golfer's elbow
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Golfer's elbow, or medial epicondylitis, is tendinosis of the medial epicondyle on the inside of the
elbow The elbow is the region between the arm and the forearm that surrounds the elbow joint. The elbow includes prominent landmarks such as the olecranon, the cubital fossa (also called the chelidon, or the elbow pit), and the Lateral epicondyle of ...
. It is in some ways similar to tennis elbow, which affects the outside at the lateral epicondyle. The anterior forearm contains several muscles that are involved with flexing 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 The humerus (; ) is a long bone in the arm that runs from the shoulder to the elbow. It connects the scapula and the two bones of the lower arm, the radius (bone), radius and ulna, and consists of three sections. The humeral upper extremity of h ...
at the elbow joint. In response to minor injury, this point of insertion becomes inflamed, causing pain.


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; however, many people develop the condition without playing golf. It is also sometimes called ''pitcher's elbow'' due to the same tendon being stressed by the throwing of objects such as a baseball, but this usage is much less frequent. Other names are ''climber's elbow'' and ''little league elbow'': all of the flexors of the fingers and the pronators of the forearm insert at the medial epicondyle of the humerus to include: ''
pronator teres The pronator teres is a muscle (located mainly in the forearm) that, along with the Pronator quadratus muscle, pronator quadratus, serves to Anatomical terms of motion#Pronation and supination, pronate the forearm (turning it so that the palm fac ...
'', '' flexor carpi radialis'', ''
flexor carpi ulnaris The flexor carpi ulnaris (FCU) is a skeletal muscle, muscle of the forearm that flexion, flexes and Adduction, adducts at the wrist joint. Structure Origin The flexor carpi ulnaris has two heads; a humeral head and ulnar head. The humeral head ori ...
'', '' flexor digitorum superficialis'', and ''
palmaris longus The palmaris longus is a muscle visible as a small tendon located between the flexor carpi radialis and the flexor carpi ulnaris, although it is not always present. It is absent in about 14 percent of the population; this number can vary in Africa ...
''; making this the most common elbow injury for rock climbers, whose sport is grip intensive. The pain is normally caused due to stress on the tendon as a result of the large amount of grip exerted by the digits and torsion of the wrist which is caused by the use and action of the cluster of muscles on the condyle of the ulna. However, more than 90% of cases are not actually from sports-related injuries, but rather from labor-related occupations with forceful repetitive activities (such as construction and plumbing). Epicondylitis is much more common on the lateral side of the elbow (tennis elbow), rather than the medial side. In most cases, its onset is gradual and symptoms often persist for weeks before a person seeks care. In golfer's elbow, pain at the medial epicondyle is aggravated by resisted wrist flexion and pronation, which is used to aid diagnosis. Tennis elbow is indicated by the presence of lateral epicondylar pain precipitated by resisted wrist extension.


Diagnosis

To diagnose golfer's elbow, clinicians may apply force to the elbow and wrist. If the subject indicates pain or inability to resist on the medial side, golfer's elbow may be present. Visual signs and symptoms are used to assist medical diagnosis. Radiography, ultrasound and magnetic resonance imaging (MRI) can be used to assess the structural integrity of the different tissues of the elbow and may assist in making a more accurate diagnosis.


Treatment

Non-specific treatments include: *
Non-steroidal anti-inflammatory drug Non-steroidal anti-inflammatory drugs (NSAID) are members of a therapeutic drug class A drug class is a set of medications and other compounds that have a similar chemical structures, the same mechanism of action (i.e. binding to the same bi ...
s (NSAIDs):
ibuprofen Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that is used for treating pain, fever, and inflammation. This includes dysmenorrhea, painful menstrual periods, migraines, and rheumatoid arthritis. It may also be used to close a paten ...
,
naproxen Naproxen is a nonsteroidal anti-inflammatory drug (NSAID) used to treat pain, menstrual cramps, inflammatory diseases such as rheumatoid arthritis, gout and fever. It is Oral administration, taken orally. It is available in immediate and delay ...
or
aspirin Aspirin, also known as acetylsalicylic acid (ASA), is a nonsteroidal anti-inflammatory drug (NSAID) used to reduce pain, fever, and/or inflammation, and as an antithrombotic. Specific inflammatory conditions which aspirin is used to treat inc ...
* Heat or ice * A counterforce brace or "elbow strap" to reduce strain at the elbow epicondyle, to limit pain provocation and to protect against further damage. Before anesthetics and steroids are used, conservative treatment with an occupational therapist may be attempted. Before therapy can commence, treatment such as rest, ice, compression and elevation (R.I.C.E.) will typically be used. This will help to decrease the pain and inflammation; rest will alleviate discomfort because golfer's elbow is an overuse injury. The subject can use a tennis elbow splint for compression. A pad can be placed anteromedially on the proximal forearm. The splint is made in 30–45 degrees of elbow flexion. A daytime elbow pad also may be useful, by limiting additional trauma to the nerve. Simple analgesic medication has a place, as does more specific treatment with oral
anti-inflammatory Anti-inflammatory is the property of a substance or treatment that reduces inflammation Inflammation (from la, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or ...
medications. These will help control pain and any inflammation. A more invasive treatment is the injection into and around the inflamed and tender area of a
glucocorticoid Glucocorticoids (or, less commonly, glucocorticosteroids) are a class of corticosteroids, which are a class of steroid hormones. Glucocorticoids are corticosteroids that bind to the glucocorticoid receptor that is present in almost every vertebr ...
(
steroid A steroid is a biologically active organic compound with four rings arranged in a specific molecular configuration. Steroids have two principal biological functions: as important components of cell membranes that alter membrane fluidity; and a ...
) agent. After causing an initial exacerbation of symptoms lasting 24 to 48 hours, this may produce an improvement of the condition in some five to seven days.


Physical therapy

Therapy includes a variety of exercises for muscle and tendon reconditioning, starting with stretching and gradual strengthening of the flexor-pronator muscles. Strengthening will slowly begin with isometrics and progresses to eccentric exercises helping to extend the range of motion back to where it once was. After the strengthening exercises, it is common for the subject to ice the area.


Surgery

After 6 months if the symptoms do not improve, surgery may be recommended. Surgical debridement or cleaning of the area is one of the most common treatments. The ulnar nerve may also be decompressed surgically. If the appropriate remediation steps are taken – rest, ice, and rehabilitative exercise and stretching – recovery may follow. Few subjects will need to progress to steroid injection, and less than 10% will require surgical intervention.
Arthroscopy Arthroscopy (also called arthroscopic or keyhole surgery) is a minimally invasive surgery, surgical procedure on a joint in which an examination and sometimes treatment of damage is performed using an arthroscope, an endoscope that is inserted in ...
is not an option for treating golfer's elbow.


See also

* Radial tunnel syndrome *
Repetitive strain injury A repetitive strain injury (RSI) is an injury to part of the musculoskeletal or nervous system caused by repetitive use, vibrations, compression or long periods in a fixed position. Other common names include repetitive stress disorders, cumula ...
* Tennis elbow


References


External links

{{Occupational safety and health Golf terminology Occupational diseases Overuse injuries Soft tissue disorders Sports injuries