Golfer's elbow

Introduction:

You step onto the fairway, swing your iron and take a divot — hard. The poor shot may do more than hurt your score. It may injure your elbow, too.

Golfer's elbow — also known as medial epicondylitis — is pain and inflammation on the inner side of the elbow, where the tendons of the forearm muscles attach to the bony bump on the inside of the elbow (medial epicondyle). The pain may spread into your for earm and wrist.

Golfer's elbow is similar to tennis elbow. But it occurs on the inside — rather than the outside — of the elbow. And it's not limited to golfers. Tennis players and others who repeatedly use their wrists or clench their fingers can develop golfer's elbow.

The pain of golfer's elbow doesn't have to keep you off the course or away from your favorite activities. With rest and appropriate treatment, you can get back into the swing of things.

Signs and symptoms:

Golfer's elbow is characterized by pain and tenderness on the inner side of the elbow. Sometimes the pain extends along the inner side of the forearm. Your elbo w may feel stiff, and it may hurt to make a fist. You may have weakness in your hands and wrists.

The pain of golfer's elbow may appear suddenly or gradually. The pain may get worse when you:

• Swing a golf club or racket
• Squeeze or pitch a ball
• Shake hands
• Turn a doorknob
• Pick up something with your palm down
• Flex your wrist toward your forearm

Causes:

Golfer's elbow is caused by damage to the muscles and tendons that control the wrist and fingers. The damage is typically related to excess or repetitive stress — especially forceful wrist and finger motions. Sometimes golfer's elbow begins after a sudden force to the elbow or wrist.

Many activities can lead to golfer's elbow, including:

• Golf. Gripping or swinging the clubs incorrectly can take a toll on your muscles and tendons.
• Racket sports. Excessive topspin can hurt your elbow. Using a racket that's too small, heavy or tightly strung also can lead to injury.
• Throwing sports. Improper pitching technique in baseball or softball can be another culprit.
• Other activities. Painting, raking, hammering, chopping wood, typing and other repetitive wrist, hand or arm movements can result in golfer's elbow as well.

Risk factors:

Golfer's elbow is most common in men ages 20 to 49 — but the condition can affect anyone who repetitively stresses the wrists or fingers.

When to seek medical advice:

Consult your doctor if rest, ice and over-the-counter pain relievers don't ease your elbow pain and tenderness. Seek immediate care if:

• Your elbow is hot and inflamed, and you have a fever
• You can't bend your elbow
• Your elbow looks deformed
• You suspect you've broken a bone

Screening and diagnosis:

Golfer's elbow is usually diagnosed based on your medical history and a physical exam. To evaluate pain and stiffness, the doctor may apply pressure to the affected area or ask you to move your elbow, wrist and fingers in various ways.

An X-ray can help the doctor rule out other possible causes of elbow pain, such as a fracture or arthritis. Rarely, more comprehensive imaging studies — such as magnetic resonance imagining (MRI) — are done.

Complications:

Left untreated, golfer's elbow can cause persistent elbow pain

Treatment:

The sooner you begin treatment, the sooner you'll be able to return to your usual activities.

• Rest. Put your golf game or other repetitive activities on hold until the pain is gone. If you return to the links too soon, you may only make it worse.
• Ice the affected area. Apply ice packs to your elbow for 15 to 20 minutes at a time, four times a day for several days. To protect your skin, wrap the ice packs in a thin towel. It also may help to massage the inner elbow with ice for five minutes at a time, two to three times a day.
• Reduce the load on your elbow. Wrap your elbow with an elastic bandage or use a forearm strap.
• Take an over-the-counter pain reliever. Try ibuprofen (Advil, Motrin, others), naproxen (Aleve), acetaminophen (Tylenol, others) or aspirin.
• Consider other medications. If over-the-counter pain relievers aren't effective, your doctor may recommend a cortisone injection to reduce pain and swelling.
• Stretch and strengthen the affected area. Your doctor may suggest specific stretching and strengthening exercises. Physical or occupational therapy can be helpful, too.
• Gradually return to your usual activities. When you're no longer in pain, practice the arm motions of your sport or activity. Review your golf or tennis swing with an instructor and make adjustments if needed.
• Ask your doctor when surgery is appropriate. Surgery is seldom necessary. But if your signs and symptoms don't respond to conservative treatment, surgery may be an option.

Depending on the severity of your condition, the pain may linger for several months — even if you take it easy and follow instructions to exercise your arm. Sometimes the pain returns or becomes chronic. While you're recovering, remember the importance of rest. Sneaking in a round of golf before your elbow heals won't help you feel better. It will only prolong your recovery.

Prevention:

Occasional divots may be unavoidable, but you can take steps to prevent golfer's elbow.

• Strengthen your forearm muscles. Use light weights or squeeze a tennis ball. Even simple exercises can help your muscles better absorb the energy of sudden physical stress.
• Stretch before your activity. Walk or jog for a few minutes to warm up your muscles. Then take time for gentle stretching before you begin your game.

• Fix your form. If you golf, ask an instructor to check your grip and swing technique. Swinging the club more slowly or gripping the club with less pressure may decrease the amount of shock in your arm when you hit the ball. A club with a flexible shaft may help, too.

  If you play tennis, ask an instructor to check your technique for hitting a forehand. You may need to decrease your topspin. The racket size and tension of the strings are important, too.

• Lift smartly. When lifting anything — including free weights — keep your wrist rigid and stable to reduce the force transmitted to your elbow.

It's also important to know when to rest. At the first sign of elbow pain, take a break. In addition to self-care measures, time off is often needed to promote healing.