Medial elbow pain / ‘Golfers Elbow’

At the bottom of the humerus (upper arm bone) are two bony bumps – the ‘lateral epicondyle’ on the outside of your arm and the ‘medial epicondyle’ on the inside of your arm.

The muscles that bend your fingers and bend your wrist, palm towards forearm (flexion) and turn your palm towards the floor (pronation) are attached to the bony part on the inside of the elbow (medial epicondyle). If these muscles are strained, they can become irritated. Micro-tears and other changes can happen in the tendons that attach the muscles to the bone. The symptoms that happen due to these changes may be referred to as ‘medial epicondylitis’ or ‘Golfer’s Elbow’.

Causes

The condition happens in less than 1% of the population. It affects men and women equally and tends to occur most often in middle age. The cause of Golfer’s Elbow / medial epicondylitis is usually repeated activities that involve strong gripping, heavy lifting, bending the wrist forward or twisting of the forearm. For example:

  • Sports such as golf, racquet sports, bowling in cricket, weight lifting
  • Using tools that require gripping and twisting or bending the wrist
  • Heavy lifting in construction, DIY and so on.

Symptoms

The symptoms of Golfer’s Elbow / medial epicondylitis are:

  • Pain on the inside of the elbow. This area is often tender to touch
  • The pain may also be felt on the little finger side of your forearm

The pain is worsened by activities such as gripping things (such as a pen or screwdriver), twisting movements of wrist or forearm (such as opening a jar) or picking things up. It is usually eased by resting the affected side.

Treatment

Most people make a full recovery within a year.

Similar to Tennis Elbow that affects the muscles on the outside of the arm, there are a range of things that you can do to help manage the symptoms and aid recovery:

Activity modification

It is important to keep your elbow, wrist and hand moving as this can reduce the risk of the elbow becoming stiff and muscles weak.

However, in the short term, avoiding or reducing the activities that make the pain worse can help to reduce stressing or irritating the tendons further. If the symptoms are relating to sports activities, it may be helpful to review your technique.

If you need to continue with activities that cause pain (for example for work), try to break up the aggravating movements with rest or movements that do not cause pain.

Pain relief

Paracetamol may be useful to reduce your pain. Please see current information about paracetamol on the NHS website

Non-steroidal anti-inflammatories (NSAIDs) such as ibuprofen may be useful to help reduce your pain. Please see current information about NSAIDs on the NHS website

Topical NSAIDs (applied directly to the affected area) are recommended to try first. Always follow the instructions on the packet and speak to a pharmacist to discuss safe use of NSAIDs especially if you have any underlying health conditions.

Using heat or ice

Using heat over the affected area such as a warm shower, wheat pack or hot water bottle may help relax muscles.

Using ice over the area may also help reduce pain. Never apply ice directly to the skin as it can cause an ice ‘burn’. Instead wrap an ice pack or frozen peas in a damp cloth and place over the area for 10-15 minutes.

When using heat or ice as a treatment make sure that you:

  • Check your skin regularly
  • Stop if there is increased pain, tingling or numbness.

If you have any circulatory problems or altered skin sensation you should be cautious about using these treatments.

Supports

A support or splint may help to reduce the strain on muscles and therefore may reduce pain.

a) An ‘epicondylitis clasp’ is a splint worn on the upper forearm. It can change the tension in the affected muscles.

b) A wrist brace minimises movement of the wrist and therefore activity in the affected muscles

Exercise

Gradual stretching and loading of the affected tendons can help you to make a full recovery. You may feel some discomfort when doing the exercises. However, they should not make your elbow pain and symptoms worse. You should start exercising gently and gradually build up the exercises as you feel able to. Try the basic exercises first. Once these feel easy and comfortable to do (this may be immediately), move on to the exercise progressions.

