Golfer’s elbow

Golfer’s elbow, or medial epicondylitis, is an inflammatory condition of the elbow which in some ways is similar to tennis elbow.
The flexor Muscles of the forearm, the Muscles responsible for bending the fingers and thumb, clenching the fist and supinating the hand excluding biceps brachialis, come together in a common tendon which is inserted in to the medial epicondyle of the humerus at the elbow joint. In response to minor injury, or sometimes for no obvious reason at all, the point of insertion becomes inflamed.

Causes

The condition is called Golfer’s elbow because in making a golf swing this tendon is stressed; many people, however, who develop the condition have never handled a golf club. 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.

Symptoms

The predominant symptom is pain on the medial aspect of the elbow joint, which is made much worse if the flexor Muscles of the forearm are under tension but may occur at rest. On examination the medial epicondyle of the humerus is exquisitely tender. There may be some weakness of flexor function, caused by pain-mediated reflex inhibition of function of the flexor Muscles.

Treatment

Simple analgesic medication has a place, as does more specific treatment with oral anti-inflammatory medications. The definitive treatment is, however, the injection into and around the inflamed and tender area of a long-acting glucocorticoid (steroid) agent. After causing an initial exacerbation of symptoms lasting 24 to 48 hours, this will produce a resolution of the condition in some five to seven days.
The ulnar nerve runs in the groove between the medial humeral epicondyle and the olecranon process of the ulna. It is most important that this nerve should not be damaged accidentally in the process of injecting a Golfer’s elbow.

Tennis Elbow

Tennis Elbow is a condition where the outer part of the elbow becomes painful and tender, usually as a result of a specific strain or overuse. Although it is called “tennis elbow”, it is not restricted to tennis players –hyperextensions of the elbow, from whatever cause, can be classified as tennis elbow. Anyone who does a lot of work involving lifting at the elbow or repetitive movements at the wrist is susceptible to tennis elbow. The condition was first described in 1883.[1]. The medical term is lateral epicondylitis.

Etiology

With tennis elbow, the extensor carpi radialis brevis tendon has been identified as the primary site of pathological change. There have also been pathological changes found at the extensor digitorum communis, longus and ulnaris tendons. The extensor carpi radialis brevis has a small origin and does transmit large forces through its tendon during repetitive grasping. It has also been implicated as being vulnerable during shearing stresses during all movements of the forearm. There is no evidence relating mode of onset to pathology although it is generally acknowledged that tennis elbow is caused by repetitive microtrauma/overuse. Inflammatory changes have been noted in the acute stages of the condition but have been found to be absent if symptoms become chronic (3 months +). This may explain why approaches such as corticosteroid injections have little impact in the chronic stages of the condition. Although the name suggests otherwise, tennis elbow can affect anyone - not just racquet sport players. However, there are numerous studies that have implicated racquet sports as a cause or contributing factor for tennis elbow. The peak incidence is between 34 to 54 years of age. No difference in incidence between men and women or association between tennis elbow and the dominant hand has been demonstrated. A weak association has been found between work and tennis elbow development. Risk factors for this condition vary from taking up tennis later in life, unaccustomed strenuous activity, decreased reaction times and speed and repetitive eccentric muscle contractions (controlled lengthening of a muscle group).

Symptoms

• Pain on the outer part of elbow (lateral epicondyle).
• Gripping and movements of the wrist hurt, especially wrist Extension and lifting movements.
• Tenderness to touch, and elbow pain on simple actions such as lifting up a cup of coffee or throwing a baseball.
• Pain usually subsides overnight.
• If no treatment given, can become chronic and more difficult to eradicate.

Exams and Tests

The diagnosis is made by clinical signs and symptoms, since x-rays usually show no abnormality. Often there will be pain or tenderness when the tendon is gently pressed near where it attaches to the upper arm bone, over the outside of the elbow.
There is also pain near the elbow when the wrist is extended (bent backwards, as when applying a motorcycle’s throttle) against resistance.
Treatment

Exercises and stretches

Stretches and progressive strengthening exercises are essential to prevent re-irritation of the tendon. Progressive strengthening for this condition involves using weights or elastic theraband to increase pain free grip strength and forearm strength. Racquet sport players also are commonly advised to strengthen their shoulder rotator cuff, scapulothoracic and abdominal Muscles by Physiotherapists to help reduce any overcompensation in the wrist extensors during gross shoulder and arm movements. Soft Tissue Release or simply Massage can help reduce the muscular tightness and reduce the tension on the tendons. Strapping of the forearm can help realign the muscle fibers and redistribute the load.