Medial elbow tendinopathy (MET - golfers elbow)

Golfers elbow can occur as a result of repetitive strain, wear or trauma of the attachment of the wrist flexors at the medial epicondyle. Pain can felt over the medial aspect of the elbow and may radiate into the forearm musculature. The insertional are is usually tender in palpation/touch and symptoms are usually aggravated by activities which involve flexion of the wrist such as lifting, gripping, shaking hands and unsurprisingly playing golf! The incidence of golfers elbow is about 1- 3% of the adult population

• Pain stretching the wrist flexors (arm at shoulder height, elbow straight and the wrist in full passive extension and supination)
• Pain on resisted wrist flexion (arm at shoulder height, elbow extended and wrist in neutral – the clinician resists wrist flexion). A positive finding if the patients symptoms are reproduced
• Tender on palpation of common flexor origin
• Mechanism of onset, location of symptoms, severity and longevity of symptoms, limitation to function.

Not indicated in primary care.

• Cervical spine/ radiculopathy
• Elbow joint/articular issue
• Medial ligament strain
• Upper limb neural tension or ulna nerve entrapment.

• Pain relief in line with agreed formularies/guidance
• Patient leaflet, patient education, activity modification
• NHS AAA MSK website
• Use of golfers elbow strap

• ****Injection: Injection as first line/ immediate management is not supported by the evidence. If persistent Sx (> 2/3 months), a one off injection can be considered in patients with troublesome/severe symptoms ensuring advised of risk of and evidenced based outcomes.

• Diagnostically uncertain
• Symptoms persist beyond 2- 3/12 and interfere with ADLs despite conservative management
• If a non red flag cervical source suspected, particularly if bilateral symptoms – refer to physiotherapy through usual pathway.