Golfer's elbow: symptoms, treatment and recovery

Golfer's elbow is treated with a variety of management techniques, says Sherwood Forest Hospitals. Treatment aims at reducing pain and irritation and promoting healing, restoring flexibility and normal movement, improving function and reducing strain on the tendon.

The Royal Orthopaedic Hospital (ROH) says the condition will settle on its own, but this could take months or years. It suggests resting the elbow and wrist between bouts of activity or stopping sport for a few weeks, because the tendon needs time to heal without repetitive irritation; modifying or avoiding the activity that causes pain; spreading the load to the larger muscles of the shoulder and upper arm; using the minimum force when gripping or enlarging the grip size; and using simple pain relief.

• Activity changes: reduce or modify aggravating activities such as lifting. Derby and Burton suggests lifting with palms down rather than up.

• Pain relief: paracetamol, ibuprofen or an anti-inflammatory gel. Sherwood Forest says it is more effective to take it regularly rather than only when the pain is bad. Ask a pharmacist or GP first if you take other medicines.

• Ice or heat: a bag of frozen peas wrapped in a towel; which suits you is individual.

• Brace or clasp: an epicondylitis clasp may help for short-term pain relief.

• Exercises: a specific strengthening and stretching programme, done regularly over several weeks or months.

• Physiotherapy: a physiotherapist can recommend an individual programme. Derby and Burton says an occupational therapist may assess you if work is affected.

ROH describes a wrist stretch: hold your affected arm with the elbow straight and palm facing down, push the back of your hand towards you until a gentle stretch is felt on the inside of the forearm, and hold for 20 to 30 seconds, repeating 3 times, 3 times a day.

For strengthening, ROH describes eccentric exercises, which may be slightly uncomfortable to begin with. Rest your affected arm over the edge of a table with the palm facing up and the forearm fully supported, use the other hand to lift the affected hand, then let go and lower it slowly over about 6 seconds. Repeat for 3 sets of 10 repetitions, 3 times a day, and progress by holding a small weight or bottle of water after a week or two.

Derby and Burton says it is normal for exercises to provoke your elbow pain and it is safe to continue, but if the pain is not at an acceptable level or you are concerned, discuss it with your physiotherapist. If the pain gets worse, reduce the exercises until things settle, then build up gradually.

Golfer's elbow, also called medial epicondylitis, is an overuse injury. Sherwood Forest says it occurs when the tendons in the forearm are strained due to repetitive, strenuous activity, and that it is a common musculoskeletal condition, though not as common as tennis elbow. It is also known as tendinopathy.

Versus Arthritis says tennis elbow and golfer's elbow are two separate but similar conditions in which tendons become painful: tennis elbow affects tendons on the outside of the elbow and golfer's elbow affects tendons on the inside.

Sherwood Forest lists pain on the inside of your upper forearm just below your elbow, which may travel down towards the wrist, pain when lifting or bending your arm, pain when gripping, and pain when twisting your forearm. Symptoms can be present while using your arm or at rest, and can range from mild discomfort to severe pain.

ROH adds that for most people the pain only occurs when they use their forearm, but for some it is constant, occurs at rest and can affect sleep. Some people report stiffness in the forearm and difficulty holding items.

ROH says golfer's elbow occurs when the muscles and tendons in the forearm are strained due to a repetitive or strenuous activity of bending the wrist, and can sometimes occur after banging or knocking your elbow. You may get it if your forearm muscles are not used to doing a certain activity. Tiny tears and inflammation can develop near the bony lump (medial epicondyle) on the inside of the elbow.

Versus Arthritis says playing golf or tennis is not the most common cause; people who continually grip and twist, such as carpenters and plasterers or people who use a computer mouse, may be at risk, as may repetitive actions combined with weight, such as lifting heavy boxes. Derby and Burton says it is usually associated with a change in the amount of activity you do with your arm, or trauma such as bumping your elbow.

Sherwood Forest says most cases resolve with conservative treatment within six to 12 months, most people make a full recovery if they follow the management plan, and sometimes symptoms can return in the future. Derby and Burton says it will get better over a few months with lifestyle changes and exercises, and in most cases symptoms get better within a year.

Versus Arthritis says both tennis and golfer's elbow can last between six months and two years, most people get better within a year, and they can both return. ROH says it could take months or years to settle on its own.

Sherwood Forest says steroid injections are sometimes used to facilitate physiotherapy in other musculoskeletal problems, but for golfer's elbow they are avoided because of the lack of evidence and the risks associated with soft-tissue steroid injections. Versus Arthritis says steroid injections are not recommended as they can make these conditions worse in the long term.

Platelet-rich plasma (PRP) injections use blood plasma with concentrated platelets. Sherwood Forest says it has been shown to help speed up healing but its long-term effectiveness is unknown, and you would need referral to orthopaedics. Surgery is a last resort in chronic severe cases when physiotherapy and other non-surgical techniques have not worked; Versus Arthritis says it is needed for only a small number of people.

Sherwood Forest says it is diagnosed from the signs and symptoms you describe and an assessment of the elbow and wrist by a healthcare professional. If the diagnosis is unclear, an X-ray or ultrasound can be performed. Derby and Burton says it does not routinely require X-rays or scans.

See a GP or physiotherapist if symptoms do not improve with the above, are severe, or affect work and sleep. Sherwood Forest says a team of advanced clinical practitioners and orthopaedic consultants can review your case if symptoms do not improve within an expected period of time.

Versus Arthritis says to see a doctor if your elbow pain does not improve after two weeks of painkillers and rest with no injury or infection, or if you have tingling, numbness or weakness in your arm or hand, and to go to A&E for severe pain that stops you moving your arm, swelling with fever, heat and redness, or a suspected fracture.

On the NHS, a pharmacist can advise on pain relief, and a GP or NHS musculoskeletal (MSK) physiotherapy service can assess and give an exercise programme; the NHS says that in many areas you can get physiotherapy from community MSK services without a GP referral. Orthopaedic referral is for people who do not respond.

Some people choose a private physiotherapist or orthopaedic clinic. Because steroid injections are generally avoided for golfer's elbow and PRP has unknown long-term effectiveness, ask for the evidence behind any injection offered.