Golfer’s Elbow

Most golfers have a love-hate relationship with the game, but that doesn’t keep us from hitting the greens every chance we get. But when elbow pain keeps you from making your best shot, you may need to hit the pause button and take care of your golfer’s elbow.

Golfer’s elbow, medically known as medial epicondylar pain, stems from an injury to the muscles responsible for flexing your fingers and wrist. Pain is felt on the inside of the elbow, and caused by repetitive stress from forceful overuse of the wrist and fingers.

While common in golfers, medial epicondylar pain is also seen in rowers, baseball players, weight lifters, and in occupations that place repetitive rotational torque on the structures of the elbow.

Medial Epicondyle Anatomy

The medial epicondyle is a bony prominence at the end of your humerus, or upper arm bone. It serves as a point of origin for the common flexor tendon of the wrist and finger flexor muscles.

The medial epicondyle protects the ulnar nerve that runs in a groove behind it. When struck, the medial epicondyle produces a painful tingling sensation in the ulnar nerve, and we say we have hit our “funny bone”.

Golfer’s elbow is actually an injury to the tendons of the muscles that flex the wrist and fingers, and rotate the hand palm down. In golfers, it is more likely to occur in the trailing arm, not in the lead arm.

Golfer’s Elbow Symptoms

Golfer’s elbow Is a cousin to tennis elbow, which affects the lateral epicondyle.

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Golfer’s elbow symptoms include:

  • Pain when gripping with the wrists and fingers
  • Pain while stretching the wrist flexor muscles
  • Tenderness over the bony condyle of the elbow
  • Presence of trigger points in the wrist flexor muscles
  • Tenderness and stiffness in the neck
  • Irritation in the median nerve that passes through the carpal tunnel

Causes of Golfer’s Elbow

Golfer’s elbow is an overuse syndrome from repetitive motion. It begins when healthy muscles and tendons are subjected to more force than they can handle, and small tears to the tendon occur that worsen over time, causing pain and inflammation. Golfer’s elbow is more often seen in amateur golfers than in pros.

Chronic golfer’s elbow that does not respond to treatment for inflammation may indicate unhealthy degenerative changes in the muscle tissue that will not heal on their own.

Underlying causes of golfer’s elbow include:

1
Poor mechanics in golf swing execution
2
Impact with the ball or ground that causes pain and tearing
3
High numbers of swings per game, including warmup

Premature release of the wrists during the downswing is a common mechanical cause of golfer’s elbow. Other related mechanical causes include weakness in the core, pelvis and hips; limited range of motion in the hip and ankle; and poor balance.

Diagnosis of Golfer’s Elbow

Golfer’s elbow is diagnosed with a clinical examination, and often confirmed with imaging by ultrasound or MRI.

At NYDNR, we use dynamic real-time ultrasound to view the structures of the wrist and elbow in motion. Ultrasound imaging is able to reveal structural abnormalities like tendon tears, scar tissue, inflammation and trigger points.

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Golfer’s Elbow Treatment

Traditional treatment approaches to golfers elbow include:
  • NSAIDs like ibuprofen or naproxen to reduce pain and inflammation
  • Rest, ice, compression and elevation
  • Elbow bracing
  • Specific therapeutic exercise to strengthen and stretch the muscles and tendons acting at the elbow

Golfer’s Elbow Rehab at NYDNR

At NYDNR, We provide comprehensive individualized treatment for our patients with golfer’s elbow. Your treatment plan may include some or all of the following:

  • DNS (dynamic neuromuscular stabilization) to restore alignment, stability and mobility in the wrist and elbow
  • Myofascial manipulation to lengthen the fascia, thereby reducing stress to the muscles and tendons
  • Ultrasound-guided dry needling to eliminate trigger points in the muscles
  • ESWT (extracorporeal shock wave therapy) to increase circulation and accelerate healing of damaged tissues
  • Therapy to correct sport-specific mechanical deficiencies

The joint pain specialists at NYDNR know how to heal golfer’s elbow, and to equip you with skills and strategies to avoid elbow injury in the future.

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130 West 42 Street Suite 1055, New York NY 10036
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In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)

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Complete tear of rectus femoris
with large hematoma (blood)

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Separation of muscle ends due to tear elicited
on dynamic sonography examination

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