Golf Doctor
(orthopaedics)
Ow, My Aching Elbow!
Michael Leighton, M.D.
Dear Golf Doctor:
Now that the season is in full swing, my husband has increased his
golfing from 3 times a week to a full 108 hole/week habit! He never
plays more than one round a day, but lately he's been having real
problems with his left elbow. He's got pain and Advil's just not
cutting it. Should he get a shot or wear a brace? Heat or ice? Help
us he's part of a county championship winning team. &emdash;G.
Ruggiero, WPB
Dear GR:
It sounds like JR has a bad case of tennis elbow. That's right,
tennis elbow. Golfer's elbow usually occurs on the dominant (right)
elbow for right-handed golfers. I hate to say it, but this is an
overuse syndrome. If he backed off a little, his symptoms would
certainly improve. Some people (like me, for instance) would be happy
playing 18 holes a week; but to play 108 &endash; this guy is my
hero! Since moderation is probably not an option, let's discuss the
problem and how to deal with it.
The elbow acts as the origin of the muscles that move the
wrist. Wrist flexion is the motion made when cupping the wrist (i.e.,
bowling); wrist extension is the motion made when cocking the wrist
(tennis backhand). The wrist extensors are the muscles located on the
outside part of the elbow and these are the ones affected in tennis
elbow or "lateral epicondylitis." In fact, the single muscle/tendon
most commonly afflicted is the extensor carpi radialis brevis (quite
a mouthful!). Stay with me, now &endash; when a golfer is at the top
of his backswing, there is a tendency to flex the left wrist. The guy
who is good enough to try and compensate will then actively,
forcefully, EXTEND the wrist in order to square the clubface (and
prevent blocking right or slicing). It is this maneuver 50 times a
round, 300 times a week, that causes this tendinitis. All of the
force on the tendon is transmitted to the origin of the ECRB on the
outside area of the elbow. And it can feel very sore! Inflammation
ensues and without some intervention, chronic tendon degeneration can
occur and it becomes more difficult to treat.
There is a three-fold treatment plan that I use. First, treat
the inflammation. Anti-inflammatories (Advil, Naprosyn, etc.) can be
helpful if taken at the appropriate dose for about 2 weeks. Some
people cannot tolerate these medicines. Ice, rather than heat, is
effective in reducing inflammation. It penetrates deeper than heat,
and has been shown to allow a better healing response in acute
inflammatory tissue. I recommend twice a day for 10 minutes at a
time. After playing, in the grill room, is fine. Do it again after
dinner. Second, stretching the tendon is effective in getting more
force from the muscle without furthering chronic injury. The best way
to stretch the tendon is to keep the elbow fully extended
(straight), then forcefully hold the wrist flexed for 5 seconds.
Relax, then repeat this four more counterforce bracing. This is a
device that fits on your forearm and distributes the forces away from
the tendon origin. Aircast makes a tennis elbow strap that is
frequently effective; Band-it is another company that makes a decent
device. You have to wear it for it to work. Copper, selenium,
molybdenum or titanium bracelts don't have any proven benefit but
they frequently look good and if they cost a lot, sometimes make you
feel better.
If these conservative methods fail, a cortisone shot may be in
order. A careful injection will give relirf in 48 hours. There are
generally no systemic effects and this is a perfectly reasonable
approach with lateral epicondylitis. It is important to rest the
elbow for 5 to 7 days after the injection. Injections may be repeated
at the discretion of yout physician. All of the bad press about
steroid (cortisone) injections really don't apply, but ask your doc
&endash; I'd gladly go into more detail if asked. Physically therapy
can be helpful also, but try an honest atempt at the basics first.
Rarely, rarely, rarely does this come to surgery. After the 4 to 6
week recovery, surgical results are excellent. You should be fighting
with this for at least six months to a year before considering the
knife.
Tennis elbow in golfers is a common ailment and can be
effectively treated conservatively. Be compliant with this treatment,
rest if you hahe to. You'll be back out there before you know it!
S-T-R-E-T-C-H!
Michael Leighton, M.D. is an avid golfer who specializes in
orthopaedic surgery and sports medicine. He can be reached at
Atlantis Orthopaedics, 561-967-4400 or by e-mail at
KNEESURG@aol.com
