Therapy of the golfer's elbow

introduction

Golfer's elbow is less common than tennis elbow, but treatment is much more difficult and lengthy.
The golfer's elbow in particular has a tendency to become chronic if there is no early treatment.

Basically, one differentiates between therapy

• of a "fresh" acute golfer's elbow
  from
• an "old" chonified golfer's elbow

The acute golfer's elbow should always be treated conservatively. Operative measures should only be considered in the case of a chonified golfer's elbow (symptoms persist for> 6 months).

Therapy of acute golfer's elbow

The following measures are useful for an acute golfer's elbow:

• Immediate reduction in the burden on the offending activity
• local infiltrations with a cortisone injection (especially efficient in the first few weeks of the disease)
• Bandage / brace for relief
• Physiotherapy with transverse friction and stretching (not in the acute inflammatory phase)
• Fascia therapy
• Kinesio taping
• acupuncture
• physical therapy, e.g. Electrotherapy

Appointment with a specialist for a golfer's elbow?

I would be happy to advise you!

Who am I?
My name is dr. Nicolas Gumpert. I am a specialist in orthopedics and the founder of .
Various television programs and print media report regularly about my work. On HR television you can see me every 6 weeks live on "Hallo Hessen".

Even if golf is not your hobby and you still suffer from a golfer's elbow, I can help you get your arm going again.
In the past few years I have successfully treated several thousand golf elbows in my main area of ​​activity.

You can find me in:

• Lumedis - your orthopedic surgeon
  Kaiserstrasse 14
  60311 Frankfurt am Main

Directly to the online appointment arrangement
Unfortunately, it is currently only possible to make an appointment with private health insurers. I hope for your understanding!
Further information about myself can be found at Dr. Nicolas Gumpert.

Therapy of the chronic golfer's elbow

The following measures are successful in treating a golfer's elbow that is chronic:

• Focused shock wave therapy (ESWT)
• OP (minimally invasive tenotomy under local anesthesia)
• X-ray stimulation / orthovolt therapy

The conservative treatment options

physiotherapy

Guided by physiotherapists, the patient can independently carry out so-called transverse frictions on the tendon attachments at home, which have a pain-relieving effect.
Through these transverse frictions, stretching stimuli are set across the tendon.
This method of treatment can be very effective. It should be noted, however, that too high a stimulus can further inflame an already inflamed tendon.

Medical therapy

• With lighter forms of the golfer's elbow, ointment wraps with Voltaren emulgel or zinc glue bandages may help.
• The doctor can infiltrate with stronger forms of the golfer's elbow. As a rule, a combination preparation consisting of local anesthetics / local anesthetic with cortisone is injected with a syringe (more commonly known as a cortisone syringe). The aim is to numb the pain in order to stretch the tendons well during this time by means of physiotherapy or independently. In the case of a chronic golf elbow / golf arm, cortisone preparations can achieve good treatment results in the short term.
  However, too frequent administration of cortisone-containing preparations should not be considered, as cortisone can cause local tissue damage over a longer period of time.
  Cortisone preparations such as Lipotalon® or Volon A®.
• An anti-inflammatory / pain reliever from the NSAID group can be temporarily prescribed to calm the inflammation.
  These include drugs such as:
  • Voltaren ®
  • Ibuprofen
  • Celebrex ®

Bandages / braces

Bandages or braces often help the patient to avoid the recurrence of the disease.
Orthopedic-technical solutions such as elbow bandages or elbow braces are used in the field of golfers or tennis elbows as aids for prevention / precaution.
Elbow bandages or elbow braces are of little help in acute complaints.

Read more on this topic at: Forearm bandage

Physical therapy

• The soft laser / cold laser can be used for therapeutic support of the golfer's elbow. Metabolic activation is triggered by it.
  Local pain relief is to be achieved and shortened tendon attachments are calmed and self-healing processes are supported.
• With the ultrasound treatments, heat and vibration are conducted deeper. The vibrations trigger a kind of micromassage, which can initially have a pain-intensifying effect on the patient in the therapeutic beginnings. .
• A special form of electrotherapy, the so-called iontophoresis, aims to bring pain relievers and medication to the tendon insertion and thus deeper.
• Cold and / or heat applications.

acupuncture

Acupuncture has proven itself here in many cases. On the one hand, it serves to relieve pain and, on the other hand, it can also stop the inflammatory process if the pain-inducing activity, such as playing tennis, is stopped.
Unfortunately, this is not always possible, especially if the activities that trigger pain are part of everyday life.
Acupuncture in the treatment of a golfer's elbow is at best part of the accompanying therapy for the golfer's elbow and is usually not sufficient in isolation.

