Golfer’s elbow

Disease Description (Causes and Symptoms)

• Definition: Medial epicondylitis (golf elbow, medial epicondylitis) is a condition that causes pain due to inflammation and tendon lesions resulting from repeated damage at the tendon and muscle attachment site on the inner side of the elbow (medial epicondyle). It is called “golf elbow” because it is known to occur in people who play golf, but it commonly occurs regardless of golf due to housework and repetitive use of the arms and hands.
• Causes and pathophysiology: Repetitive wrist flexion (bending toward the palm) and forearm pronation overload the tendons of the wrist flexor muscle group at the medial epicondyle, resulting in microtears, inflammation, or chronic tendinopathy (tendon fibrosis and degeneration).
• Main symptoms:
  • Localized pain and tenderness on the inner side of the elbow (at the medial epicondyle)
  • Worsening pain when gripping objects, flexing the wrist, or twisting it (e.g., wringing out a mop, turning a doorknob)
  • Morning stiffness, reduced grip strength, and, rarely, abnormal sensation in the fingers (when accompanied by ulnar nerve compression)
• Prevalence characteristics: Occurs mainly in people aged 25 and older, with a high incidence in the 40s. It may recur frequently.

Treatment Methods

• Conservative treatment (first-line choice)
  • Restrict activities and avoid repetitive movements (rest)
  • Relieve pain with cold compresses (temporarily); consider using a support device for immobilization (compression bandage or elbow brace)
  • Medication: Control pain and inflammation with nonsteroidal anti-inflammatory drugs (NSAIDs) (short-term)
  • Physical therapy and rehabilitation: Stretching, progressive strengthening (especially eccentric strengthening of the forearm flexor muscle group), manual therapy, functional correction, and occupational therapy
  • Adjunctive procedures: Procedures such as ultrasound-guided PRP (platelet-rich plasma) and extracorporeal shock wave therapy (ESWT) may be considered in some cases, but the evidence varies
• Injection treatment
  • Local steroid injections: Effective for short-term pain relief, but repeated injections may weaken the tendon and increase the risk of recurrence, so they are used selectively
• Surgical treatment (when conservative treatment fails)
  • Surgery may be considered when symptoms are severe or there is no improvement after 6–12 months or more of conservative treatment (open tendon release/removal or arthroscopic surgery may be performed). Arthroscopic surgery has the advantages of smaller incisions and faster recovery.
• Treatment precautions, risk of complications, and self-care considerations
  • If left untreated for a long time, ulnar nerve compression and paralysis may occur: decreased sensation in the fingers (fourth and fifth fingers), weakened hand strength, etc.
  • Steroid injections are intended for short-term relief; avoid excessive repeated administration
  • Rehabilitation, strengthening, and improvement of the work environment (posture and tools) should be carried out together
  • During the acute phase, avoid excessive exercise and lifting heavy objects

Outpatient Visit Checklist (Including Example Questions)

• Items and information to prepare
  • List of medications currently being taken (especially anticoagulants and steroids)
  • Bring any existing test results or images (X-ray, ultrasound, MRI, etc.)
  • When the symptoms began and their progression (when and after what activities they worsened)
  • The nature of the pain (at rest, at night, and which movements make it worse), and the frequency and habits of using the affected hand in daily life and at work
  • Previous treatments (physical therapy, injections, use of a brace, etc.) and whether they were effective
• It is recommended to check whether imaging should be taken to show directly to the doctor during the outpatient visit: plain X-ray or ultrasound findings

General Example Questions to Ask the Doctor

• "Can this condition be completely cured? How long does recovery usually take?"
• "What are the side effects of the medication you prescribed, and how long should I take it?"
• "What specific lifestyle changes should I make to reduce the risk of recurrence?"
• "When is surgery necessary, and what is the recovery period after surgery?"

Examples of Condition-Specific Questions

• "In my case (based on my work and housework patterns), which rehabilitation exercises should I start and when? (Please provide specific exercises and repetitions.)"
• "I have tingling in my fingers (fourth and fifth fingers) along with pain on the inner side of my elbow. If an ulnar nerve problem is suspected, what additional tests should I undergo?"