Golfer's Elbow (Medical Epicondylitis)

Background

The elbow consists of three bones, the humerus, ulna, and radius. At the distal end of the humerus, there are two condyles, the medial and lateral epicondyles. This is a condition of the medial epicondyle of the distal humerus. Also known as golfer’s elbow and often caused by overuse. It is an inflammation or microtearing of the flexor tendons on the inside of the elbow, which often results in pain and decreased function.

 

Causes

  • Overuse injury
  • Occupations requiring repetitive tasks such as construction, plumbing, carpentry, musicians, use of hand tools, or traveling and carrying a heavy suitcase
  • Playing racquet sports such as tennis or racquetball due to weak shoulder and wrist muscles, or from improper strokes, serving, or spin
  • Improper throwing or pitching techniques in sports like baseball, football, or javelin

Symptoms

  • Dull pain over the inside of the elbow
  • Tenderness to touch over inside of the elbow
  • Weakness with wrist flexion and forceful gripping
  • Tingling and numbness, especially in the small and ring fingers

Prevention

  • Maintain strength and range of motion, especially if you perform repetitive activities
  • Avoid repetitive movements if possible. If not, take breaks for rest and stretching
  • Warm up before doing activities that cause stress
  • Ensure you are using proper form when doing activities, including maintaining the wrist in a neutral position
 

Diagnostic Tests

  • X-rays are taken to check the bones and joints to ensure there are no fractures or degenerative changes
  • An MRI can help determine inflammation or microtearing of the tendons
  • Palpation around elbow to determine where pain and tenderness are present
  • Resistive wrist flexion with hand in a fist to note pain over inside of the elbow

Medical Treatment

  • Rest and taking a break from repetitive activities that are causing pain
  • Ice
  • Anti-inflammatory medications
  • Wrist splint to decrease repetitive wrist flexion and put the tendons at rest
  • Counterforce brace on forearm to assist during resistive exercises
  • Surgical debridement of the medial epicondyle, if conservative treatment fails
 

Hand Therapy Interventions

  • Education on activity adaptation to avoid pain, decrease inflammation, and avoid recurrence of condition
  • Modalities for pain management such as heat, ice, ultrasound, and infrared laser
  • Massage and soft tissue mobilization to release flexor muscle tightness
  • Range of motion/stretching of elbow and wrist
  • Nerve mobilization if ulnar nerve symptoms are present (tingling/numbness in small and ring fingers)
  • Kinesiotaping
  • Strengthening exercises, once pain and inflammation have decreased

Elbow Injuries

Tennis Elbow

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Golfer's Elbow

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