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Golfer's Elbow

Summary:


Golfer's elbow is an overuse injury involving the muscles and tendons of the forearm that attach to the bony prominence called medial epicondyle.




Contents

What is Golfer’s Elbow?

  • Golfer’s elbow or medial epicondylitis, is an overuse injury which refers to pain over the common flexor tendon origin, i.e. inside of the elbow
  • It is commonly called golfer's elbow, due to the high occurrences in golfers. However people who do not play golf can also suffer from these pains, e.g. people who are partake in gripping tightly or carrying things

What are the common causes?

  • The exact mechanism of this injury can vary from a single violent action to, more commonly, repetitive or overuse injuries, where an action is performed repeatedly and pain gradually develops
  • Overloading the inner forearm muscles can cause microtrauma of its tendons attached to the medial epicondyle, leading to golfer's elbow

What are the signs and symptoms?

  • Pain or tenderness on the inside of the elbow and when pressing onto the medial epicondyle of the elbow
  • Pain when you bend or straighten your wrist and hand
  • Pain made worse by lifting a heavy object with your palm up
  • Pain may shoot from the elbow down into the forearm or up into the upper arm

What types of treatment are available?

You are encouraged to reduce activity to decrease repetitive loading of the damaged tendon during the initial inflammatory stage. Relative rest prevents ongoing damage, reduces pain and may promote tendon healing. However, complete rest should be avoided to prevent muscular atrophy and deconditioning. Your doctor, occupational therapist and physiotherapist will work together and advise you according to your need

Medication

  • Anti-inflammatory medication during the initial inflammatory stage


Occupational therapy

  • Splinting helps to rest your wrist flexors
  • Brace helps to redirect pressure away from injured area


  • Your occupational therapist may also advise you on activity modifications or changing the pattern of hand use to minimise strain on the injured tendon


Physiotherapy

  • Your physiotherapist can help you to manage your pain through modalities such as ultrasound therapy or cryotherapy
  • Once pain has subsided, your physiotherapist will advise you on stretching and strengthenging exercises. Light loading of the tendon stimulates collagen production and guides normal alignment of newly formed collagen fibers. Eccentric strengthening is an effective treatment of tendinopathy and may reverse degenertive changes


Surgical

  • If conservative treatment fails to work for you, your doctor may suggest steriod injection. Nonsteroidal anti-inflammatory drugs (NSAIDs) effectively relieve tendinopathy pain and may offer additional benefit in acute inflammatory tendonitis because of their anti-inflammatory properties
  • When there is no improvement with conservative treatment and/or steriod injection, surgical treatment may be an option

What can I do to help myself?

  • Adequate warm up. Gently stretch your elbow and arm muscles before and after exercise
  • Ice your elbow after exercise or work, if pain presents.
  • Minimise load to the elbow
  • Avoid repetitive and forceful wrist, hand or forearm movement
  • Avoid aggravating the pain. Review your daily routine and list down those activities or movements that may aggravate the pain. Make an effort to avoid these activities whenever possible
  • Keep your wrist straight. Avoid moving your wrist when you are engaged in lifting tasks or sports. This allows you to engage your stronger upper arm muscles, rather than the smaller forearm muscles
  • Take frequent short breaks and use elbow splint/brace. If you are unable to avoid tasks that require repetitive and forceful motions, you should make an effort to intersperse them with other lighter tasks or take regular breaks to do some stretches
  • Review your technique. If your condition is sports-related, have a professional review your techniques. Golfer's elbow is commonly associated with golf, racket sports and sports which involve repetitive and forceful ‘throwing’ actions

FAQs

1. When can I return to my normal activities?

  • Everyone recovers from an injury at a different rate. In general you can return to normal activity when
    • You are able to forcefully grip things, or do activities such as working at a keyboard without pain in your elbow
    • There is no swelling around your elbow
    • You have regained normal strength and range of motion in your elbow, as compared to your uninjured elbow

2. How long do I have to wear the splint/brace?

  • Splinting is recommended for at least 6 weeks. It is recommended that you continue to use the elbow brace during sports

3. Will my symptoms return?

  • Unless you make an effort to modify the way you perform your daily activities and work, the symptoms can recur

References

  1. Ciccotti, M. C., Schwartz, M. A. & Ciccotti, M. G. (2004). Diagnosis and treatment of medial epicondylitis of the elbow. Clin Sports Med, 23; 693-705.
  2. Mayo Foundation for Medical Education and Research (MFMER). (1998-2010). Golfer's Elbow. [Online]. Available: https://www.mayoclinic.org/diseases-conditions/golfers-elbow/symptoms-causes/syc-20372868 (6 January, 2010).
  3. Stanley, B. G. & Tribuzi, S. M. (Eds.) (1992). Concepts in Hand Rehabilitation. USA: F. A. Davis Company.
  4. The Hand Rehabilitation Center of Indiana. (2001). Diagnosis and Treatment Manual for Physicians and Therapists. (4th ed.) USA: The Hand Rehabilitation Center of Indiana.


- Last updated 23 Jan 2018,4:36 pm




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