Dr. Vic's Q & A: "Golfers' elbow"

courtesy of Dr. Vic Goradia, MD
Knee, Shoulder & Sports Medicine Specialist
Go Orthopedics | www.GoOrtho.net

Question: I am a 50-year-old man suffering from what seems to be golfers’ elbow. I have mostly been icing it at home. What is the best way for me to get back to golfing, and what are some options that I might explore in regards to treatment?

Answer:“Golfer’s elbow” is tendonitis on the inner part of the elbow while “tennis elbow” is tendonitis of the outer part of the elbow. Interestingly I actually see more patients with these conditions that do not play either golf or tennis. Tendonitis usually occurs from repetitive activity where extra stress is placed on a particular tendon. The overuse causes microscopic tears within the tendon. In normal situations these tears will heal without any treatment. When they don’t heal you are left with symptoms of tendonitis which are primarily pain, weakness and sometimes stiffness.

Since you are a golfer you should have a golf pro look at your club grips. In general, a larger grip will reduce stress to the elbow when you make contact with the ball. Also, consider whether you have made any recent changes in your swing or if you have been playing much more than normal.

The standard treatment for tendonitis is rest, ice, non-steroidal anti-inflammatory medications and exercises. In some cases a tennis/golf elbow strap that fits just below the elbow can be beneficial. A variety of specific stretching and strengthening exercises can treat and prevent recurrence. To view these exercises you can visits the patient education section at www.GoOrtho.net. You can begin the stretching immediately but should wait for strengthening until your symptoms of pain decrease.

When I see patients in the office with tennis elbow, I will also discuss options of cortisone and platelet rich plasma (PRP) injections. Cortisone is a strong steroid that will reduce or eliminate inflammation. On the inner part of the elbow (i.e. golfer’s elbow), I generally do not recommend cortisone because the tendon is close to the ulnar nerve (i.e., “funny bone” nerve). PRP, however, can be used for both golfer’s and tennis elbow.

For PRP, blood is drawn from your arm and then spun in a centrifuge to separate the plasma from the cells. The plasma part of the blood that contains nutrients and growth factors is injected into the tendon. This process is thought to promote healing of the microscopic tears.

If these treatments fail then surgery is an option. Tennis and golfer’s elbow surgeries are both outpatient procedures. Afterwards, patients wear a sling for 1-2 weeks. They begin physical therapy 1 week after surgery and continue exercises for 6-12 weeks. Most patients can begin putting and chipping at 4-6 weeks, short swings at 6-10 weeks and full swings by 12 weeks.