What is Golfer’s elbow?
Golfer’s elbow (medial epicondylitis) is typified by pain on the inside of the elbow, where the flexor muscles of the wrist attach. It usually starts with inflammation as a result of overloading the wrist, followed by microscopic tears in the tendon, which may not heal. The quality of the tendon then deteriorates exacerbating the problem.
Sometimes, the problem is associated with an irritable or compressed ulnar nerve on the inside of the elbow. This may cause tingling and numbness in the ring and little finger, and occasionally a reduction in grip strength.
Before you get referred to a surgeon
If your GP believes you have Golfer’s elbow, they can arrange an ultrasound scan and an x-ray to confirm the diagnosis prior to referring you for physiotherapy. In the vast majority of cases things will settle down by around 6 months to one-year.
Your clinic visit
Your surgeon will take a history of the problem and examine you with some special tests, which may provoke pain. Usually, a minimum of an X-ray and an ultrasound are requested or the results reviewed, but this is not always necessary. If you have problems affecting the nerves around the elbow we will arrange nerve conduction tests to confirm the diagnosis.
What is the treatment?
The best treatment for Golfer’s elbow is physiotherapy, and surgery is only considered in those patients who have undertaken a good course of treatment with the correct regime. Taking anti-inflammatory medications and very occasionally having a single injection can increase the success of the physiotherapy.
The operation is an open procedure. Inflammation and scar tissue is removed from the attachment of the tendon, which is then repaired back to bone if necessary. The ulnar nerve can be released at the same time or moved if it is considered unstable in its normal groove. For complex or repeat cases the whole muscle group can be lengthened (fractional lengthening) which has equal results to other techniques but may prevent further problems associated with a painful superficial scar.
After the surgery
The elbow will normally be placed in a bulky dressing. This should remain in place for 5 days but the elbow can be moved gently within the confines of the dressing. It can then be removed to reveal a surgical dressing, which should remain and be kept dry until 10 days has passed. If the nerve has been relocated we occasionally place you in a plaster splint for 2 weeks prior to mobilizing the elbow.
Splints and dressings are removed at your first followup appointment or by a GP practice nurse. The elbow can then be moved fully though we ask you not to load it for 6 weeks; straightening the elbow is often difficult at the start. After six weeks, the elbow may be used again as able.
The general complications include bleeding, infection, pain and stiffness. The serious but rare complications include nerve injury, ligament injury causing elbow instability and chronic scar pain. If you get recurrence of your problem you might require further surgery in the future.
The results of this operation are good or excellent in 95% of patients. The worst outcomes are seen in those patients with significant involvement of the nerve associated with muscle wasting. In a small percentage, there remains some mild pain or discomfort during exercise and in a very small percentage there is little improvement following surgery, or they may feel it’s made them worse.
Most patients will regain mobility of the elbow by around 2-4 weeks and start to feel improvement from 6 weeks onwards.
Mr Sam Vollans
Consultant Orthopaedic Surgeon
I graduated from the University of Leeds and completed my specialist training in Yorkshire. Following this, I undertook further training in both elective and trauma shoulder & elbow surgery in Sheffield with David Stanley, David Potter and Amjid Ali.
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