Golfer's elbow

Last updated
Golfer's elbow
Other namesMedial epicondylitis
Gray329-Medial epicondyle of the humerus.png
Left elbow-joint, showing anterior and ulnar collateral ligaments. (Medial epicondyle labeled at center top.)
Specialty Orthopedics

Golfer's elbow, or medial epicondylitis, is tendinosis of the medial epicondyle on the inside of the elbow. It is in some ways similar to tennis elbow, which affects the outside at the lateral epicondyle.

Contents

The anterior forearm contains several muscles that are involved with flexing the digits of the hand, and flexing and pronating the wrist. The tendons of these muscles come together in a common tendinous sheath, which originates from the medial epicondyle of the humerus at the elbow joint. In response to minor injury, this point of insertion becomes inflamed, causing pain.

Causes

Still shot from a 3D medical animation illustrating golfer's elbow affecting the medial epicondyle on the lower inside of the joint. Golfers-Elbow SAG.jpg
Still shot from a 3D medical animation illustrating golfer's elbow affecting the medial epicondyle on the lower inside of the joint.

The condition is called golfer's elbow because in making a golf swing this tendon is stressed, especially if a non-overlapping (baseball style) grip is used; however, many people develop the condition without playing golf. It is also sometimes called pitcher's elbow [1] due to the same tendon being stressed by the throwing of objects such as a baseball, but this usage is much less frequent. Other names are climber's elbow and little league elbow: all of the flexors of the fingers and the pronators of the forearm insert at the medial epicondyle of the humerus to include: pronator teres , flexor carpi radialis , flexor carpi ulnaris , flexor digitorum superficialis , and palmaris longus ; [2] making this the most common elbow injury for rock climbers, whose sport is grip intensive. The pain is normally caused due to stress on the tendon as a result of the large amount of grip exerted by the digits and torsion of the wrist which is caused by the use and action of the cluster of muscles on the condyle of the ulna. [3] However, more than 90% of cases are not actually from sports-related injuries, but rather from labor-related occupations with forceful repetitive activities (such as construction and plumbing). [4]

Epicondylitis is much more common on the lateral side of the elbow (tennis elbow), rather than the medial side. In most cases, its onset is gradual and symptoms often persist for weeks before a person seeks care. In golfer's elbow, pain at the medial epicondyle is aggravated by resisted wrist flexion and pronation, which is used to aid diagnosis. Tennis elbow is indicated by the presence of lateral epicondylar pain precipitated by resisted wrist extension. [5] [6]

Diagnosis

To diagnose golfer's elbow, clinicians may apply force to the elbow and wrist. If the subject indicates pain or inability to resist on the medial side, golfer's elbow may be present. Visual signs and symptoms are used to assist medical diagnosis. [7]

Radiography, ultrasound and magnetic resonance imaging (MRI) can be used to assess the structural integrity of the different tissues of the elbow and may assist in making a more accurate diagnosis. [4]

Treatment

Non-specific treatments include:[ citation needed ]

Before anesthetics and steroids are used, conservative treatment with an occupational therapist may be attempted. Before therapy can commence, treatment such as rest, ice, compression and elevation (R.I.C.E.) will typically be used. This will help to decrease the pain and inflammation; rest will alleviate discomfort because golfer's elbow is an overuse injury. The subject can use a tennis elbow splint for compression. A pad can be placed anteromedially on the proximal forearm. [8] The splint is made in 30–45 degrees of elbow flexion. A daytime elbow pad also may be useful, by limiting additional trauma to the nerve. [9]

Therapy includes a variety of exercises for muscle and tendon reconditioning, starting with stretching and gradual strengthening of the flexor-pronator muscles. [7] Strengthening will slowly begin with isometrics and progresses to eccentric exercises helping to extend the range of motion back to where it once was. After the strengthening exercises, it is common for the subject to ice the area. [8]

Simple analgesic medication has a place, as does more specific treatment with oral anti-inflammatory medications. These will help control pain and any inflammation. [8] A more invasive treatment is the injection into and around the inflamed and tender area of a glucocorticoid (steroid) agent. [10] After causing an initial exacerbation of symptoms lasting 24 to 48 hours, this may produce an improvement of the condition in some five to seven days.[ citation needed ]

Physical therapy

Therapy includes a variety of exercises for muscle and tendon reconditioning, starting with stretching and gradual strengthening of the flexor-pronator muscles. Strengthening will slowly begin with isometrics and progresses to eccentric exercises helping to extend the range of motion back to where it once was. After the strengthening exercises, it is common for the subject to ice the area.[ vague ]

