GOLFER’S ELBOW

  • INTRODUCTION

Golfer’s elbow, or medial epicondylitis, is tendinosis of the medial epicondyle on the inside of the elbow. It is in some ways similar to tennis elbow, which affects the outside at the lateral epicondyle. The anterior forearm contains several muscles which flexes the digits of the hand, and flexing and pronating the wrist. The tendons of these muscles come together in a common tendinous sheath, which originates from the medial epicondyle of the humerus at the elbow joint. In response to minor injury, or sometimes for no obvious reason at all, this point of insertion becomes inflamed , which is called medial epicondylitis.

muscle tear
muscle tear

 

Anatomy of medial                 epicondyle

 

 

 

 

 

 

 

 

 

CAUSES

The condition is called golfer’s elbow because in making a golf swing this tendon is stressed, especially if a non-overlapping (baseball style) grip is used. But, this condition doesn’t just affect golfers.Any repetitive hand, wrist, or forearm motions can lead to golfer’s elbow. Risky sports include tennis, bowling, and baseball — in fact, it’s sometimes called pitcher’s elbow.
The tendon of the wrist flexor muscles on the inside of the elbow becomes painful and inflamed at their attachment point on the inner elbow because of the overuse of the muscle.
In this condition, pain at the medial epicondyle is aggravated by resisted wrist flexion and pronation, which is used to aid diagnosis.
Epicondylitis is much more common on the lateral side of the elbow (tennis elbow), rather than the medial side.

SIGNS & SYMPTOMS

The main symptoms are –

  • pain
  • tenderness on the medial epicondyle
  • problem in gripping
  • general weakness in the wrist and
  • Inflammation of the flexor tendons.

DIAGNOSIS

The diagnosis of medial epicondylitis is based on local pain at the elbow.Tenderness and pain with palpation on distal and anterior of the medial epicondyle. An increase in pain at the medial epicondyle with resisted isometric flexion, repetitive flexion and pronation of the wrist can also be examined.
In particular the Golfer’s Elbow Test is useful :

In this,the patient should be seated or standing and should have his/her fingers flexed in a fist position.The examiner palpates the medial epicondyle with one hand and grasps the patient’s wrist with his/her other hand.The examiner then passively supinates the forearm and extends the elbow and wrist. A positive test would be a complaint of pain or discomfort along the medial aspect of the elbow in the region of the medial epicondyle.

                                            Golfer’s Elbow Test

 

MANAGEMENT

– Non-specific treatments include:

Non-steroidal anti-inflammatory drugs (NSAIDs): ibuprofen, naproxen or aspirin
Heat or ice therapy.

A counter-force brace or “elbow strap” to reduce strain at the elbow epicondyle, to limit pain provocation and to protect against further damage.

-Surgical Management:

When conservative management fails and there is persistent pain after 6 to 12 months and all other pathologies  are considered, surgical treatment must be considered.Surgery for failure of conservative treatment relieves pain,  restored strength and allows a return to the previous level of daily living and sports activity.Following surgical  procedures are prefer:

  1. Minimally invasive method,
  2. Ultrasound-guided removal of scar tissue in the region of the tendon pain
  3. Corticosteroid injections.

-Physiotherapy Management:

  • Rest: Put your golf game or other repetitive activities on hold until the pain is gone. If you return to activity too soon, you may make it worse.
  • For pain relief:

Ultrasound

IFT(inter ferential therapy)

TENS ( Transcutaneous Electrical Nerve Stimalation )

  • Ice: On the affected area. Apply ice packs to your elbow for 15 to 20 minutes at a time, three to four times a day for several days. To protect your skin, wrap the ice packs in a thin towel. It might help to massage the inner elbow with ice for five minutes at a time, two to three times a day.
                  ice pack

     

Use a brace: Your doctor might recommend that you wear a counter force brace on your affected arm, which might reduce tendon and muscle strain.

  •                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        

  • Stretching and Stengthening exercise: Your doctor may suggest stretching and strengthening exercises. A type of strengthening (eccentric) that lengthens the tendon of the wrist extensor muscles has been shown to be particularly effective in treating chronic tendon irritation. Exercises are like-

Resisted exercise for elbow flexion and pronation

Strenghtening exercise for wrist flexion with dumbel

Wrist flexor stretching

            

strengthening of wrist flexors

 

 

 

 

 

 

 

 

               rehabilitation exercise

wrist flexor stretching

 

Gradually return to your usual activities. When your pain is gone, practice the arm motions of your sport or activity. Review your golf or tennis swing with an instructor and make adjustments if needed.

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