MAYO CLINIC

DEAR MAYO CLINIC: A few months ago I noticed minor pain in my elbow when I'd lift anything - even something light. Recently, the pain is worsening and moving down my inner forearm. My elbow hurts even when I'm not lifting. Turning my wrist or twisting my arm causes pain. What could be the reason for this? Are there things I can do at home to make it better, or do I need to see my health care provider?

ANSWER: The problem you describe sounds like "golfer's elbow." The medical term for this disorder is medial epicondylitis. This disorder develops when muscles and tendons on the inside, or medial, side of your arm become damaged, usually due to overuse. Self-care measures often are enough to ease the pain. If you don't see improvement after a few weeks, however, make an appointment with your health care provider for an evaluation.

The muscle and tendon damage of golfer's elbow triggers pain and tenderness on the inner part of your elbow. As in your case, the pain may extend down the inside of the forearm. It also can lead to stiffness in the elbow and weakness in the hand and wrist. A related condition that tends to be more common is tennis elbow (also called lateral epicondylitis). It affects the outside (lateral side) of the forearm and leads to symptoms similar to those of golfer's elbow.

Despite its name, golfer's elbow doesn't only affect athletes. The condition develops due to excessive or repeated stress on the muscles and tendons of the inner arm. That can happen over time as a result of any activity that involves repeatedly bending and straightening your elbow.

Although it can be painful, golfer's elbow doesn't require urgent care. It's safe to try some remedies at home before you see your health care provider. Rest your arm, and avoid activities that require you to turn or twist it. Use an ice pack on your elbow, 15 to 20 minutes at a time, three or four times a day. Take a nonprescription anti-inflammatory medication, such as ibuprofen or naproxen sodium, to ease discomfort. In many cases, following these self-care steps consistently for several weeks is enough to relieve symptoms of golfer's elbow and allow you to gradually return to your activities.

If there's no improvement after several weeks, then it's time to see your health care provider. A review of your health history and activities, along with a physical exam usually are all that's needed to diagnose golfer's elbow. In some cases, X-rays may be useful to rule out other conditions, such as a broken bone or arthritis.

Once the diagnosis has been confirmed, physical therapy is the next step in treatment. Strengthening and stretching exercises called "eccentric exercises" are particularly effective in treating golfer's elbow. A physical therapist can teach you these, and other strengthening and flexibility techniques.

In most cases, golfer's elbow resolves completely with self-care and physical therapy, and no further treatment is needed. Recovery can take time and patience, however. Total symptom relief often requires three to six months of consistent physical therapy. Although that may become frustrating, the effort is worth it. For most people who take the time to work through physical therapy to treat golfer's elbow, symptoms don't return.

Rarely, symptoms may persist despite consistent self-care and physical therapy. In those cases, an injection of platelet-rich plasma may be beneficial. In severe cases where all other treatment options have failed, surgery may be necessary.

Once your symptoms are gone, take care to help prevent golfer's elbow in the future. Strengthen your forearm muscles, and stretch before physical activity. Use lightweight equipment when working, exercising or playing sports. Don't overuse your elbow. If you notice discomfort when doing an activity, take a break. - Christopher Camp, M.D., Orthopedic Surgery, Mayo Clinic, Rochester, Minn.