Flexor tendinopathy (Golfer’s Elbow)

What is it?

Commonly referred to as ‘golfer’s elbow’, flexor tendinopathy refers to degeneration and inflammation within the tendons on the inside of the elbow. These tendons connect the forearm muscles to their origin from the arm bone. These muscles function to move the wrist, hand and fingers.

How does it happen?

Flexor tendinopathy is a common injury in activities requiring a lot of use of the wrist and hand, and results from overuse of the tendons on the inside of the forearm. The function of these tendons is to transmit forces produced by the forearm muscles to their origin from the arm bone. Repetitive use of the forearm muscles and, therefore, the forearm tendons can lead to microscopic tears within the tendons and degeneration or breakdown of the tendons. To repair this damage the body commences an inflammatory response.

How does it feel?

The primary sensation with flexor tendinopathy is pain felt along the inside of the elbow and forearm. This pain typically develops gradually. Initially, it may only be a painful following exercise. Associated with the pain may be stiffness or tightness in the elbow and forearm region. Typically, these initial signs of flexor tendinopathy are ignored as they disappear quickly with use of the arm or applying heat (i.e. a hot shower) over the elbow and forearm region. However, as you continue to exercise, the tendinopathy progresses and the pain within the tendon becomes more intense and more frequent. In the earlier stages, this pain during exercise may initially disappear as you warm up only to return when you cool down. However, as you continue to exercise, the tendinopathy worsens, and your pain may begin to be present for longer periods during exercise until it is present all of the time. This may interfere with your performance.

What should you do?

Flexor tendinopathy generally does not get better on its own if the cause is not addressed and you continue to exercise. If you have or suspect you have flexor tendinopathy, you should consult your nearest Sports Physiotherapist. In the meantime, you can begin initial treatment. This should consist of icing following exercise and regular gentle stretching of the forearm muscles. Icing should consist of crushed ice wrapped in a moist towel applied for 15-20 minutes or ice in a paper cup massaged over the inside of the elbow until the skin is numb.

What shouldn’t you do?

If you have or suspect that you have flexor tendinopathy, you shouldn’t ignore the problem. Your pain may get better as you exercise; however, the exercise you are doing may be interfering with the healing process and causing further damage. This can lead to your injury getting worse such that your pain does not ‘warm up’ and you feel it throughout exercise. If this occurs, your recovery may be prolonged and it may take a number of weeks or months for you to return to exercise and sport.

Could there be any long-term effects?

Flexor tendinopathy does not produce any long-term effects, as long as it is properly diagnosed and appropriately treated. If not, it can lead to prolong pain along the inside of the elbow and a prolonged lay off from exercise and sport.

Management

The assistance of a sports physiotherapist is important in the treatment of flexor tendinopathy. Initially, they can assist in diagnosing the problem and determining its severity. From this, the sports physiotherapist will be able to determine an appropriate treatment plan. This may involve activity modification, soft tissue treatment such as massage and stretching, and the progression through a series of specific strengthening exercises. The sports physiotherapist will also be able to assess and determine why you developed flexor tendinopathy and address this during your recovery to prevent a re-occurrence when you return to exercise and sport.

Tom is a physio in Balgowlah who is highly experienced in Golfer’s elbow and similar elbow pain. Tom is the only physio in Balgowlah with post-graduate Master’s experience in diagnosing and treating elbow pain. To make an appointment, click here.

Brukner & Khan (2012) Clinical Sports Medicine.