Golfers elbow injections are helpful in complex cases that fail other treatments. But how do you correctly diagnose Golfer’s elbow, and what treatments are available apart from injections? For example, is a steroid or cortisone injection for Golfers elbow beneficial? And are other injection options preferable?
What is a Golfers Elbow?
Golfer’s elbow, also known as medial epicondylitis, is a form of elbow tendonitis that causes pain and swelling inside the elbow. The pain centres on the bony bump called the medial epicondyle, where the forearm muscles attach to the elbow joint. A Golfer’s elbow is less well known than the tennis elbow, a similar form of tendon damage on the outside of the elbow. Tennis elbow is also known as lateral epicondylitis.
Golfer’s elbow not only occurs in golfers. This injury also happens in manual workers, tennis players, and gym-goers.
What are the symptoms of a Golfers Elbow?
Common symptoms of Golfer’s elbow include:
- Pain inside your elbow is triggered by movements such as hitting a tennis ball or playing golf.
- Tenderness at the bony bump on the inside of your elbow.
- Weakness of your forearm and wrist.
Other conditions mimic Golfer’s elbow, such as ulnar nerve entrapment, elbow joint swelling, and biceps tendonitis.
In some cases, ultrasound or MRI is helpful to view the tendon changes, such as tendon swelling or tearing, and rule out other causes.
What are the causes?
Golfer’s elbow is caused by overusing the forearm muscles, especially when you grip, rotate your forearm, or bend your wrist. Repetitive or excessive movement leads to overload and swelling of the tendon. Apart from hitting a golf club, other activities that can cause Golfer’s elbow include:
- Playing tennis using the wrong technique or a too heavy or light racquet.
- Throwing or pitching a ball incorrectly in archery or baseball.
- Repetitive and forceful forearm and wrist movements as a carpenter, plumber, or office worker.
What are the treatment options for medial epicondylitis?
Most cases will improve with a combination of activity modification and exercise therapy.
Rest and ice can improve pain in the short term. Additionally, a forearm brace placed just below the elbow reduces forces on the tendon relieving pain. Moreover, progressive strengthening of the forearm muscles by flexing and rotating the wrist helps reduce pain. Finally, recent evidence suggests that more frequent but lighter weights are effective for elbow tendonitis.
You should change your activity or sport to allow the tendon time to heal. Then, as pain improves, you can gradually return to your actions. Finally, you should also have your golf or tennis swing checked by a professional.
What happens if simple treatments fail: are golfers elbow injections an option?
You may consider other options if activity modification and exercise fail to settle symptoms.
We place GTN patches onto the skin above the diseased tendon. These patches contain nitric oxide, increasing collagen production and promoting tendon healing. Recent evidence suggests that GTN patches improve pain from elbow tendonitis. This current blog discusses the use of GTN patches for tendonitis.
Shockwave therapy uses sound waves to change the properties of cells, promoting healing. It also stuns the small nerves that transmit pain messages to the brain. There are two different types of shockwave: radial and focussed. Often, we recommend 3-5 sessions with at least a 1-week separation between sessions.
Hydrolysed collagen supplements taken 30 minutes before Achilles tendon loading exercises show a more significant improvement in tendon pain compared to exercises alone. We recommend taking collagen supplements to enhance the effect of exercise therapy.
Finally, we use Golfers elbow injections to help with more complex cases. Medial epicondyle injections are an option in cases that fail simple treatments.
Golfers Elbow injections: what are the options?
Traditionally, doctors used cortisone or steroid injection for Golfers elbow. However, we now know that cortisone is potentially harmful to elbow tendonitis. Evidence suggests that while cortisone reduces pain in the tennis elbow in the short term, people often do worse at three months. Unfortunately, however, we don’t have data for Golfer’s elbow. So, in general, we try to dissuade people from having a steroid injection for Golfers elbow.
Other injections for Golfer’s elbow are used with greater success.
Needle tenotomy describes a technique using a local anesthetic. Repeated dry needling of a diseased tendon stimulates tendon healing, reducing pain. In addition, platelet-rich plasma injections have shown promising results in tennis elbow. We obtain PRP from whole blood. The plasma is separated from the red cells using a centrifuge. The plasma is then injected into the diseased tendon. Like cortisone, we only have evidence of effectiveness in tennis elbow but not Golfers elbow.
Dr. Masci has written a summary on injections in tendonitis, including Golfer’s Elbow.
Other frequently asked questions about Golfers elbow:
What simple treatments should you use for painful golfers elbow?
Generally, we suggest ice packs (for 10-15 minutes 3 times a day), topical and oral ibuprofen, and a tennis elbow brace. Sometimes, in painful cases, using GTN patches early is helpful.
Final word from Sportdoctorlondon about Golfers elbow injection
Generally, we treat Golfers elbow similarly to Tennis elbow. After simple treatment, we suggest GTN patches and shockwave therapy. Failing this, we recommend needle tenotomy or PRP injections. Cortisone injection for Golfers elbow is not recommended.
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