Ultrasound-Guided Cortisone Injections and Hyaluronic Acid for Golfer’s Elbow

 

Introduction

Golfer’s elbow, also known as medial epicondylitis, is a condition that affects the tendons on the inner side of the elbow. It is caused by repetitive strain, overuse, or excessive force applied to the forearm muscles, leading to pain, inflammation, and degeneration of the tendons. Despite its name, golfer’s elbow is not limited to golfers—it can affect individuals who perform repetitive wrist and arm movements, such as tennis players, weightlifters, office workers, and manual labourers.

Management of golfer’s elbow involves conservative treatments, rehabilitation, and interventional therapies. Ultrasound-guided cortisone and hyaluronic acid injections are commonly considered for individuals with persistent symptoms, as they provide targeted pain relief and help improve function.

This blog explores golfer’s elbow in detail, including its anatomy, pathology, symptoms, diagnosis, and treatment options, with a focus on cortisone and hyaluronic acid injections.

Anatomy of the Medial Elbow and Flexor Tendons

The elbow joint consists of three bones:

  • Humerus – The upper arm bone.
  • Ulna and Radius – The two forearm bones.

The medial epicondyle is the bony prominence on the inner side of the humerus. It serves as the attachment site for the common flexor tendon, which connects to several forearm muscles responsible for wrist flexion and grip strength.

Key Structures Involved in Golfer’s Elbow

  • Common Flexor Tendon – A group of tendons originating from the medial epicondyle, including the flexor carpi radialis, flexor digitorum superficialis, and pronator teres.
  • Ulnar Nerve – Runs near the medial epicondyle and may contribute to nerve-related symptoms.
  • Medial Collateral Ligament (MCL) – Provides stability to the inner elbow.

Golfer’s elbow occurs when excessive strain leads to degeneration and microtears in the common flexor tendon, particularly affecting the flexor carpi radialis and pronator teres muscles.



Pathology of Golfer’s Elbow

Golfer’s elbow is classified as a tendinopathy rather than a purely inflammatory condition. The pathological changes involved include:

1. Tendinosis and Collagen Degeneration

  • Repetitive stress leads to microtears in the tendon structure.
  • Instead of healing properly, the tendon undergoes degeneration with disrupted collagen fibres.

2. Angiofibroblastic Hyperplasia

  • The affected tendon develops abnormal blood vessels and fibroblasts, contributing to chronic pain and poor healing.

3. Mechanical Overload and Biomechanical Factors

  • Overuse of forearm muscles leads to increased tensile stress on the medial epicondyle, worsening the condition.

Since golfer’s elbow is primarily a degenerative process, treatments that enhance tendon healing and reduce mechanical stress are essential.

Symptoms of Golfer’s Elbow

Golfer’s elbow presents with a gradual onset of pain and functional impairment. Common symptoms include:

  • Pain and tenderness on the inner elbow, especially near the medial epicondyle.
  • Pain worsened by wrist flexion and gripping movements.
  • Weak grip strength, making it difficult to hold objects.
  • Pain radiating to the forearm and wrist.
  • Stiffness and reduced range of motion in severe cases.

Symptoms often develop gradually and can persist for weeks or months if untreated.

Diagnosis of Golfer’s Elbow

Diagnosis is based on clinical evaluation and imaging studies.

1. Clinical Examination

  • Resisted Wrist Flexion Test – Pain is reproduced when the patient resists wrist flexion.
  • Passive Wrist Extension Test – Stretching the flexor muscles while extending the wrist may provoke symptoms.
  • Grip Strength Test – Patients may have reduced grip strength due to pain.

2. Ultrasound Imaging

  • Identifies thickening of the common flexor tendon, hypoechoic changes (degeneration), and neovascularisation.
  • Detects tendon tears or calcifications.
  • Guides precise injections into the affected area.

Management of Golfer’s Elbow

Treatment aims to reduce pain, improve function, and promote tendon healing.

1. Conservative Management

  • Rest and Activity Modification – Avoiding activities that aggravate symptoms.

2. Ultrasound-Guided Injections

For persistent cases, ultrasound-guided cortisone or hyaluronic acid injections can be considered.

Ultrasound-Guided Cortisone Injections for Golfer’s Elbow

Cortisone injections contain corticosteroids, which act as potent anti-inflammatory agents. When delivered under ultrasound guidance, the injection ensures precise targeting of the affected tendon, reducing pain and inflammation.

Mechanism of Action of Cortisone Injections

  • Reduces inflammation by inhibiting inflammatory mediators like prostaglandins and cytokines.
  • Decreases local swelling, relieving pain and improving movement.
  • Suppresses immune response, limiting further tendon irritation.

Benefits of Cortisone Injections

  • Provides fast-acting pain relief, allowing patients to participate in rehabilitation.
  • Reduces acute inflammation, particularly in early-stage cases.
  • Improves function and mobility by reducing discomfort.

Ultrasound-Guided Hyaluronic Acid Injections for Golfer’s Elbow

Hyaluronic acid (HA) is a naturally occurring substance that provides lubrication and shock absorption. HA injections for golfer’s elbow aim to enhance tendon gliding and reduce friction, improving movement and reducing pain.

Mechanism of Action of Hyaluronic Acid Injections

  • Enhances tendon lubrication, reducing mechanical stress.
  • Improves viscoelastic properties of the tendon.
  • Supports tissue healing by promoting cell proliferation and reducing oxidative stress.

Benefits of Hyaluronic Acid Injections

  • Provides longer-lasting symptom relief compared to cortisone.
  • Enhances tendon healing and function.
  • Reduces pain and stiffness, particularly in chronic cases.

Conclusion

Golfer’s elbow is a common tendinopathy that can significantly impact daily activities. Ultrasound-guided cortisone and hyaluronic acid injections provide targeted relief by reducing inflammation and enhancing tendon lubrication.

At Alton Pain Clinic, expert ultrasound-guided techniques ensure precise and effective injection therapy for individuals with persistent golfer’s elbow symptoms.

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