such as platelet-rich plasma (PRP) injections may be an alternative option. A person’s own blood is used for a PRP injection. Blood is composed of mainly a liquid (plasma) with small solid components (red cells, white cells, and platelets.) Platelets are very important in the healing of injuries. PRP is plasma with many more platelets than what is typically found in blood. To help promote healing with golfer’s elbow, a person’s blood will be drawn and prepared through a special process that separates platelets from the blood. The increased concentration of platelets is then combined with blood again and injected into the affected tendon area. Physical therapy will continue to be an important and necessary aspect of the healing process as well as reoccurrence prevention after the PRP injection.