Golfer's Elbow Treatment

What is Golfer's Elbow?

Golfer's elbow, medically known as medial epicondylitis, is a condition that causes pain where the tendons of your forearm muscles attach to the bony bump on the inside of your elbow. The pain might spread into your forearm and wrist. Despite its name, this condition isn't limited to golfers. Any activity that involves repetitive wrist, hand, or forearm movement can lead to golfer's elbow, including throwing sports, racket sports, weight training, and various occupational activities.

Types and Causes of Golfer's Elbow

Understanding Golfer's Elbow

• Acute Golfer's Elbow: Develops suddenly, often due to a specific incident or injury.
• Chronic Golfer's Elbow: Develops gradually over time, usually from repetitive motions.
• Primary vs. Secondary: Primary occurs from direct overuse; secondary can develop due to referred pain from neck or shoulder issues.

Common Causes

• Repetitive Stress: Overuse of the flexor muscles in the forearm that control wrist and finger movement.
• Sports Activities: Golf, baseball, javelin throwing, football, archery, and racquet sports can all contribute to this condition.
• Occupational Activities: Carpentry, plumbing, construction, assembly line work, computer work, and any job requiring repetitive wrist flexion or gripping.
• Poor Technique or Equipment: Improper form during sports or work activities, or using equipment that's not properly fitted.
• Age Factor: Most common in people over 40 due to decreased tendon elasticity with age.
• Forceful Activities: Activities requiring a combination of force and repetitive movement can increase risk.

Symptoms and Diagnosis

Common Symptoms

• Pain and tenderness on the inner side of your elbow
• Stiffness in the elbow, with pain when making a fist
• Weakness in the hands and wrists
• Pain that radiates from the elbow down into the forearm
• Discomfort that worsens with certain movements such as swinging a golf club or gripping objects
• Pain when flexing the wrist toward the forearm
• Numbness or tingling that might radiate into one or more fingers (usually the ring and little fingers)

Diagnostic Process

Dr. Saxena employs a comprehensive approach to diagnose golfer's elbow:

• Physical Examination: Dr. Saxena will check for tenderness at the medial epicondyle (inner part of the elbow) and perform specific tests that replicate the pain, such as having you flex your wrist against resistance.
• Imaging Studies:
  • X-rays: To rule out arthritis or other bone abnormalities
  • MRI: May be ordered for persistent cases or to rule out other conditions like ulnar nerve entrapment
  • Ultrasound: Can visualize inflammation in the tendons and rule out other causes of pain
• Electromyography (EMG): In some cases, to check for nerve compression that might mimic or accompany golfer's elbow.

Treatment Options

Dr. Abhishek Saxena develops personalized treatment plans based on the severity of the condition, duration of symptoms, and the patient's activity level and goals. Treatment options include:

Non-Surgical Management

• Rest and Activity Modification: Avoiding activities that aggravate symptoms and modifying techniques to reduce strain.
• Physical Therapy: Specific exercises to stretch and strengthen the forearm flexor muscles, focusing on eccentric strength training.
• Bracing: Counterforce braces below the elbow can reduce strain on the tendon by dispersing pressure throughout the arm.
• Anti-inflammatory Medications: NSAIDs to reduce pain and inflammation.
• Corticosteroid Injections: May provide temporary relief in moderate to severe cases, though limited in number due to potential tendon weakening.
• PRP (Platelet-Rich Plasma) Therapy: An injection of your own platelets to stimulate healing in chronic cases.
• Extracorporeal Shock Wave Therapy: Using sound waves to promote healing and increase blood flow to the area.
• Dry Needling or Acupuncture: May provide relief for some patients.

Most cases of golfer's elbow respond well to conservative treatment, with approximately 90% of patients improving without surgery. Complete healing typically takes 3-6 months with appropriate care.

