Ultrasound guided Golfer's elbow injections

What is Golfer’s elbow?

Golfers elbow refers to inflammation of the tendons attaching to the inner aspect of the elbow. It is also referred to as “medial epicondylitis”, meaning inflammation of the medial epicondyle (the bony attachment of the tendon at the inner aspect of the elbow), and “common flexor tendinitis”, referring to inflammation of the tendon attachment. It is not only seen in Golf players but also in other sports that involve repetitive movements like weightlifting and manual workers. It usually results in pain at the inner aspect of the elbow, which can be exacerbated by arm activities.

Relevant anatomy

Golfers elbow affects the common flexor origin tendon that attaches to the inner aspect of the elbow. This tendon is formed by the flexor muscles that run at the inside of the forearm and converge to attach to the inner part of the arm bone (humerus) called the medial epicondyle.

When the tendon is subjected to excessive strain, it can become acutely inflamed, a condition referred to as tendonitis. If this condition persists, it can interfere with tendon healing resulting in chronic tendon thickening known as common flexor tendinopathy, commonly referred to as Golfer’s elbow.

What are the causes of golfer's elbow?

Golfer’s elbow typically occurs due to repeated arm movements that put excessive strain on the flexor muscles tendon attaching to the inner aspect of the elbow. It is frequently observed in people who play racket sports, lift weights, or engage in manual labour.

What are the causes of golfer’s elbow?

Golfer’s elbow typically occurs due to repeated arm movements that put excessive strain on the flexor muscles tendon attaching to the inner aspect of the elbow. It is frequently observed in people who play racket sports, lift weights, or engage in manual labour.

What are the symptoms of golfer’s elbow?

The main symptom of golfer’s elbow is pain and tenderness at the inner aspect of the elbow at the attachment of the flexor tendons.
The pain is usually worsened by movements that put extra stress on the flexor muscles of the forearm, like lifting heavy objects or repeated forceful gripping movements.
Direct hits to the area can worsen the pain.

How to tell if I have golfer’s elbow?

Golfer's elbow is not as frequently observed as tennis elbow. Surprisingly, it is commonly seen in individuals who do not play golf. The condition typically begins with pain on the inside of the elbow and is not usually linked to any previous injuries. Initially, the pain may be mild and unnoticed. With repeated elbow and wrist movements that put extra stress on the tendon, the pain usually worsens. The pain can affect your grip strength and interfere with daily activities.

What conditions can mimic golfer’s elbow?

Conditions that can mimic the golfer’s elbow pain include:

Tennis Elbow. This causes pain on the outside of the elbow.
Cubital tunnel syndrome

How to diagnose golfer’s elbow?

When golfer’s elbow is suspected after assessment by an elbow specialist, you are usually referred for an ultrasound examination. The following information can be obtained from a specialist musculoskeletal ultrasound:

Confirm the diagnosis of golfer’s elbow.
Rule out other causes for pain at the inner aspect of the elbow, like cubital tunnel syndrome.
Assess the severity of the tendinopathy.
Assess for neovascularity. This refers to the formation of small new blood vessels within the thickened and inflamed tendon. It is one of the signs indicating the severity of the condition. Doppler ultrasound is a reliable method for evaluating this.
Rule out any tendon tear. Ultrasound is excellent in assessing the size and type of tear, which may require surgical treatment.
Ultrasound is useful to follow up on the status of the tendon following treatment.
Ultrasound is usually used to guide injection therapy to the common flexor origin. Ultrasound guidance ensures accuracy and safety.

Ultrasound guided Golfer's elbow injection

What is the treatment for golfer’s elbow?

Golfer’s elbow treatment starts with conservative management including physiotherapy, activity modification and elbow support. Topical anti-inflammatory medicines can be used. Please ask a doctor or pharmacist before starting any new medicine.

What if conservative management is not working?

If the above treatment options are not helping, other treatment options include:

Extracorporeal Shockwave Therapy (ESWT)

ESWT is often used in the management of tendon pain. It uses strong ultrasound waves to directly induce micro traumas within the chronically inflamed tendon to initiate a natural healing process. Usually a few sessions, a few weeks apart are needed.

Ultrasound Guided Injection Therapy

If your pain is not responding to the measures above, then an ultrasound-guided injection might be helpful in the management. Indications for an injection include: