Golfers Elbow
(Medial Epicondylitis)


What is Golfer's Elbow?

The elbow is a seemingly simple joint, yet when you look deeper you will find that it is a complex system of bones, muscles, nerves and tendons. The elbow joint gives us the ability to lift with strength, climb trees and build our modern world; further to this, all the nerves and bloodflow required by the forearm, wrist and hand must pass through the elbow. Part of the uniqueness of the elbow is that the joint allows muscles in the forearm to rotate when we twist our wrist; it is this unique aspect of the elbow joint that provides us with multiple planes of rotation and motion in the hand and wrist.

Much like tennis elbow, Golfer's Elbow is a form of tendinosis which means chronic degeneration of the tendon or tendons. You will have damage to the tendons that attach to the small bony part on the inside of your elbow (medial epicondyle), and perhaps a bit of swelling but not much. Golfer's Elbow is caused from the overuse of the tendons located in your forearm that help contract your wrist and fingers - basically from a tightened grip; this means golfer's elbow can stem from any activity that involves gripping and twisting the forearm. Though the term is Golfer's Elbow, *this condition can stem from a multitude of non-golf related activities such as turning a screwdriver, shovelling snow, chopping wood, gardening, using a computer keyboard or mouse, etc. The wear and tear on these tendons is a result of small tears in your tissue that don't heal properly. The inability of your tendon to heal properly causes the tendons to weaken until the tissues become very thin, and eventually wear out.

*"Golfers Elbow (Medial Epicondylitis)". 2014. Computer Posture. Accessed April 23 2019. https://www.computer-posture.co.uk/golfers-elbow/.

golfer elbow anatomical image

To learn more about the elbow specifically, please go to our Elbow Anatomy page.

To learn what causes Tennis Elbow, please go to our Golfer's Elbow Causes page.


Have You Developed Chronic Golfer's Elbow?

Golfer's Elbow means you most like have tendinosis in the tendons attaching to the medial epicondyle. Tendinosis is a form of chronic degeneration of the tendon that will get worse over time if not dealt with properly. Your body is trying very hard to heal the damaged tissue but if you keep straining your tendons, the damage grows faster than your body can heal it. This cycle of pain, swelling and unhealing causes medial epicondylitis to go on for a very long period of time (ie. years). Why? Failed healing, not inflammation; if you cannot rest the elbow and wrist while you are healing then your odds of healing it for good are quite low.

Chronic = Persisting for a long period

In working aged adults, approximately 0.6% (6 in 1000) of them will be suffering from Golfers Elbow. Prolonged absence from work occurs in about 5% of epicondylitis cases. (both medial and lateral)

(source: NCBI U.S. National Library of Medicine)



Tendinosis: What is it?

Tendonosis is a noninflammatory, degenerative condition of the collagen fibers in the tendon often caused by repetitive stress injury of the tendon fibers. As the collagen breaks down, the typically straight and flexible fibers become a tangled mess with little pockets of jelly.

Tendonosis is caused by repetitive motion which causes an accumulation of microinjuries. The tendon tries to repair itself but eventually the breakdown of the collagen fibers exceeds the repair speed and the new collagen is produced with an abnormal structure and composition.

microscopic view of tendinosis

Unlike tendonitis, there are no inflammatory cells with a tendonosis injury making it hard to diagnose visually as there are no visible symptoms such as swelling, heat and redness. However, both injuries cause pain, tenderness and stiffness of the joints.

If not treated correctly the tendon will continue to degenerate causing a continually worsening injury.



Are You Sure It's Golfers Elbow?

Visiting your doctor when you have elbow pain is always recommended, as there are many possible issues that can happen within the arm and elbow. Sometimes, one set of symptoms can result in multiple diagnoses. In rarer cases, a patient may be misdiagnosed as suffering from Golfer's Elbow whereas they are actually suffering from a chronic condition that presents symptoms similar to medial epicondylitis - this most frequently happens with nerve disorders and chronic pain disorders that commonly go undiagnosed such as:

  • Diabetic Neuropathy
  • Peripheral Neuropathy
  • Multiple Sclerosis
  • Fibromyalgia
  • Arthritis
  • Chronic Pain Syndromes
  • Migraines

The more common conditions (not including nerve disorders or chronic pain conditions) that can show similar symptoms to Golfer's Elbow are as follows:


Elbow Bursitis (olecranon bursitis)

The olecranon bursa (just below the skin) susceptibile to trauma or injury during falls on the elbow and to infection from scrapes or cuts on the skin covering the joint.

Repeated excessive pressure and/or friction, such as leaning on a table top at work, may cause this bursa to become inflamed producing excessive swelling and elbow pain in this area.

