Ultrasound-Guided Cortisone Injections for Golfer’s Elbow at Alton Pain Clinic

 

Introduction

Golfer’s elbow, medically termed medial epicondylitis, is a condition that affects the tendons attached to the inner side of the elbow. Despite its name, it is not exclusive to golfers and can develop in anyone who engages in repetitive forearm movements. This overuse injury can result in discomfort, reduced strength, and functional limitations, particularly during activities requiring grip and wrist flexion.

At Alton Pain Clinic, we provide tailored approaches for individuals experiencing this condition, including ultrasound-guided cortisone injections, which are performed by experienced clinicians. This blog explores the condition in detail, from its underlying anatomy to the pathology involved, and discusses the role of cortisone in managing symptoms.

Anatomy of the Medial Elbow

Understanding the anatomy of the elbow is fundamental to appreciating the mechanics of golfer’s elbow.

The elbow joint is a complex hinge joint formed by three bones: the humerus (upper arm bone), the ulna, and the radius (forearm bones). On the inner side of the distal humerus lies a bony prominence known as the medial epicondyle. The tendons of the flexor-pronator muscle group — responsible for bending the wrist and fingers and pronating the forearm — attach to this area.

Key structures involved in golfer’s elbow include:

• Medial epicondyle: Bony landmark where flexor tendons originate.
• Flexor-pronator group: Muscles involved in wrist flexion and forearm pronation, including flexor carpi radialis, flexor carpi ulnaris, palmaris longus, and pronator teres.
• Ulnar nerve: Runs close to the medial epicondyle, making it susceptible to irritation in some cases.

Damage to these tendinous attachments is central to golfer’s elbow pathology.

Pathology of Golfer’s Elbow

Golfer’s elbow is classified as a tendinopathy rather than a simple inflammatory condition. Repetitive wrist flexion and forearm pronation can lead to microtears within the tendon fibres, especially at their origin on the medial epicondyle. Over time, this microtrauma can result in:

• Degenerative changes: Disruption of collagen structure within the tendon.
• Neovascularisation: Development of new, often fragile, blood vessels within the tendon.
• Tendon thickening: Resulting from attempts at repair.

It is often an overuse injury, affecting athletes, manual workers, and individuals engaged in repetitive tasks such as typing, gardening, or using tools. Though pain is localised on the inner side of the elbow, symptoms may radiate down the forearm.

Causes and Risk Factors

Golfer’s elbow may develop due to:

• Repetitive strain: Continuous stress on the flexor tendons.
• Poor technique: In sports like golf, tennis (forehand strokes), or weightlifting.
• Sudden increase in activity: Overloading the tendons beyond their capacity.
• Occupational strain: Jobs involving gripping or lifting.

Risk factors include age (30–50 years most common), reduced tendon flexibility, inadequate warm-up, and poor ergonomics.

Symptoms of Golfer’s Elbow

The clinical presentation typically includes:

• Pain and tenderness: On the inner side of the elbow, sometimes radiating down the forearm.
• Stiffness: Particularly in the morning or after periods of inactivity.
• Weak grip strength: Difficulty holding objects firmly.
• Aggravation by movement: Pain worsens with wrist flexion, gripping, or forearm rotation.

Early recognition and intervention can help manage symptoms effectively.

Diagnosis of Golfer’s Elbow

A clinician typically diagnoses golfer’s elbow through:

• History-taking: Identifying symptom patterns, activities, and contributing factors.
• Physical examination: Palpation of the medial epicondyle, pain reproduction with resisted wrist flexion and pronation.
• Imaging:
• Ultrasound: Can visualise tendon changes and guide injections.

Management Options

Management strategies depend on severity and duration of symptoms. Options include:

• Activity modification: Reducing or altering repetitive tasks.
• Exercise therapy: Stretching and strengthening programmes targeting the flexor-pronator group.
• Bracing and supports: Counterforce braces may reduce tendon loading.
• Modalities: Such as ice application or shockwave therapy.
• Injections: Administered by trained clinicians, these can be considered when symptoms persist despite initial interventions.

Ultrasound-Guided Cortisone Injections

Cortisone injections can play a role in reducing symptoms associated with golfer’s elbow. At Alton Pain Clinic, these injections are performed under ultrasound guidance, ensuring precise delivery to the affected tendon origin.

Why Ultrasound Guidance?

• Accuracy: Visualisation of tendon structures ensures correct placement.
• Safety: Avoids nearby nerves and blood vessels.
• Efficacy: Targeted delivery may enhance outcomes compared to blind injections.

What is Cortisone?

Cortisone is a synthetic corticosteroid with potent anti-inflammatory properties. When injected locally, it may help modulate the inflammatory response associated with tendon pathology.

Mechanism of Action of Cortisone in Golfer’s Elbow

While golfer’s elbow involves degenerative changes rather than pure inflammation, cortisone may still offer benefits:

• Reduction of inflammatory mediators: Cortisone can decrease the activity of substances contributing to pain and tissue irritation.
• Decrease in local swelling: Helps reduce pressure on surrounding structures, including the ulnar nerve.
• Facilitation of rehabilitation: By alleviating symptoms, it may enable patients to participate more effectively in exercise programmes.

At Alton Pain Clinic, the procedure is typically quick, with minimal discomfort, and carried out by a clinician experienced in musculoskeletal ultrasound.

Why Choose Alton Pain Clinic?

• Specialist Expertise: Our clinicians have in-depth knowledge of musculoskeletal conditions and ultrasound-guided techniques.
• Tailored Care: We assess each case individually and provide personalised treatment plans.
• Advanced Imaging: Use of high-resolution ultrasound ensures precise and targeted interventions.

Summary

Golfer’s elbow is a common condition resulting from overuse of the flexor tendons of the forearm, leading to pain and functional limitation. Management is multifaceted, with ultrasound-guided cortisone injections serving as one option when conservative measures are insufficient. These injections, performed by experienced clinicians at Alton Pain Clinic, are aimed at targeting the source of symptoms accurately, potentially facilitating rehabilitation and recovery.

This comprehensive approach ensures that individuals receive evidence-informed care tailored to their specific needs, enabling them to work towards improved function and symptom management.