Surgery

After 6 months if the symptoms do not improve, surgery may be recommended. Surgical debridement or cleaning of the area is one of the most common treatments. [7] The ulnar nerve may also be decompressed surgically. [8] If the appropriate remediation steps are taken - rest, ice, and rehabilitative exercise and stretching - recovery may follow. Few subjects will need to progress to steroid injection, and less than 10% will require surgical intervention. [8] Arthroscopy is not an option for treating golfer's elbow. [7]

See also

Related Research Articles

Humerus Long bone of the upper arm

The humerus is a long bone in the arm that runs from the shoulder to the elbow. It connects the scapula and the two bones of the lower arm, the radius and ulna, and consists of three sections. The humeral upper extremity consists of a rounded head, a narrow neck, and two short processes. The body is cylindrical in its upper portion, and more prismatic below. The lower extremity consists of 2 epicondyles, 2 processes, and 3 fossae. As well as its true anatomical neck, the constriction below the greater and lesser tubercles of the humerus is referred to as its surgical neck due to its tendency to fracture, thus often becoming the focus of surgeons.

Median nerve Nerve of the upper limb

The median nerve is a nerve in humans and other animals in the upper limb. It is one of the five main nerves originating from the brachial plexus.

In human anatomy, the extensor carpi ulnaris is a skeletal muscle located on the ulnar side of the forearm. It acts to extend and adduct at the carpus/wrist from anatomical position.

Flexor carpi radialis muscle

In anatomy, flexor carpi radialis is a muscle of the human forearm that acts to flex and (radially) abduct the hand. The Latin carpus means wrist; hence flexor carpi is a flexor of the wrist.

Ulnar nerve

In human anatomy, the ulnar nerve is a nerve that runs near the ulna bone. The ulnar collateral ligament of elbow joint is in relation with the ulnar nerve. The nerve is the largest in the human body unprotected by muscle or bone, so injury is common. This nerve is directly connected to the little finger, and the adjacent half of the ring finger, innervating the palmar aspect of these fingers, including both front and back of the tips, perhaps as far back as the fingernail beds.

Tennis elbow Condition in which the outer part of the elbow becomes sore and tender

Tennis elbow, also known as lateral epicondylitis, is a condition in which the outer part of the elbow becomes painful and tender. The pain may also extend into the back of the forearm and grip strength may be weak. Onset of symptoms is generally gradual. Golfer's elbow is a similar condition that affects the inside of the elbow.

Cubital fossa

The cubital fossa,chelidon, or elbow pit is the triangular area on the anterior view of the elbow of a human or other hominid animal. It lies anteriorly to the elbow when in standard anatomical position.

Flexor carpi ulnaris muscle

The flexor carpi ulnaris (FCU) is a muscle of the forearm that flexes and adducts at the wrist joint.

Lateral epicondyle of the humerus Structure of humerus

The lateral epicondyle of the humerus is a large, tuberculated eminence, curved a little forward, and giving attachment to the radial collateral ligament of the elbow joint, and to a tendon common to the origin of the supinator and some of the extensor muscles. Specifically, these extensor muscles include the anconeus muscle, the supinator, extensor carpi radialis brevis, extensor digitorum, extensor digiti minimi, and extensor carpi ulnaris. In birds, where the arm is somewhat rotated compared to other tetrapods, it is termed dorsal epicondyle of the humerus. In comparative anatomy, the term ectepicondyle is sometimes used.

The pronator teres is a muscle that, along with the pronator quadratus, serves to pronate the forearm. It has two attachments, to the medial humeral supracondylar ridge and the ulnar tuberosity, and inserts near the middle of the radius.

Snapping hip syndrome Medical condition

Snapping hip syndrome, also referred to as dancer's hip, is a medical condition characterized by a snapping sensation felt when the hip is flexed and extended. This may be accompanied by a snapping or popping noise and pain or discomfort. Pain often decreases with rest and diminished activity. Snapping hip syndrome is commonly classified by the location of the snapping as either extra- articular or intra-articular.

Medial epicondyle of the humerus A rounded eminence on the medial side of the humerus

The medial epicondyle of the humerus is an epicondyle of the humerus bone of the upper arm in humans. It is larger and more prominent than the lateral epicondyle and is directed slightly more posteriorly in the anatomical position. In birds, where the arm is somewhat rotated compared to other tetrapods, it is called the ventral epicondyle of the humerus. In comparative anatomy, the more neutral term entepicondyle is used.

Anterior interosseous nerve

The anterior interosseous nerve is a branch of the median nerve that supplies the deep muscles on the anterior of the forearm, except the ulnar (medial) half of the flexor digitorum profundus. Its nerve roots come from C8 and T1.

The common flexor tendon is a tendon that attaches to the medial epicondyle of the humerus.