Subtendinous olecranon bursitis is much less common. This type of elbow bursitis results from excessive friction between the triceps tendon and olecranon. This may result, for example, from repeated flexion-extension of the forearm which occurs during certain assembly line jobs, and is one of many repetitive motion type injuries. The pain is most severe during the flexion of the forearm because of pressure exerted on the inflamed subtendinous olecranon bursa by the triceps tendon.

olecranon bursitis in the elbow

Elbow bursitis can happen to anyone though it occurs more frequently in:

  • those who regularly stress their elbow with repetitive arm movements as part of their job
  • those who engage frequently in sports related activities where impacts to the elbow are common
  • those who suffer acute trauma to the elbow
  • the eldery: as you age, the soft tissue around the elbow weakens and increases your risk of olecranon bursitis

Elbow bursitis is one of those injuries that can really bring down the quality of your life. Anyone - young or old - can suffer from this injury, and if you're active this condition will keep you from doing the things you love to do. The pain from elbow bursitis will interrupt many of your normal daily tasks and make living life harder than it really needs to be.

A Warning About Infection (Septic Bursitis)

The Olecranon bursae are one of the most commonly bursae to get infected as they are close to the skin surface.

The closer the bursa is to the surface of the skin, the more likely the chance of infection from specific bacteria (staphylococcus epidermis or staphylococcus aureus) that are commonly found on the surface of the skin. This bacterial infection is known as septic bursitis. Septic bursitis occurs most commonly in men (85% of all cases occur in men) and you are at a higher risk of contracting this if you:

  • have diabetes
  • have recently experienced trauma
  • are undergoing steroid treatments
  • have a certain kidney condition

If the bursitis in your olecranon bursa is septic, it can quickly become life-threatening and you will require antibiotics from your doctor to treat the infection. Warmth and redness in the area are signs of an infection as well as a fever. If you suspect your bursitis is septic, be sure to see a doctor immediately.

To learn more about Elbow Bursitis, go here. (opens in new window)


Crystal Deposits

Some people with diseases such as rheumatoid arthritis, gout or scleroderma may contract bursitis from crystalline deposits in the joints. Although not much is known about how this process happens, it is common knowledge that Uric acid is a normal byproduct of daily metabolism. If you are diagnosed with gout then you are unable to break down this uric acid properly, leading to crystallization of this excess acid which deposits in joints, a painful symptom that can often lead to bursitis.


Tennis Elbow (lateral epicondylitis)

Tennis Elbow is signified by pain that is felt on the outside of the elbow, whereas Golfer's Elbow pain is felt on the inside of the elbow. The tendons attached to the bone at your elbow are connected to muscles in your forearm, which is why these conditions will typically radiate pain from the elbow down the forearm. This condition occurs among both men and women who stress their wrist and elbow through twisting or extending motions in repetitive work and/or activity. It is a common condition found often in racquet sports, plumbing, swimming, landscaping, carpentry, etc.

To learn more about Tennis Elbow, go here.



Golfer's Elbow Can Lead to Other Conditions and Injuries

If you are suffering from Golfer's Elbow, every time we use our bad elbow - damaged tendons and muscle tissue move. When significant stress is applied to this damaged tissue, you feel pain - sometimes a LOT of pain, so we try not to move it. So, when doing something we purposefully avoid using the "bad elbow" - ff we can, we use our other joints instead even though it is inconvenient and difficult.

A couple days later the pain recedes in the elbow and forearm, and we start using our elbow normally again. At this point the golfer's elbow pain starts up again like it did before - all because the injury wasn't fully healed in the first place. We continually worsen our golfer's elbow through our daily activities and thus the downward spiral of golfer's elbow continues.

Eventually, we use the other joints more and more. This is why the other joints start to hurt more - they are being overused now. Soon, aches and pain can become commonplace - all as a result of the original golfer's elbow and the body's instinctive nature to "protect" the area - all because the injury wasn't fully healed in the first place!

overcompensation-injury-prevention-and-rehabilitation

Muscle imbalances result, placing tension on bone and softer tissues - leading to a misalignment in the body. The extra stress on the opposite elbow (and shoulder) will also result in weakness and fatigue of soft tissue - increasing the chances they can eventually be injured or gradually degenerate (ie. muscle strain and/or tendinitis). This is a textbook example of how you get an overcompensation injury.

An injury to one area can easily lead to straining in other areas - just due to the pain response in your biomechanics - making an overall recovery hard to initiate. For example, a serious case of golfer's elbow in the right elbow will often lead to over-straining of the left elbow. Most commonly, the injury occurs on the dominant side, so the risk of straining the other (weaker) side increases even further as it is the weaker joint to begin with. The longer the injury (and corresponding pain) persists, the greater the chance that you will sustain more strain from overcompensation, eventually leading to issues in those areas as well. To minimize potential secondary injuries, know that it is important to deal with your injury quickly and completely.

Truly, living with golfer's elbow can lead you into a vicious downward cycle - which is why it is absolutely critical to focus on healing methods designed to rebuild and strengthen the damaged extensor tendons in the forearm in a timely manner. The faster you truly heal, the less chance you have of sinking into a downward spiral of re-injury, scar tissue growth and overcompensation injuries.



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During your recovery, you will probably have to modify and/or eliminate any activities that cause pain or discomfort at the location of your soft tissue injury until the pain and inflammation settle. Always consult your doctor and/or Physical Therapist before using any of our outstanding products, to make sure they are right for you and your condition. The more diligent you are with your treatment and rehabilitation, the faster you will see successful results!


 
 

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