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Medial Epicondylitis

Also known as Golfer’s Elbow

“Hey doc! My elbow hurts.” – Unfortunately, this is not an uncommon thing I hear from people on the golf course, at the gym, or in clinic. Medial epicondylitis, also known as golfer’s elbow, climber’s elbow, common flexor tendinosis, and others, affects people from a variety of occupations and activities and is certainly not limited to the golfer or rock climber.

A personal note from Dr. Money – I have a long history of medial epicondylitis since high school! Yes, I was and still am an avid golf enthusiast…and amateur rock climber. Until a few months ago, it was well managed with turmeric supplements, a low sugar diet, and the occasional prolotherapy injection. I increased my training intensity in the gym and started practicing for Long Drive golf competitions. The pain in my right elbow got to the point where needed something more. So I had one of our other doctors perform platelet-rich plasma (PRP) injections to the tendon, ulnar collateral ligament, and joint. Less than two weeks after treatment, I played 54 holes over a weekend (including 36 in one day) and only had mild soreness the day after.  My elbow is feeling better than it has in a LONG time only a few weeks after being treated.

What Is Medial Epicondylitis (Golfer’s Elbow)?

golfer's elbow / medial epicondylitis - anatomical view of the elbow

Golfer’s elbow involves tears in the ulnar collateral ligament and pain or soreness on the inside of the elbow. The bony bump you feel there is the medial epicondyle of the humerus (upper arm bone). There are five forearm muscles that attach at this point, all of which are involved in helping to flex or rotate the forearm and wrist. Pain can get worse when you throw a ball, grip a dumbbell, turn a screwdriver, and other movements that involve the fingers, hand, wrist, and/or elbow.

Tennis elbow is similar, however, it refers to the outside of the elbow, at the lateral epicondyle. Pain typically can be reproduced if you make a fist and bend your wrist backward into extension. It is actually much more common than golfer’s elbow but is generally treated in a similar fashion.

Symptoms of Medial Epicondylitis

Golfer’s elbow symptoms include:

  • Pain and tenderness. Pain and tenderness start on the inside of the elbow and can expand into the forearm.
  • Stiffness. You might feel achy or stiff in your elbows. And making a fist might be painful.
  • Weakness. You might experience weakness in your hands and wrists.
  • Numbness or tingling. These sensations might radiate into one or more fingers — usually the ring and little fingers.

Pain in the elbow of a golfer can come on suddenly or gradually. The discomfort may get worse with certain activities, such as swinging a golf club.

Arm Pain at Night

Arm pain at night can be miserable.  The pain can interrupt your sleep and erode your quality of life. Irritability becomes increasingly more common.  What are the causes?  When should I worry about it?  What are the treatment options for arm pain at night? The neck is composed of 7 boney building blocks numbered 1- 7. Sandwiched between the bones is a disc that functions as an important shock absorber. The cervical discs are susceptible to injury due to trauma, degeneration, repetitive motion, and surgery. Common disc injuries include disc bulges, and herniations. The injured disc can compress or irritate one or more nerves resulting in arm pain at night. It can…

Read More About Arm Pain at Night

Arm Throbbing

In many patients, irritated neck nerves don’t present as a symptom in the neck. In fact, sometimes the only symptoms of irritated nerves in the neck occur in the arm muscles, as either tightness, throbbing, or both. While the arm throbbing might be frustrating as it’s happening, you might not think a whole lot about it, especially if it only happens on occasion. However, ignoring it is not a good idea since it is often a warning signal of a bigger problem in the neck. These body connections occur all the way back to when we were a fetus, like the neck, shoulder, and arm.

Read More About Arm Throbbing

Left Arm Numbness

Treatment depends upon the underlying cause of the arm numbness. Left-arm numbness is a warning sign that requires attention. As noted above unexplained numbness requires immediate attention. At the Centeno-Schultz Clinic, we are experts in the treatment of left-arm numbness due to cervical nerve irritation, cervical stenosis, thoracic outlet syndrome, and peripheral nerve injuries. When appropriate first-line treatment should involve conservative care including physical therapy and stretching. Steroid injections should be avoided as they are toxic to orthopedic tissue and can accelerate damage. Surgery for Cervical Stenosis and Thoracic Outlet Syndrome is major surgery and associated with significant risks. These risks…

Read More About Left Arm Numbness

Pain on Outside of Elbow

Pain on the outside of the elbow which is referred to as lateral epicondylitis can be disabling. Typically seen in 30-60 year olds, patients complain of point tenderness over the outside aspect of the elbow ( lateral epicondyle) aggravated by gripping and activities that extend the wrist. The pain is thought to arise from degenerative changes in the muscles that attach to lateral epicondyle called the extensor muscles.

