Golfer's elbow: symptoms and treatments

Golfer's elbow, "epitrocleitis" or "medial epicondylitis," is a tendinopathy at the insertion of the trochlear muscles. The pain usually occurs on the inside of the elbow when performing certain movements, but it can also be extended to the forearm and wrist. The prevalence is estimated at 0.4% of the population, so it is not a very common condition.

In any case, the incidence of this disorder increases dramatically in people who perform frequent and continuous hyperflexion movements of the elbow. In most cases, this condition results from repeated traction microtrauma; hence its name.

It should be noted that most of those affected are between 45 and 64 years old, and that the pathology is slightly more common in women than in men. In certain occupations, however, the prevalence can reach up to almost 10% of workers. Do you want to know more about it? Keep reading!

What is golfer's elbow?

This clinical picture consists of a tendinopathy, that is, a type of disorder located in the tendon that causes pain, inflammation and deterioration of the affected limb. As indicated in an article published in National Center for Biotechnology InformationIn this case, the damage occurs in the common flexor tendon of the elbow, which is the point of insertion of 5 different muscles.

All of these muscle groups – palmar major, palmar minor, anterior ulnar, pronator teres, and superficial common flexor of the fingers – are innervated by the median nerve. This gives the arm mobility and opposing the thumb; however, it is usually damaged in this pathology.

The injury is different from tennis elbow, although they are sometimes confused. In tennis elbow (lateral epicondylitis), the inflamed and torn tendons are the extensors of the forearm. Medial epicondylitis (golfer's elbow) is less common than tennis elbow, accounting for only 10-20% of all general epicondylitis.

To know more: Diagnosis of tennis elbow

Symptoms of golfer's elbow

Medial epicondylitis produces localized pain in the area of ​​inflammation, which is located on the inside of the elbow. This discomfort can radiate to the forearm, the inner part of the arm, and even the hand. In general, the pain only appears when making movements or when the affected area is touched.

Patients describe peaks of discomfort when bending the wrist, during acts such as writing, lifting something, or suddenly grasping a physical item (such as a golf club).

As indicated by a publication in InformedHealth, sometimes it is experienced a slight loss of range of motion in the affected arm. The pain usually diminishes when the arm is kept at rest, but it can make it difficult for the person to sleep and certain vital processes.

If the perceived discomfort occurs on the outside of the elbow, tennis elbow is suspected, not medial epicondylitis. The Mayo Clinic lists the general symptoms of this type of injury. Among all the clinical signs we find the following:

• Rigidity: the entire elbow is stiff and the patient's movements are limited.
• Pain when flexing the wrist with the palm of the hand facing downward.
• Severe pain when shaking hands.
• Discomfort that radiates much of the inside of the arm, from the elbow, through the forearm, to the wrist.
• Numbness or tingling: These paresthesias occur mainly in the ring and little fingers.
• Gripping movement very weakened.

What are your causes?

Despite the common name of the pathology, 90% of the cases are not related to sports activities. Professions such as carpentry, butchery, cooking and construction work or assembly lines often require repetitive efforts that cause micro-tears and injuries to the tendon structure already described.

It should be noted that in certain professions the prevalence rises to 8.2% of workers, compared to 0.4% of the general population. In addition, 3/4 of the cases occur in the dominant arm, which shows that it is a pathology entirely linked to repeated efforts.

Anyway, Medial epicondylitis also develops from the practice of certain physical activities. Golfers, football players, goalkeepers, bowlers, javelin throwers, among other disciplines, are at risk of developing golfer's elbow.

In short, any activity that requires sudden efforts of the arm will favor its appearance. In any case, the etiological mechanism of the condition is still under study.

Diagnosis

The first step in diagnosing medial epicondylitis is to collect the patient's medical history (history) and a physical examination of the affected area. According to a publication in Professional Pharmacy, the diagnosis of golf elbow and tennis elbow follow very similar parameters of action.

After collecting enough information from the patient, the professional will ask you to perform a series of movements. The most common is the extension of the arm with the palm of the hand facing downwards, and then trying to move the limb downwards with different degrees of resistance. If there is pain, the pathology is confirmed.

In general, a physical examination is sufficient for the diagnosis of golfer's elbow. X-rays, ultrasound analysis and magnetic resonance imaging (MRI) are only used if concomitant pathologies or causes other than prolonged exertion are suspected.

Golfer's elbow treatment

There is very little literature that addresses the treatment of medial epicondylitis. However, the United States Library of Medicine details some general guidelines for those affected.

• First of all, the doctor recommend stopping demanding physical activities with the affected arm, for 2 or 3 weeks.

• It is also usually useful to apply ice packs for 20 minutes about 4 times a day, in order to reduce the local inflammatory process.
• If the doctor sees it necessary, suggests the use of an immobilization device, which will reduce the pressure on the affected nerve, muscles and tendon.
• In any case, it is usually necessary to perform certain periodic exercises, in order for the muscles to remain active and not atrophy during recovery.

Medicines

Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) are often used to reduce the symptoms of these types of conditions. Examples are ibuprofen (Motrin), naproxen (Aleve), and acetylsalicylic acid (Aspirin). If you have golfer's elbow, ask your doctor about the benefits and harms of these drugs in your case.

Eccentric exercises

As a final note, we present an example of an eccentric exercise, used to rehabilitate the muscles during the golfer's elbow box.

• Grab a weight with the hand of the affected arm and sit up.
• Rest your elbow on your thigh, with the palm of your hand facing upward. Your elbow should be bent and your wrist rotated.
• Gradually bend your hand with the weight. You can use your free hand to reposition the weight in its original location.
• Repeat the movement about 15 times. After resting a bit, restart the series 2 more times.

These types of exercises help prevent muscle atrophy. Even so, before performing them, always consult your situation with the relevant physiotherapist. If you are not ready for rehab, any physical activity will make your symptoms worse.

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What should you remember?

As you may have seen, golfer's elbow is a tendinopathy that has a lot in common with tennis elbow, since it presents in a similar way and for similar causes. However, tennis elbow manifests with pain on the outside of the elbow, while medial epicondylitis causes pain in the internal structures of the arm.

If you have any of the above symptoms, see your GP without delay. These types of injuries usually heal with rest and rehabilitation, but if ignored, they will get worse over time.