Surgical Management

Surgery may be recommended when:

• Symptoms persist for 6-12 months despite comprehensive non-surgical treatment
• Pain significantly interferes with daily activities
• The patient has specific occupational demands that cannot accommodate prolonged conservative management
• There is significant tendon damage seen on imaging

Dr. Saxena specializes in various surgical techniques:

• Open Surgery: Traditional approach involving an incision over the inner elbow to remove damaged tendon tissue and reattach healthy tissue.
• Percutaneous Tenotomy: A minimally invasive technique where the damaged portion of the tendon is released through a small incision.
• Arthroscopic Surgery: Using small incisions and a tiny camera, Dr. Saxena can remove damaged tissue with less disruption to surrounding structures.
• TENEX Procedure: An ultrasound-guided, minimally invasive technique that precisely targets and removes damaged tissue.

Our Advanced Surgical Approach

Dr. Saxena utilizes state-of-the-art techniques for golfer's elbow treatment:

• Minimally invasive techniques for reduced scarring and faster recovery
• Precise identification and selective removal of only the diseased tissue
• Advanced imaging for improved surgical planning and accuracy
• Comprehensive assessment of potential contributing factors, including ulnar nerve issues
• Tailored approach based on the specific pattern of tendon damage and individual patient factors
• Biologic augmentation with platelet-rich plasma in appropriate cases to enhance healing

The Surgical Experience

Golfer's elbow surgery is typically performed as an outpatient procedure, allowing you to return home the same day. The procedure is usually performed under regional anesthesia (which numbs just the arm) or sometimes with general anesthesia.

For minimally invasive surgery, Dr. Saxena makes small incisions around the elbow. Using specialized instruments, he identifies and removes the damaged tendon tissue, sometimes releasing or repairing the tendon attachment. The procedure typically takes 30-60 minutes.

After surgery, your arm will be bandaged and might be placed in a splint temporarily. A comprehensive pain management plan will be in place to ensure your comfort during the initial recovery period. Most patients can return home within a few hours after the procedure with specific aftercare instructions.

Recovery and Rehabilitation

Recovery from golfer's elbow treatment follows a general timeline:

• Initial Recovery (0-2 weeks): Rest, protection of the surgical site, ice application, and limited activities. A splint or brace may be used.
• Early Rehabilitation (2-6 weeks): Gentle range of motion exercises begin, with progressive introduction of light forearm and wrist strengthening.
• Progressive Strengthening (6-12 weeks): More intensive strengthening of the forearm flexor muscles and grip, with gradual reintroduction of functional activities.
• Return to Activity (3-4 months): Sport-specific or occupation-specific training with proper form and technique.

Dr. Saxena and his team provide a customized rehabilitation protocol for each patient, with regular follow-up appointments to monitor progress. Complete recovery may take 4-6 months, though many patients notice significant improvement in symptoms within the first 6-12 weeks.

Outcomes and Success Rates

Treatment for golfer's elbow has favorable outcomes:

• 90% of patients improve with comprehensive non-surgical treatment
• Surgical treatment has a success rate of 85-95% for patients who have failed conservative management
• Most patients report significant or complete pain relief following appropriate treatment
• Return to sports and occupational activities is possible for the vast majority of patients
• Long-term outcomes are excellent when proper technique and preventive measures are adopted

Factors that influence outcomes include duration of symptoms before treatment, severity of tendon damage, patient age, compliance with rehabilitation, and willingness to modify activities that may have contributed to the condition.

Prevention Strategies

To prevent golfer's elbow or its recurrence, Dr. Saxena recommends:

• Strengthening the forearm muscles with specific exercises
• Stretching before and after activities that stress the elbow
• Proper technique in sports and occupational activities
• Using equipment that fits properly (golf clubs, tools, etc.)
• Ergonomic workstation setups for computer users
• Taking breaks during repetitive activities
• Wearing a counterforce brace during activities that stress the elbow
• Gradual progression in intensity and duration of activities
• Ice application after activities if you're prone to golfer's elbow

Dr. Saxena can provide personalized recommendations for prevention based on your specific activities and risk factors.