Read More About Pain on Outside of Elbow

What Causes this Inside Forearm Pain?

Small tears develop in the tendons that attach muscles to bone. These small injuries can occur over time with normal day-to-day activities, not just with a traumatic event. Most of the time, our body does a good job of repairing them without issue. As we age, those repair mechanisms do not work quite as well, so small tendon tears may not heal back to 100%. Often, there are other issues that can result in excess muscle/tendon load or improper firing of the muscles.

The ulnar collateral ligament is something all too familiar with baseball players. It is triangular shaped and acts like pieces of duct tape, stabilizing the humerus and ulna, the two bones that make up the inner elbow joint, together. This ligament can get loose, acting like a rubber band instead of a piece of duct tape. This causes the flexor tendons to work harder to provide stability to the elbow joint, which can result in injury to the tendon.

The nerve supply to the flexor muscles originates from the lower half of the cervical spine. If any of these nerves are irritated, it can result in disrupted communication to the muscles, causing them to improperly activate. Think of it like the circuit breaker in your home. If the problem is at the breaker box, it doesn’t matter how many times you change the lightbulb until you fix the source. This is why the physicians at Centeno-Schultz Clinic may ask about your neck when you’re having elbow pain.

How Is Medial Epicondylitis / Golfer’s Elbow Diagnosed?

A trained musculoskeletal physician is usually able to diagnose golfer’s elbow by talking with you about your history and performing a physical exam. Those who are experts in diagnostic ultrasound imaging may do this in the office in order to assess for any tendon abnormalities such as swelling or tears. As mentioned above, other areas of the body may be examined to see if there are any other factors leading to your elbow pain. At times, imaging such as an MRI or nerve conduction tests are done to rule out other issues.

What Are My Treatment Options?

Conservative treatment with rest, stretching, counterforce bracing, natural anti-inflammatories such as turmeric and bromelain is a good place to start. Chronic use of medications such as ibuprofen (Advil) and naproxen (Aleve) are not recommended as they block inflammation, which is required for the healing process to occur. They have also been shown to negatively impact the gastrointestinal (GI), cardiovascular and renal systems1. High-dose corticosteroid injections are unfortunately common in the traditional orthopedic and sports medicine world. There are many studies out there that show the negative effects of these. Although they may mask the pain for a short period of time, they are doing nothing to heal the tissue and can actually cause MORE injury to tendon cells and cartilage2,3.

If conservative treatment does not provide sufficient relief of symptoms, a safe injection-based treatment from Centeno-Schultz Clinic may be recommended. Prolotherapy is the utilization of hyperosmolar dextrose to act as an irritant, stimulating your natural healing response. This results in the release of growth factors and increases collagen production4,5.

Platelet-rich plasma (PRP) injections are a step up from prolotherapy, putting platelets (which contain growth factors) directly at the site of injury. A newer study from Bohlen et al compared PRP treatment of golfer’s elbow to surgery. They found that overall treatment outcomes were the same, but those who had PRP injections had full range of motion and were pain-free almost 2 months earlier than the surgery patients6.

Bone marrow concentrate (BMC) is usually reserved as a treatment option for large tendon tears, severe arthritis, or injuries that do not respond adequately to prolotherapy or PRP injections. The bone marrow usually is taken from the back of your pelvis and concentrated to put all the healing cells into a small volume. Then under ultrasound or x-ray guidance, the BMC is injected into the tissues that need help with healing.

Surgery for this issue should be a LAST resort. I would not recommend even considering surgery until all of the above options have been tried. Even the most careful surgeon is still using a knife to cut into you, which can create scar tissue and potentially other issues down the road.

