Medial Epicondylitis

What is Golfer’s Elbow?


The piece of bone that can be felt on the inner side of the elbow is called the medial epicondyle. When the tendons attached to this bone are overstretched or torn, they become inflamed and painful.
While commonly called golfer’s elbow, this ailment is not restricted to people who play golf. It can occur in tennis players and other people who repeatedly grip objects tightly.

Medial Epicondylitis

Elbow Injuries


The elbow is a hinge joint consisting of three bones that serve as the mechanical link between the upper arm and forearm. The normal range of motion of the elbow is zero degrees of extension (straightening) to 150 degrees of flexion (bending), although an arc of motion from 30 to 130 degrees is sufficient to perform most activities of daily life.

Elbow injuries are relatively common among athletes. Adolescents and older adults are most at risk — adolescents because their bones and ligaments are still growing, and older adults because their ligaments and tendons lose normal elasticity with age.

Golfer’s elbow is caused by overusing the flexor muscles of the forearms. Overusing these muscles can stretch or tear the tendons attached to the medial epicondyle. Causes include:

  • improper golf swing technique or grip of golf clubs
  • wrong model of golf clubs
  • improper technique for hitting a tennis ball
  • improper size of tennis racquet or tension of racquet strings
  • doing certain arm motions too much, such as:
    • golf swings
    • tennis strokes (forehand or serve)
    • painting
    • raking
    • pitching
    • rowing
    • using a hammer or screwdriver

You may increase your chance of suffering golfer’s elbow if you have any of these risk factors:

  • playing golf or tennis
  • work that requires repetitive gripping or clenching of the fingers
  • muscle imbalance
  • decreased flexibility
  • advancing age
Golfer's Elbow
Golfer’s Elbow

Diagnosis


Symptoms of golfer’s elbow include:

  • pain or tenderness on the inner side of the elbow
  • pain increases when:
    • shaking hands
    • turning doorknobs
    • picking up objects with your palm down
    • hitting a forehand in tennis
    • swinging a golf club
    • applying pressure to this area
  • possibly pain extending down the forearm
  • tightness of forearm muscles
  • stiffness or trouble moving the elbow or hand

The doctor will ask about your symptoms and medical history, your recent physical activity, and how the injury occurred. You may not remember the event that caused the injury because golfer’s elbow pain develops over time. The doctor will examine your elbow for:

  • pain on the inner side of the elbow when:
    • doing certain arm motions
    • pressing on the medial epicondyle
    • stiffness of elbow and pain with wrist movement

X-rays are not usually necessary, but the doctor may decide to x-ray your elbow to:

  • make sure the bones of the elbow are normal
  • look for a calcium deposit in the injured tendons

Treatment Options for golfer’s elbow


Treatment includes:

A realistic alternative to surgery.

  • rest

Do not do activities that cause pain. Do not play sports, especially golf and tennis, until the pain is gone.

  • cold

Apply ice or a cold pack to the inner side of the elbow for 15 to 20 minutes, four times a day for several days after the injury. Wrap the ice or cold pack in a towel. Do not apply the ice directly to your skin.

  • medication

If you still have tenderness in the elbow while taking the medicine, do not return to physical activity. Check with your doctor.

  • compression

Wear a counter-force brace on your forearm if recommended by your health care professional. This brace limits the force generated by your forearm muscles when you use them.

  • heat

Apply heat to the elbow only when you are returning to physical activity. Then use it before stretching or getting ready to play sports.

  • stretching

When the acute pain is gone, start gentle stretching as recommended by a health care professional. Stay within pain limits. Hold each stretch for about 10 seconds and repeat six times.

  • strengthening

Begin strengthening exercises for the flexor muscles of the forearm as recommended by a health care professional.

  • gradual return to your sport

Begin arm motions of your sport or activity as recommended by a health care professional. (For example: golf swings, tennis strokes, painting)

  • injection

The doctor may inject medicine into the elbow near the medial epicondyle to reduce pain and inflammation.

Prevention


To reduce your risk of getting golfer’s elbow:

  • Keep your arm muscles strong so they can absorb the energy of sudden physical stress.
  • After a short warm-up period, stretch out your arm muscles before physical activity.
  • Learn the proper technique for activities that require forearm motion.
  • If you play golf, ask a golf specialist to check your:
    • swing technique
    • grip
    • model of golf clubs
  • If you play tennis, ask a tennis specialist to check your:
    • technique for hitting a forehand
    • racket size and tension of racket strings
    • How can I prevent golfer’s elbow?
  • Keep your arm muscles strong so they can absorb the energy of sudden physical stress.
  • After a short warm-up period, stretch out your arm muscles before physical activity.
  • Learn the proper technique for activities that require forearm motion.
  • If you play golf, ask a golf specialist to check your:
    • Swing technique
    • Grip
    • Model of golf clubs
  • If you play tennis, ask a tennis specialist to check your:
    • Technique for hitting a forehand
    • Racket size and string tension
    • Improving sports performance

The key to improving sports performance after recovering from golfer’s elbow is proper rehabilitation and adhering to some of those same principles and exercises after the injury is gone.

The single most important aspect of improving performance is stretching before and after you step onto the golf course.

Benefits derived from stretching include:

  • increased physical efficiency and performance
  • decreased risk of injury
  • increased blood supply and nutrients to joint structures
  • increased coordination
  • improved muscular balance and postural awareness
  • decreased risk of lower-back pain
  • reduced stress
  • enhanced enjoyment

Golfer’s elbow rehabilitation


As an athlete, your number one concern is getting back to full strength as soon as possible so that you can return to training and competition. That is why appropriate rehabilitation is extremely important. Rehabilitation for golfer’s elbow often includes the following:

  • Medication

Take medicine to help reduce inflammation and pain.

  • Compression

Wear a counter-force brace on your forearm if recommended by your doctor. This brace limits the force generated by your forearm muscles when you use them.

The doctor may do an injection into the tendon attachment at the medial epicondyle to reduce pain and inflammation.

Shockwave therapy is high energy sound wave that is administer to the elbow to stimulate the body’s healing mechanism.

Platelet has self-repair purpose, so in concentrated form to be injected back to the painful elbow to stimulate the body’s healing mechanism.

Alternative exercises


During the period when normal training should be avoided, alternative exercises may be used. These activities should not require any actions that create or intensify pain at the site of injury. They include:

  • swimming (if pain allows)
  • jogging
  • stationary bicycle

How long will the effects of my injury last?


Duration of effects varies significantly. Unless surgery is required, symptoms may diminish within 7 to 10 days and disappear in two or three weeks. Grip strength can return to normal in about the same time period. However, some cases requiring injection or surgical intervention may last for months. Keep in mind that recurrence of golfer’s elbow is common. It may take months for you to return to full activity and all symptoms to disappear.

When can I return to my sport or activity?


Some may be ready to golf in two weeks, others not for two months or more.

Remember: The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon you may worsen your injury, which could lead to permanent damage. Everyone recovers from injury at a different rate. Return to your activity is determined by how soon your golfer’s elbow recovers, not by how many days or weeks it has been since your injury occurred.

A good rule is to allow pain to dictate when you’re ready to return to activity. You should return in moderation, and back off if you feel any pain.

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