What can I do about my golfer’s elbow?

I HAVE been advised to have a platelet-rich plasma (PRP) injection for golfer’s elbow. What is the success rate of these injections?

Mrs R. Taylor, St Helens, Merseyside.

GOLFER’S elbow, known medically as medial epicondylitis, is a painful condition affecting the inside of the elbow joint.

The medial epicondyle is the bony point of the joint that’s closest to the body when you stand with your arms by your side, palms facing forwards. The muscles attached to this point are used to flex your wrist towards the inner forearm (as you do in golf).

It used to be thought golfer’s elbow was the result of inflammation. But we now know that it’s due to tendinopathy — degeneration of the tendons (tough bands of tissue that connect muscle to bone).

Risk factors include smoking, obesity and middle age. But the problem is usually triggered by repetitive over-use of these muscles and tendons.

Though golf is known to cause this injury, other activities can cause it, too, such as windsurfing or lifting heavy furniture.

Most people wait months or longer before they seek help. And in many cases the symptoms do get better of their own accord. However, this can take up to two years. And if the pain is so bad it interrupts sleep or makes everyday life difficult, then a more active treatment approach is needed.

It may help to seek expert advice on modifying your golfing technique. If that doesn’t work it is advisable to consult a specialist with knowledge of this condition, such as a physiotherapist, sports physician or orthopaedic specialist.

THERE is a range of treatments, including wearing a wrist brace to reduce tendon and muscle strain, doing certain forearm exercises or having steroid injections and acupuncture.

The fact is that no single treatment has been found to be effective in every case.

This is true of platelet-rich plasma injections, too — where a sample of your own blood is taken and then ‘spun’ in a machine to extract the part of the blood that is rich in platelet cells, which are thought to contain growth factors that can stimulate repair processes in the tendon.

This is then injected directly into the painful area.

The treatment has been tested in many trials — some have found the injections to be ineffective, while other studies have shown they do help. The jury is still out on this.

However, I would advise you to go ahead with the treatment, provided the recommendation has come from a specialist experienced in the technique — in good hands, it’s a safe procedure.

But if the advice has come from a non-medical contact, then seek the opinion of a sports physician or an orthopaedic consultant with an interest in upper limbs.

I WAS recently diagnosed with a condition my neurologist described as ‘localised motor neurone disease’.

This started as foot drop and now affects my left leg, as well as causing weakness and poor grip in my hands. Will it stay localised? I’ve been prescribed riluzole and gabapentin, but I have also heard that cannabis oil may be of some benefit.

Naeem Khalid, by email. THIS diagnosis must have come as a shock, and you have my sympathy. Motor neurone disease involves progressive damage to the nerves that control muscles, leading to weakness and muscle wasting.

It only affects the muscles that we can consciously control — such as those we use to grip, walk, swallow, breathe and speak.

Muscles such as the bladder, intestine and heart are not affected. Nor are the sensory nerves, which means that patients’ hearing, sight, touch, smell and sight also remain unaffected.

Motor neurone disease is not a single condition, but a group of neurological disorders. These each have different patterns of nerve cell damage, affecting different parts of the body at different stages.

I would glean that your diagnosis is amyotrophic lateral sclerosis. This typically starts with foot drop (weakness in one leg), before spreading to the other leg and then to the arms.

While the symptoms may be localised at the moment, regrettably, the disease is inevitably progressive. The riluzole you’ve been prescribed will not reverse nerve cell damage but may slow the progression of the disease.

It does this by lowering levels of glutamate, a chemical messenger that helps nerve cells communicate (high levels, as seen in motor neurone disease, are toxic).

Gabapentin, an epilepsy drug, is sometimes prescribed to relieve nerve pain arising from damaged nerve cells. To be effective, the dose has to be increased gradually until good pain control is achieved. I hope this is proving helpful.

AS YOU know, there is interest in the potential of cannabis for treating the symptoms of motor neurone disease. Some patients say it helps with loss of appetite, depression and pain, though it won’t help with muscle weakness.

Interestingly, there is emerging evidence that cannabis may be neuroprotective — it may prolong nerve cell survival — though nothing has been proven and this drug remains illegal, with potentially serious side-effects.

However, there are medical preparations — nabiximols (known by the brand name Sativex) comes in the form of an oral spray and is licensed for use in multiple sclerosis patients to alleviate pain and spasticity (muscle spasms).

There is no reason why it can’t be prescribed ‘off licence’ for a patient such as you if symptoms, particularly pain, are not eased by your current medication.

your doctor may agree to prescribe this for you to try.

I wish you well — do write again and let me know if you have received Sativex and whether or not it has proved helpful.