Conclusion

Golfer’s elbow is a condition of the medial elbow that can take you out of work and the things you enjoy doing in life. It definitely did to me. Reach out to the Centeno-Schultz Clinic education center to schedule an appointment. Rest assured that you will receive a treatment plan for Golfer’s elbow personalized for you, designed to target the cause of injury and boost your body’s ability to heal.

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All Our Doctors Who Treat Golfer’s Elbow

Christopher J. Centeno, MD

Christopher J. Centeno, M.D. is an international expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate in orthopedics. He is board-certified in physical medicine and rehabilitation with a subspecialty of pain medicine through The American Board of Physical Medicine and Rehabilitation. Dr. Centeno is one of the few physicians in the world with extensive experience in the culture expansion of and clinical use of adult bone marrow concentrate to treat orthopedic injuries. His clinic incorporates a variety of revolutionary pain management techniques to bring its broad patient base relief and results. Dr. Centeno treats patients from all over the US who…

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John Schultz, MD

My passion and specialization are in the evaluation and treatment of cervical disc, facet, ligament and nerve pain, including the non-surgical treatment of Craniocervical instability (CCI). I quit a successful career in anesthesia and traditional pain management to pursue and advance the use of PRP and bone marrow concentrate for common orthopedic conditions. I have been a patient with severe pain and know firsthand the limitations of traditional orthopedic surgery. I am a co-founder of the Centeno-Schultz Clinic which was established in 2005. Being active is a central part of my life as I enjoy time skiing, biking, hiking, sailing with my family and 9 grandchildren.

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John Pitts, M.D.

Dr. Pitts is originally from Chicago, IL but is a medical graduate of Vanderbilt School of Medicine in Nashville, TN. After Vanderbilt, he completed a residency in Physical Medicine and Rehabilitation (PM&R) at Emory University in Atlanta, GA. The focus of PM&R is the restoration of function and quality of life. In residency, he gained much experience in musculoskeletal medicine, rehabilitation, spine, and sports medicine along with some regenerative medicine. He also gained significant experience in fluoroscopically guided spinal procedures and peripheral injections. However, Dr. Pitts wanted to broaden his skills and treatment options beyond the current typical standards of care.

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Jason Markle, D.O.

Post-residency, Dr. Markle was selected to the Interventional Orthopedic Fellowship program at the Centeno-Schultz Clinic. During his fellowship, he gained significant experience in the new field of Interventional Orthopedics and regenerative medicine, honing his skills in advanced injection techniques into the spine and joints treating patients with autologous, bone marrow concentrate and platelet solutions. Dr. Markle then accepted a full-time attending physician position at the Centeno-Schultz Clinic, where he both treats patients and trains Interventional Orthopedics fellows. Dr. Markle is an active member of the Interventional Orthopedic Foundation and serves as a course instructor, where he trains physicians from around the world.

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Matthew William Hyzy, D.O.

Doctor Hyzy is Board Certified in Physical Medicine and Rehabilitation (Physiatry) and fellowship-trained in Interventional Orthopedics and Spine. Dr. Hyzy is also clinical faculty at the University of Colorado School of Medicine in the Department of Physical Medicine and Rehabilitation; In addition, Dr. Hyzy is an Adjunct Clinical Assistant Professor at The Rocky Vista University College of Osteopathic Medicine. Dr. Hyzy also maintains an active hospital-based practice at Swedish Medical Center and Sky Ridge Medical Center. He is also recognized and qualified as an expert physician witness for medical-legal cases and Life Care Planning. He is published in the use of autologous solutions including…

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Brandon T. Money, D.O., M.S.

Dr. Money is an Indiana native who now proudly calls Colorado home. He attended medical school at Kansas City University and then returned to Indiana to complete a Physical Medicine and Rehabilitation residency program at Indiana University, where he was trained on non-surgical methods to improve health and function as well as rehabilitative care following trauma, stroke, spinal cord injury, brain injury, etc. Dr. Money has been following the ideology behind Centeno-Schultz Clinic and Regenexx since he was in medical school, as he believed there had to be a better way to care for patients than the status quo. The human body has incredible healing capabilities…

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Mairin Jerome, MD

Mairin Jerome, MD

Dr. Mairin Jerome is a physiatrist with subspecialty fellowship training in Interventional Orthopedics and Regenerative Medicine. This subspecialty serves to fill the gap for patients who are interested in therapeutic options that lie between conservative treatment and surgery. Dr. Jerome uses regenerative medicine techniques, including prolotherapy and orthobiologics, via X-ray or ultrasound guidance to precisely deliver injections to areas of musculoskeletal injury or degeneration. Orthobiologics refers to tissue harvested typically from a person’s own body, such as platelets (platelet-rich plasma, PRP) or bone marrow, for use in treating painful musculoskeletal conditions. The goal is to stimulate the body’s healing mechanisms to improve pain, function, and decrease inflammation.