Basic exercises

Stretch for the muscles that bend your wrist and fingers:

Straighten your arm out in front of you with your palm facing the ceiling. Drop your wrist, fingers to the floor (back of hand towards forearm). Place your other hand on the palm of the one being stretched. Gently hold or increase the bend at your wrist until you feel a stretch in the front of your forearm towards your elbow. Hold for 30 seconds, then relax. Repeat once or twice a few times a day.

Strengthening the muscles that bend your wrist and fingers:

With the elbow bent, tuck your elbow in towards your waist. Position your forearm so that your thumb is pointing up towards the ceiling. With your fingers straight, place your other hand on the palm of the hand to be exercised (A). Gently push your affected hand into your other fingers without moving the wrist or fingers. Hold for a few seconds. Relax. Repeat as able.

To make this more difficult you can resist over the front of the knuckles of your hand (B) or over the fingers (C). You can also increase the force from the other hand or increase the number of repetitions that you do.

Exercise progression 1:

You should aim to do these exercises 3-4 times a week to allow your muscles to rest between loading.

Strengthening the muscles that bend your wrist and fingers:

With the elbow bent, bring your elbow in towards your waist. Position your forearm so that your palm is facing towards the ceiling. With your fingers straight, place your other hand on the palm of the hand to be exercised. Gently push your affected hand into your other fingers without moving the wrist or fingers. Hold for a few seconds. Relax. Repeat as able.

To make this more difficult you can resist over the front of the knuckles of your hand or over the fingers. You can also increase the force from the other hand or increase the number of repetitions that you do. You can also make this harder by doing the exercise with your elbow straight

Strengthening the muscles that turn your forearm:

Hold a long object that has some weight to it (such as a hammer or rolling pin) in the hand of the affected side. Bend your elbow and bring it in towards your waist (A). Slowly turn your forearm so that the front of your arm is facing down (B) (the object in your hand will move in front of your body), then slowly turn your forearm the other way (C) (object moves in an arc to the side of your body). Try to keep your wrist still as you do the exercise.

You can make this easier by holding the object towards the middle, or harder by holding towards the bottom. Gradually build up the repetitions so that you can do 3 sets of 10 repetitions without worsening your pain.

Exercise progression 2:

You should aim to do these exercises 3-4 times a week to allow your muscles to rest between loading.

Strengthening the muscles that bend your wrist and fingers:

Hold a weight (such as a small dumbbell or water bottle) in the hand to be exercised. Bend the elbow and bring it in towards your waist with your palm facing up.

Slowly lower the weight down, bringing the back of your hand towards your forearm. Then bring the weight up, bringing your palm towards your forearm. Start with a small range of movement and gradually increase it to make your muscles work harder.

You can make this exercise more difficult by increasing the number of repetitions that you do, increase the weight that you are holding or do the exercise with the elbow straight. Only change one thing at a time. A good aim is to work towards being able to carry out 3 sets of 10 repetitions without making your pain worse, before making the exercise more difficult.

Strengthening the muscles that turn your forearm:

To progress this exercise from the one in ‘Exercise progression 1’, increase the weight of the object you are holding (such as using a mallet) or do the exercise with the elbow straight.

A good aim is to work towards being able to carry out 3 sets of 10 repetitions without making your pain worse, before making the exercise more difficult.

When should I seek help?

Improvements may be gradual over a number of weeks or months rather than on a day-to-day basis – especially if you have had symptoms for a long time.

If your elbow pain is worsening or you are not improving after trying this advice for 6-12 weeks, you should see your healthcare practitioner.

A physiotherapist will be able to provide expert advice and treatment to guide your recovery.

Other treatment options:

Steroid injections

There is very little evidence to support the use of corticosteroid injections for Golfer’s Elbow. Recent research has shown that steroid injections may make outcomes worse in the longer term and may have a negative impact on the benefits of exercise in tendon conditions at the elbow

If your symptoms do not improve with conservative treatment (including self-management and physiotherapy) for 6-12 months, your healthcare practitioner may refer you to an orthopaedic surgeon.

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