Medial epicondylitis, commonly known as Golfer’s Elbow, causes pain and soreness on the inside of the lower arm, near the elbow. This discomfort arises from damage to the tendons that connect the forearm muscles to the medial epicondyle (the inner side of the elbow bone). These forearm muscles are responsible for flexing the wrist, bending the fingers, and rotating the palm downward. Repetitive stress from activities like a golf swing or heavy gripping can cause tiny tears in these tendons, leading to irritation and chronic pain. The most common symptom is pain and tenderness that radiates from the inner elbow down the forearm toward the wrist, often accompanied by a weakened grip.
The Conservative Treatment Pathway
The initial approach to managing Golfer’s Elbow is non-surgical, with 80% to 90% of cases resolving successfully without an operation. The primary step is rest and activity modification, which means temporarily avoiding the specific movements that trigger the elbow pain. Giving the irritated tendons a chance to heal is important, as returning to the activity too soon can worsen the condition.
Alongside rest, managing pain and inflammation often begins with over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, and applying ice packs to the affected area several times a day. Patients may also be advised to wear a counterforce brace or a wrist splint to reduce strain on the tendons during daily activities. These devices work by absorbing some of the tension that would otherwise be placed directly on the damaged tendon attachment.
Physical therapy is an effective part of recovery, focusing on stretching and strengthening exercises. Progressive loading of the tendon through specific strength training, particularly eccentric exercises, is effective in rehabilitating the tissue. If these initial methods are insufficient, a physician might consider injections to aid in recovery.
Corticosteroid injections can provide short-term pain relief by reducing local inflammation, though they are not considered a long-term solution. Platelet-Rich Plasma (PRP) injections involve injecting a concentration of the patient’s own platelets to promote tissue healing, although more study is needed to fully evaluate its effectiveness. These injections are typically reserved for cases that have not responded to weeks or months of physical therapy and rest.
Indicators That Surgery May Be Necessary
Surgery for Golfer’s Elbow is considered a last resort for patients whose symptoms fail to improve after conservative management. The primary threshold for surgical consideration is the failure of structured non-operative treatment—including rest, physical therapy, and injections—after a significant duration, typically six to twelve months. This prolonged period allows sufficient time for the body’s natural healing processes to resolve the tendon issue.
Indicators that may prompt surgery include chronic, persistent pain that severely limits daily function or prevents a return to work or sport activities. If imaging studies, such as an MRI or ultrasound, confirm severe degeneration, a large tear, or significant scarring within the tendon tissue, this strengthens the case for surgical intervention. If symptoms include numbness, tingling, or weakness in the hand or fingers, it may suggest involvement or irritation of the ulnar nerve, which can sometimes be addressed during the elbow procedure. The decision is based on the severity of the tendon damage and the extent to which the pain impairs quality of life.
Surgical Procedures and Recovery Timelines
The goal of a surgical procedure is to remove the damaged or diseased tendon tissue and encourage healthy tissue regeneration. The most common approach is a medial epicondyle release, which involves making an incision over the inner elbow to access the flexor-pronator tendon. The surgeon identifies and removes the degenerated tendon segments, often scraping the bone attachment site to stimulate a healing response.
This procedure is typically performed on an outpatient basis, meaning the patient can go home the same day. There are variations in technique, including traditional open repair or a minimally invasive approach like percutaneous tenotomy, which uses smaller incisions. Following surgery, the arm is often placed in a splint or heavy dressing for one to two weeks to protect the repair.
Physical therapy begins soon after the initial immobilization period to restore motion and strength to the elbow and forearm. Light daily activities can usually be resumed within a few weeks, but strenuous tasks and heavy lifting must be avoided for 6 to 12 weeks to allow the tendon to heal completely. A full return to demanding sports or heavy labor typically requires four to six months.