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Other Resources for Elbow Pain

  • PRP for UCL Injury – PRP Injections for UCL Tear

    Dr. Pitts Talks About PRP for UCL Injury as an Alternative to Tommy John Surgery Transcript Hi everybody. This is Dr. John Pitts with the Centeno-Schultz Clinic, where we lead and invented much of the field of Interventional Orthopedics and regenerative medicine. Mainly we treat most musculoskeletal and orthopedic problems with injections of your own … Continued


  • Tennis Elbow vs Golfer’s Elbow: Things You Must Know

    Elbow pain can be debilitating. Dr. Schutlz discusses the differences between Tennis elbow and Golfers elbow and successful treatment options that do NOT include steroids, NSAIDs or surgery.


  • Ulnar Shortening Surgery: What You Need to Know

    Ulnar shortening surgery, also known as ulnar osteotomy, is cutting out a portion of the ulna bone which is thought to be causing excessive force, injury, and pain in the wrist. Dr. Schultz discusses the indications, complications and non surgical alternatives in the treatment of ulnar sided wrist pain.


  • Tommy John Surgery Success Rate

    Injury to the ulnar collateral ligament in the arm and the surgical procedure commonly used to “repair” it is called the Tommy John Surgery. Dr. Schultz discusses complications, return to play and decline in performance, shorter career, and re-injury.


  • Centeno-Schultz Clinic Proudly Sponsors United States Tennis Association

    The Centeno-Schultz Clinic was excited to announce their sponsorship of the United States Tennis Association this week and get involved in the tennis community. It was a very exciting weekend. On Saturday morning we sponsored a coaches workshop at the Denver Tennis Park led by Wayne Bryan. Wayne is a former tennis club owner and … Continued


  • Dumb Surgery Alert: Biceps Tenodesis

    We’ve added yet another surgery to our dumb-surgeries list here at the clinic. You’d think after all these years, the crazy surgeries patients come to us after having endured wouldn’t still shock us. Unfortunately, however, we still seem to be thinking, They did what to you? a bit too often when these patients are explaining … Continued


References

1– Laine L. Gastrointestinal effects of NSAIDs and coxibs. J Pain Symptom Manage. 2003 Feb;25(2 Suppl):S32-40.

2– Dean BJ, Franklin SL, Murphy RJ, Javaid MK, Carr AJ. Glucocorticoids induce specific ion-channel-mediated toxicity in human rotator cuff tendon: a mechanism underpinning the ultimately deleterious effect of steroid injection in tendinopathy?. Br J Sports Med. 2014;48(22):1620‐1626.

3– McAlindon TE, LaValley MP, Harvey WF, et al. Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial. JAMA.2017;317(19):1967–1975.

4– Ekwueme EC, Mohiuddin M, Yarborough JA, Brolinson PG, Docheva D, Fernandes HAM, Freeman JW. Prolotherapy Induces an Inflammatory Response in Human Tenocytes In Vitro. Clin Orthop Relat Res. 2017 Aug;475(8):2117-2127.

5– Hung CY, Hsiao MY, Chang KV, Han DS, Wang TG. Comparative effectiveness of dextrose prolotherapy versus control injections and exercise in the management of osteoarthritis pain: a systematic review and meta-analysis. J Pain Res. 2016;9:847-857.

6- Bohlen HL, Schwartz ZE, Wu VJ, Thon SG, Finley ZJ, O’Brien MJ, Savoie FH 3rd. Platelet-Rich Plasma Is an Equal Alternative to Surgery in the Treatment of Type 1 Medial Epicondylitis. Orthop J Sports Med. 2020 Mar 25;8(3):2325967120908952.

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