GOLFERS ELBOW

Repetitive trauma often from sporting activities but also from activities such as hammering. Faulty sporting technique, poorly fitting equipment [e.g. wrong sized grips on golf clubs] and poor biomechanics often combine to cause the problem.

It can come on after an unusual increase in activity such as a sporting tournament or D.I.Y. It is also sometimes seen in assembly line workers who repeatedly preform the same hand task all day long. Office workers with poorly designed workstations can also be predisposed to this type of problem.

Biomechanical analysis of the upper limb to determine any causative factors will be undertaken on the initial assessment. Posture will be assessed and ergonomics of the work place discussed.  Muscle strength , flexibility and balance will be tested.

It is vital that the cause be identified so that recurrence of the condition is avoided. Sports equipment may need to be evaluated and the physiotherapist may liaise with professional coaches to determine necessary changes. Video analysis of sporting technique may be advised.

In the acute phase the R.I.C.E. principles will be followed. Rest from aggravating activities. Ice the area for 10 minutes at a time- especially important in the first 48 hours. Compresssion– a tubular bandage will help control swelling as will Elevation. Painkilling medication can also be helpful.

Treatment may involve mobilizing stiff joints, massage, dry needling,electrotherapy such as ultrasound and interferential [to optimize healing and help with pain control] and individually prescribed exercises. Sometimes taping is used to offload sensitive structures and/or braces prescribed.

There is now good scientic evidence to support the use of ESWT – Extracorpeal shockwave therapy in the physiotherapy management of  medial epicondylitis.

It is very important that the patient complies with physiotherapy . Early return to sport or manual activities before the injured structures are strong enough will most likely cause re-injury.

If the injury is work related , modifications may need to be made to the workstation.

In the past cortico steroid injections were used to treat this problem. In the short term this often provided symptom relief. However more recent clinical trials have shown long term benefits of this form of treatment to be poor.

A minority of golfers elbow patients do not respond to conservative /physiotherapy treatment. These cases will be referred on to an Orthopaedic surgeon who specializes in upper limb [arm] surgery. This is for very severe cases and they may require surgery as a last resort.