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Golfers Elbow

Categories
  • Elbow
  • Joint/Tendon
Tags
  • Elbow injury
Elbow

Arm Muscles

Arm Muscles
Muscles of the Forearm
Elbow Joint

Medial Epicondylitis (Golfers Elbow)

Golfers elbow (medial epicondylitis) is caused by repetitive microtrauma to the flexor and pronator mass tendon insertion at the elbow joint and it is due to eccentric overloading of the tendinous mass. It is less common than Tennis elbow and is usually the dominant arm that is affected.

Medial aspect of right forearm

Medial aspect of right forearm

Mechanism of injury:

  • Most commonly overuse strain to arm on the medal side
  • Local trauma to medial side of elbow
  • Risk factors include throwing sports

Presentation:

  • Pain
  • Swelling
  • Deformity
  • Inability to flex and extend the elbow with pain that worsens with activity
  • Multiple joint arthralgia when cause due to an inflammatory cause

Clinical:

  • Localized tenderness near the insertion of common flexor tendon
  • Provocative test: resisted forearm pronation and wrist flexion evokes the medial elbow pain
  • Assess elbow stability and exclude ulnar neuritis

Investigation:

  • X-rays: AP, Greenspan and lateral views usually unremarkable. Occasional calcification may be seen.
  • Ultrasound: tendinous tears and areas of degeneration with hypoechoic signal change at sonography
  • MRI scan: tendon and peritendon oedema, useful to exclude associated elbow instability

Management

Non-operative:

  • Rest
  • Athlete activity modification is necessary while rehabilitating
  • Non-steroidal anti-inflammatory medication (NSAIDs)
  • Arm counter-force bracing
  • Kinesiology taping
  • Extracorporeal shockwave therapy
  • Local anaesthetic and steroid injection (LASI)

Surgery:

  • Failed conservative management for 6 months
Surgery options:
  • Debridement of flexor-pronator mass with reattachment
Tennis elbow management

Counter-force elbow brace

Golfers Elbow Rehabilitation

Non-operative

  • Stretching & Strengthening exercises of musculature around the elbow joint
Forearm strength exercise

Forearm strength exercise

Strength exercises only performed after union

Stretching Flexor Forearm Compartment

Surgery Technique

Surgery

Surgery Approach: Medial Approach to Elbow

Medial approach to elbow

Medial 3-4 cm incision across medial epicondyle

Structures at risk Ulnar nerve posterior to medial epicondyle

Surgery for Golfers Elbow

Surgery for Golfers elbow
  • Medial approach to medial epicondyle
  • Debride necrotic tissue
  • Reattachment and fixation of common flexor-pronator muscle
  • Closure

Post Surgery Rehabilitation

Immobilization in arm splint for 2 weeks: maintain hand gripping exercises, however avoid wrist volar flexion

  • After healing start ROM
  • Start strengthening exercises after 6-8 weeks after union
  • Return to sport after 3 months after successful rehabilitation
Arm sling

Arm sling

Hand grip exercises with arm in splint

Hand grip exercises

Strength exercises only performed after union

Stretching flexor forearm compartment

Download ASSIC Performance Fingerprint or Strength & Conditioning apps for rehab guideline routines or create own under professional supervision

apple app store  google play store

References

  1. Diagnosis and treatment of medial epicondylitis of the elbow. MC Ciccotti, MA Schartz, MG Ciccotti. Clin Sports Med. 2004 Oct;23(4): 693-705.
  2. Medial epicondylitis: evaluation and management. NH Amin, NS Kumar, MS Schickendantz. J Am Acad Ortjop Surg. 2015 Jun;23(6): 348-55.
  3. Kinesiology taoing reduces elbow pain during resisted wrist extension in patients with chronic lateral epicondylitis: a randomized, double blinded, cross-over study. YT Cho, WY Hsu, LF Lin, YN Lin.BMC Musculoskelet Disord. 2018 Jun 19;19(1): 193.

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