Golfer’s Elbow

Elbow

Everything I am going to say about Tennis Elbow also holds good for Golfers Elbow so, to make things easier, I am just going to use Tennis Elbow in this section but remember we are discussing both conditions. Golfers Elbow is pain and tenderness on the inside of the elbow and Tennis Elbow is on the outside.

And the other thing to add straight away is that you don’t have to play Tennis to get Tennis Elbow or Golf to get Golfers Elbow!

We have to learn a little bit of anatomy to understand what happens to give you Tennis Elbow. A tendon is the bit of tissue that joins a muscle to a bone and the easiest one to visualise is the calf muscle which is connected to the heel bone by the Achilles Tendon. In the forearm the tendons start at the finger tips and then link into the big groups of muscle on the forearm before becoming a tendon again that joins to the sticky-out bit of bone on the outside (Tennis) or inside (Golfers) of the elbow. The proper name for those bony protruberances is an epicondyle and the technical name for Tennis Elbow is Lateral Epicondylitis. In laymans terms that means inflammation of the tendon at the elbow.

It can be quite easy to irritate, annoy and inflame the tendon with overuse or, somteimes, an acute injury which causes the pain. And if the irritation continues then the inflammation can change into degeneration. That happens because tendon doesn’t have a very good blood supply at the best of times and if there is very little blood flowing through it then it doesn’t get much oxygen or many nutrients from the blood. And when you make a fist and tense up the forearm muscles, what little blood there was going to the tendon decreases even further. So no blood means no oxygen and no nutrients and if a tissue is starved of those things then it can actually start to die. That sounds rather dramatic and the technical term we use is degeneration but it amounts to the same thing.

So how do I know if I’ve got Tennis Elbow?

The usual problems are pain in the forearm and the point of the elbow when you are making a grip. That can mean something as simple as picking up a bottle of milk or holding a pen but frequently it is involved with sports. Obviously Tennis and Golf but also using weights in the gym, holding a badminton or squash racquet or a cricket bat. It can effect people who have jobs that involve gripping and lifting such as painters and decoraters, plasterers and brick layers. But it doesn’t have to be as physical as that. It can be a big enough problem just trying to live your life day to day.

So doing activities where you have to make a strong grip for longish periods causes Tennis Elbow.

There can a lot of inflammation there initially as well which is why anti-inflammatory tablets or creams can help and why steroid injections may help because they reduce the inflammation bit of the condition. But they don’t help with the longer term degeneration and thats when we have to consider other treatments.

How do I make it better? What is the treatment?

There are lots of different ways to treat Tennis Elbow and when there are lots of different options available that usually means that none of them works for everybody. Some people can do brilliantly with a steroid injection whereas at the other end of the spectrum some people will need an operation to get them better.

Everyone you see will tell you they have the answer and there are always new trends and new machines coming along. I‘ve been treating Tennis Elbow for 20 years so I’ve seen things come and I’ve seen things go and my treatment plan is detailed further on.

Can’t I just leave it alone? Won’t it get better eventually?

Of course you can. If you can manage with the pain and it isn’t stopping you working or enjoying your sports then by all means wait it out. A Tennis Elbow strap might be worth trying just to make life a bit easier. If you ask Doctors and Surgeons how they have dealt with their own Tennis Elbow, you will find that very, very few have any interventional treatment: most just manage it and wait till it gets better!

It’s too painful and I don’t want to wait. What do you suggest then?

In very acute cases where you are struggling to work then an ultra-sound guided steroid injection is a very good place to start and in fact I recently had one for my Tennis Elbow when it became so bad that and I couldn’t work or do my sports.

However recent work suggests that this traditional method should not be used other than in those very severe acute cases.

So how do you treat it?

In the early or acute or severe phase I would suggest an ultrasound guided para-tendinitis steroid injection. This is not like the blind jab that I used to do and some GPs and Rheumatologists still do: it is much more accurate and selective. The ultrasound scan confirms the diagnosis and allows the Radiologist to get the steroid exactly where it needs to go.

In the more chronic phase (say after 3 months) then the treatment is based around trying to regenerate that ‘dying’ tendon. We need to get more blood flowing to it because that brings the oxygen and nutrients the tendon needs to recover.

How do you do that?

I use a sticky patch containing GTN which you stick over the elbow every day for 3 months. The GTN opens up the blood vessels so more blood flows into the area and brings that vitals oxygen and those essential nutrients so the tendon can start to recover.

3 months sounds a long time!

It does take that long I’m afraid. But there are other things hype can do at the same time to make life more manageable.

Such as?

Wear your Tennis Elbow strap. And I do mean wear it. Put it on BEFORE you start doing something that irritates your elbow rather than half-way through cutting the grass when you realise it’s starting to hurt! Maybe have a couple so there is always one available. And make sure you have it on in the right place and nice and tight.

Maybe put slightly bigger grips on your racquet or golf clubs. And remember – you can keep on doing stuff if you can manage the pain.

In the gym, use an open-hand technique to lift weights. Leave the free weights alone and move to the machines and just don’t grip. Use an ‘open hand’. You can do everything except a pull-down or pull-up without having to make a fist.

And see a specialist physiotherapist who will help you stretch and reload the tendon. It’s not about acupuncture and neck stretches! Physio treatment is an important element of recovery

Do I have to stop doing everything that hurts while it gets better?

What I suggest is that you ‘manage’ your symptoms so you can do some things (if you can cope) and avoid others (if you can’t). You won’t really be making it any worse and no-one knows if using the elbow makes the condition last any longer.

How long does it take to get better?

That is the million dollar question – anything from a few months to several years. Hopefully the steroid injection will do the trick early on but it is more likely to be an on-going issue to some level or another for a year.

And if it doesn’t settle?

If we really get nowhere with all this and the pain is bad enough or has come back again then we can consider an operation. And, like everything with Tennis Elbow, it can be great and within 6 weeks you could be back to normal. You can find out about the surgery in the ‘operations’ section.

Tennis and Golfers Elbow are difficult conditions to treat. There are a vast range of options all of which might work for some people but none of which works for everybody.

So I now advocate a joint approach using GTN patches, physio, altered techniques and activities and a Tennis Elbow strap. And, if all else fails and the symptoms keep coming back then, occasionally, surgery is required.