Ulnar nerve entrapment Medical condition

Ulnar nerve entrapment is a condition where the ulnar nerve becomes physically trapped or pinched, resulting in pain, numbness, or weakness, primarily affecting the little finger and ring finger of the hand. Entrapment may occur at any point from the spine at cervical vertebra C7 to the wrist; the most common point of entrapment is in the elbow. Prevention is mostly through correct posture and avoiding repetitive or constant strain. Treatment is usually conservative, including medication, activity modification and exercise, but may sometimes include surgery. Prognosis is generally good, with mild to moderate symptoms often resolving spontaneously.

Elbow Joint between the upper and lower parts of the arm

The elbow is the visible joint between the upper and lower parts of the arm. It includes prominent landmarks such as the olecranon, the elbow pit, the lateral and medial epicondyles, and the elbow joint. The elbow joint is the synovial hinge joint between the humerus in the upper arm and the radius and ulna in the forearm which allows the forearm and hand to be moved towards and away from the body.

Median nerve palsy Medical condition

Injuries to the arm, forearm or wrist area can lead to various nerve disorders. One such disorder is median nerve palsy. The median nerve controls the majority of the muscles in the forearm. It controls abduction of the thumb, flexion of hand at wrist, flexion of digital phalanx of the fingers, is the sensory nerve for the first three fingers, etc. Because of this major role of the median nerve, it is also called the eye of the hand. If the median nerve is damaged, the ability to abduct and oppose the thumb may be lost due to paralysis of the thenar muscles. Various other symptoms can occur which may be repaired through surgery and tendon transfers. Tendon transfers have been very successful in restoring motor function and improving functional outcomes in patients with median nerve palsy.

Injuries in rock climbing may occur due to falls, or due to overuse. Injuries due to falls are relatively uncommon; the vast majority of injuries result from overuse, most often occurring in the fingers, elbows, and shoulders. Such injuries are often no worse than torn calluses, cuts, burns and bruises. However, overuse symptoms, if ignored, may lead to permanent damage.

Ulnar collateral ligament injury of the elbow Medical condition

Ulnar collateral ligament injuries can occur during certain activities such as overhead baseball pitching. Acute or chronic disruption and/or attenuation of the ulnar collateral ligament often result in medial elbow pain, valgus instability, neurologic deficiency, and impaired throwing performance. There are both non-surgical and surgical treatment options.

Muscle strain is one of the most common injuries in tennis. When an isolated large-energy appears during the muscle contraction and at the same time, bodyweight applies huge amounts of pressure to the lengthened muscle, which can result in the occurrence of muscle strain. Inflammation and bleeding are triggered when muscle strain occur which resulted in redness, pain and swelling. Overuse is also common in tennis players from all levels. Muscle, cartilage, nerves, bursae, ligaments and tendons may be damaged from overuse. The repetitive use of a particular muscle without time for repair and recover in the most common case among the injury.

References

  1. "Pitcher's Elbow - Stanford Sports Medicine - Stanford Medical Outpatient Center". Stanford University Medical Center . Retrieved 9 September 2009.
  2. "McGraw-Hill Connect". connect.mcgraw-hill.com. Retrieved 13 April 2018.
  3. "The Basics of Golfer's Elbow". webmd.com. Retrieved 13 April 2018.
  4. 1 2 Kiel, John; Kaiser, Kimberly (27 October 2018), Golfers elbow, StatPearls Publishing, PMID   30085542 , retrieved 2019-03-12
  5. Wilson, JJ; Best, TM (1 September 2005). "Common overuse tendon problems: A review and recommendations for treatment". Am Fam Physician. 72 (5): 811–8. PMID   16156339 . Retrieved 4 June 2012.
  6. Matthews, Phillip. "Acute Classification in Tennis and Golfer's Elbow" (PDF). Oxford Journal. Retrieved 1 March 2012.[ dead link ]
  7. 1 2 3 4 Amin, Nirav H.; Kumar, Neil S.; Schickendantz, Mark S. (1 June 2015). "Medial Epicondylitis: Evaluation and Management". Journal of the American Academy of Orthopaedic Surgeons. 23 (6): 348–355. doi:10.5435/JAAOS-D-14-00145. ISSN   1067-151X. PMID   26001427. S2CID   31827631.
  8. 1 2 3 4 5 Gibbs, Sharon J.; Dauber, Kenneth S. (8 September 2014). "Medial Epicondylitis". eMedicine. Retrieved 13 January 2014.
  9. "Golfers Elbow | Orthopedic Solutions". orthopedicsolutionsokc.com.
  10. Jacobs, J.W.G.; Michels-van Amelsfort, J.M.R. (April 2013). "How to perform local soft-tissue glucocorticoid injections?". Best Practice & Research Clinical Rheumatology. 27 (2): 171–94. doi:10.1016/j.berh.2013.03.003. PMID   23731930.
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