Golfers elbow injections: what are the options?

Golfers elbow injections are useful in difficult cases that fail other treatments. But how do you correctly diagnose Golfer’s elbow and what treatments are available apart from injections? Are injections for medial epicondylitis useful?

What is Golfers Elbow?

Golfer’s elbow, also known as medial epicondylitis, is a form of elbow tendonitis that causes pain and swelling on the inside of the elbow. The pain centres on the bony bump called the medial epicondyle where the muscles of the forearm attach to the elbow joint. Golfer’s elbow is less well known than 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 Golfers Elbow?

Common symptoms of Golfer’s elbow include:

pain on the inside of your elbow and forearm often triggered by movements such as hitting a tennis ball or swinging a golf club.
tenderness at the bony bump on the inside of your elbow.
weakness of your forearm and wrist.

Other conditions can 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 muscles of the forearm, 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 racquet that is too heavy or light.
Throwing or pitching a ball incorrectly in archery or baseball.
Repetitive and forceful movements of the forearm and wrist 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 that flex and rotate the wrist helps reduce pain. 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. As pain improves, you can gradually go back to your activities. Finally, you should also have your golf or tennis swing checked by a professional.

What happens if simple treatments fail?

If activity modification and exercise fail to settle symptoms, then you may consider other options.

We place GTN patches onto the skin above the diseased tendon. These patches contain nitric oxide, which increases collagen production and promotes tendon healing. Recent evidence suggests that GTN patches improve pain from elbow tendonitis. This recent 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.

Finally, we use Golfers elbow injections to help with more difficult cases.

Golfers Elbow injections: what are the options?

Traditionally, doctors used cortisone to treat pain from Golfer’s elbow. However, we now know that cortisone is potentially harmful to elbow tendonitis. Evidence suggests that while cortisone reduces pain in tennis elbow in the short term, people often do worse at 3 months. However, we don’t have data for Golfer’s elbow.

Next, other injections for Golfer’s elbow are used with limited success. Needle tenotomy describes a technique using local anesthetic. Repeated needling of a diseased tendon stimulates tendon healing reducing pain. 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. Similar to cortisone, we only have evidence of effectiveness in tennis elbow but not Golfer’s elbow.

Dr Masci has written a summary on injections in tendonitis including Golfer’s Elbow.

Final word from Sportdoctorlondon

Generally, we treat Golfers elbow similarly to Tennis elbow. After simple treatment, we suggest GTN patches and shockwave therapy. Failing this, we suggest needle tenotomy or PRP injections.