Golfer's Elbow: Is There a Link to the Neck?

More than half the time, elbow pain along the inside of the elbow is caused by a pinched nerve in the neck. That was the reported result of examining 102 patients with elbow pain called medial epicondylitis, golfer's elbow, or pitcher's elbow.

Pressure on the spinal nerve roots as they exit the spinal column can cause neck and/or arm pain, and numbness and tingling down the arm. Weakness of the muscles supplied by the affected nerve root is another main symptom of a pinched nerve. The medical term for a pinched nerve in the neck is cervical radiculopathy.

In the case of medial epicondylitis linked with cervical radiculopathy, weakness of the muscles supplied by the pinched nerve leads to problems at the elbow. The spinal nerve roots affected and thus associated with golfer's elbow are C6 and C7.

Weakness compounded by repetitive motion and overload of the muscle-tendon junction can then lead to microtearing and tendon damage. But as this study showed, weakness from cervical radiculopathy can be enough to put the elbow at risk for the development of medial epicondylitis. The 55 patients who developed golfer's elbow didn't golf or play ball.

Abnormal findings on MRIs taken as part of the diagnostic workup confirmed the diagnosis of cervical radiculopathy in 54 per cent of these patients. The levels affected most often were C5-6 and C6-7. Three-fourths of the patients had bilateral (both elbows) medial epicondylitis.

With epicondylitis, it is known that the damaged tendon doesn't heal correctly. Degeneration occurs with fibrotic (scar) tissue forming instead of new, healthy tissue. The lack of tendon healing is possibly another end-result of the compromised (pinched) nerve tissue in the neck. The connection between poor tendon healing and the cervical radiculopathy has not been proven yet, so this is just a suggested theory for now.

The importance of this study was to remind physicians to consider cervical radiculopathy as the primary diagnosis when a patient presents with medial elbow pain. A history of repetitive elbow motion is not always present. If the diagnosis is missed at first, failure to resolve the symptoms with conservative (nonoperative) care is likely. This should point back to the need to look to the neck as the possible cause of the elbow symptoms.

References: Aaron Taylor Lee, and Ayse L. Lee-Robinson, MD. The Prevalence of Epicondylitis Among Patients with C6 and C7 Radiculopathy. In Sports Health. July/August 2010. Vol. 2. No. 4. Pp. 334-336.