Sports therapy

Especially in the early stages of the golfer's elbow, often only a short break is necessary. Before you really start practicing “your” sport again, you should conduct “training advice” with an experienced trainer.
Frequently - as in the tennis elbow area, for example, it is also necessary to check the training device (in the tennis elbow area: racket and strings).
Remember, if you continue doing all of the activities as before, it is very likely that the pain will recur.

stretch

Stretching plays a very important role in the healing of a golfer's elbow.
A stretching stimulus makes the muscle belly longer and the tension at the tendon insertion decreases.
A stretch has no direct effect on the inflamed tendon. It is therefore plausible that stretching in the acute phase is counterproductive.
Regular stretching is a must as a prevention after a healed golfer's arm.

Fascia therapy

Fascia therapy is supposed to loosen adhesions that were triggered by the inflammation.
For this purpose, a physiotherapist or the person affected can roll out the glued regions with a fascia roller.

The same applies to fascia therapy as to stretching. Not in the acute phase!

Further information is available under our topic: Facial Therapy

Treatment approaches for chronic golf elbow

Symptoms that are older than 6 months should always be confirmed by an MRI of the elbow, as partial tears of the common flexor tendon on the elbow could be present after this period of illness.

You can find further information under our topic: MRI of the elbow

X-ray stimulation

In the event that the above-mentioned conservative therapeutic measures do not work, there is still the possibility of X-ray stimulation.
The X-rays are aimed solely at the elbow. The radiation exposure is lower when performing 3 to 4 times than when X-raying the elbow joint in 2 planes.

Further information is available under our topic: X-ray stimulation

Extracorporeal shock wave therapy (ESWT)

As part of the extracorporeal shock wave therapy, ultrasound impulses are directed to the painful tendon attachments. This is a specific ultrasound device that is similar to a kidney stone breaker.
Success occurs in about 80% of all patients, but complications can arise during treatment. Pain in the area of ​​the epicondyles and injuries to small blood vessels with the resulting appearance of bruises are examples.

Further information can be found under our topic: Shock wave therapy

Cost of shock wave therapy

NOTE: Please note that extracorporeal shock wave therapy as a form of treatment is not covered by every health insurance company. Talk to your orthopedic surgeon about this and, if necessary, ask your health insurance company about the cost coverage before starting the treatment.

OP

Information on the operation of the golfer's elbow can be found here.

Other forms of therapy used

Occupational therapy

Since there are innumerable moments of overload at most workplaces, which trigger one-sided stress and monotonous constrained postures, occupational therapists can bring about pain relief in a golfer's elbow with a few but specific changes. For example, a foldable PC keyboard or a so-called ergonomically shaped keyboard, as well as an ergonomically designed computer mouse, can significantly alleviate the pain of the golfer's elbow / arm. Even in the manual sector, for example, screwing in screws by hand can be replaced by an electric screwdriver.

General information can be found under our topic: Occupational therapy

Plaster immobilization

Such immobilization is only necessary in exceptional cases of the golfer's elbow.
The total immobilization can lead to additional stiffening in the area of ​​the elbow and / or wrist.
This would then also have an impact on muscles, tendons and ligaments, which under certain circumstances could further shorten.
Plaster restraints are being used less and less because studies have not proven any clear benefit.

Magnetic therapy

Further forms of therapy are:

• magnetic therapy and
• the pulsating signal therapy

It has not yet been possible to scientifically ascribe clearly positive effects to both forms of therapy. In many patients, however, shock wave therapy achieves clear subjective symptom relief or even freedom from symptoms.

Botulinum toxin

"Botox" therapy is not one of the standard therapies for a golfer's elbow.
As with stretching therapy, the principle of action should take place via a temporary reduction in tension in the muscles.
Even if the treatment approach seems logical, this therapy has not yet established itself as a standard therapy.
The causes are certainly costs and an unfavorable risk-benefit ratio.

Further information is also available from: Botulinum toxin

leech

Leech therapies are also not part of the standard forms of therapy.
Leeches release the active ingredient hirudin. This is said to have positive properties in the case of tendinitis.
Unfortunately, it is not known whether there is a reliable study situation.

Cryoprobe therapy

A therapy probe cools the tendon attachment area to 2 - 4 ° C for a few seconds.
This effect should have a positive influence on the healing process.
Unfortunately, the author is not aware of the data available on this either.