Golfer's elbow

Diagnosis

Golfer's elbow is usually diagnosed based on your medical history and a physical exam. To evaluate pain and stiffness, the doctor might apply pressure to the affected area or ask you to move your elbow, wrist and fingers in various ways.

An X-ray can help the doctor rule out other causes of elbow pain, such as a fracture or arthritis. Rarely, more comprehensive imaging studies — such as MRI — are performed.

Treatment

Treatment begins with avoiding activity that causes pain. To help relieve pain, use ice.

Medication

You can take an over-the-counter pain reliever. Try ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve) or acetaminophen (Tylenol, others).

Corticosteroid injections are not commonly given because they haven't been shown to be effective long-term. A newer treatment being tried is platelet-rich plasma. This involves drawing a small amount of your blood and injecting a concentrated amount of platelets and other anti-inflammatory factors into the tender area. More studies are needed to evaluate the effectiveness of this treatment.

Therapy

Try the following:

• Rest. Put your golf game or other repetitive activities on hold until the pain is gone. If you return to activity too soon, you can worsen your condition.
• Ice the affected area. Apply ice packs to your elbow for 15 to 20 minutes at a time, three to four times a day for several days. To protect your skin, wrap the ice packs in a thin towel. It might help to massage your inner elbow with ice for five minutes at a time, two to three times a day.
• Use a brace. Your doctor might recommend that you wear a counterforce brace on your affected arm, which might reduce tendon and muscle strain.
• Stretch and strengthen the affected area. Your doctor might suggest exercises for stretching and strengthening. Progressive loading of the tendon with specific strength training exercises has been shown to be especially effective. Other physical or occupational therapy practices can be helpful too.

Gradually return to your usual activities. When your pain is gone, practice the arm motions of your sport or activity. Review your golf or tennis swing with an instructor to ensure that your technique is correct, and make adjustments if needed.

Surgery

Surgery is seldom necessary. But if your signs and symptoms don't respond to conservative treatment in six to 12 months, surgery might be an option. A new approach called the TENEX procedure involves minimally invasive, ultrasound-guided removal of scar tissue in the region of the tendon pain. More study is needed.

Most people will get better with rest, ice and pain relievers. Depending on the severity of your condition, the pain might linger for months to years — even if you take it easy and follow instructions on exercising your arm. Sometimes the pain returns or becomes chronic.

Preparing for your appointment

You'll probably start by seeing your primary doctor. If you don't improve with rest, ice and over-the-counter medications, your doctor might refer you to a sports medicine specialist or to a doctor with advanced training in musculoskeletal disorders.

Here's some information to help you get ready for your appointment.

What you can do

Make a list of:

• Your symptoms and when they began.
• Key medical information, including other conditions you have and all medications and supplements you're taking, including doses.
• Your typical daily activity, including how often, long and hard you play sports or do other activities that tax your elbow. Note whether you've recently changed the frequency, intensity or method of your workouts.
• Recent injuries that could have damaged your elbow.
• Questions to ask your doctor to help you make the most of your time together.

Below are some questions to ask your doctor.

• What's the most likely cause of my pain?
• Are there other possible causes?
• Do I need tests?
• What treatment approach do you recommend?
• With treatment, will I eventually be able to resume the sport or activity that caused my elbow problems?
• How long will I need to avoid the sport or activity that caused my elbow problems?
• What kind of exercise routine can I safely follow while I'm healing?
• Will I need surgery?
• How often will you see me to monitor my progress?

Don't hesitate to ask other questions.

What to expect from your doctor

Your doctor is likely to ask you questions, including:

• Is your pain constant? How severe is it?
• Do tasks that use your elbow — lifting, gripping, carrying, typing, shaking hands — trigger pain?
• Are your symptoms affecting your ability to complete daily tasks? Are they affecting your sleep?
• What is your exercise routine?
• Have you recently changed your training or equipment, such as using new techniques or a new racket?
• What activities does your work require?
• What are your recreational activities or hobbies?
• Have you tried at-home treatments? If so, has anything helped?