Medial Epicondylitis AKA Golfers Elbow
Hi Everyone, following on from lasts week topic on lateral epicondylitis or ‘tennis elbow’ today we are going to discuss pain affecting the inside or medial side of the elbow.
This condition is known as medial epicondylitis or more commonly ‘golfers elbow’.
Medial epicondylitis is a common condition that affects the muscles and tendons along the little finger side of the forearm and elbow.
However, although the name suggests it only affects golfers, it is also prevalent in people who engage in a lot of activity involving repetitive use of the arms or wrists.
Specifically, medial epicondylitis affects the tendons of the muscles which arise from the medial epicondyle of the elbow and run through the wrist to insert in the hand and fingers.
These muscles and tendons are primarily responsible for bending or flexing the joints in the fingers and wrist.
The tendons belong to a group of muscles commonly termed the flexor bulk who individually are made up of pronator teres, flexor carpi radialis, palmaris longus, flexor digitorum superficialis and flexor carpi ulnaris.
In this condition an external irritation, often caused by repetitive activation, causes these muscles and tendons to become swollen and painful.
Symptoms of the condition can present as pain on the inside of the elbow, stiffness at the elbow, weakness in the hand and wrist and sometimes a tingling sensation or numbness down the inside of the arm, into the wrist and specifically the ring and little fingers.
Medial epicondylitis is usually caused by one of two things:
1. Repetitive Overuse à Overuse injuries are commonly seen in athletes such as golfers, baseball players, rower and weightlifters. It is also common in occupations such as painting, carpentry, butchers and plumbers who are almost always using their arms in a loaded position (gripping, vibration from power tools etc).
In these cases, the constant and repetitive use of the small muscles in the forearms outweighs the amount of strength they have. This loading eventually becomes too much for the muscles doing the work which respond by becoming tight and pulling the tendon away from its insertion on the medial epicondyle. The repetitive pulling creates micro tears through the tendon resulting in inflammation, pain and swelling over the inside of the elbow.
2. Specific Trauma à Direct trauma to the medial epicondyle (such as a bump or knock) can itself cause inflammation to the area. Given the high use of these muscles and tendons, once the inflammation is present, there is increased likelihood of developing medial epicondylitis, especially in the populations mentioned above.
Medial epicondylitis is usually well managed with a course of conservative therapy, administered and managed by your physiotherapist, chiropractor or remedial massage therapist. It will generally flow through 3 phases;
1. Phase 1 focuses on reducing pain and inflammation. This involves avoiding any aggravating activities (sport or work) for a short period to allow healing. Your therapist will also use ice, massage, dry needling, stretching and the use of a brace or taping to maximize pain relief.
2. Phase 2 focuses on maintaining pain relief whilst restoring range of motion and function to the elbow and wrist. This involves combining soft tissue therapies with a home program consisting of range of motion and low-grade strengthening exercises for the upper arm, forearm and wrist.
3. Phase 3 is the return to sport or sport specific strengthening phase. It begins when the pain has fully subsided, range of movement has been restored and functional strength has returned. During this phase your therapist will progress you through a series of eccentric and sport specific strengthening exercises to maximize strength and performance and minimize the risk of re occurrence in the future.
If a course of conservative therapy is found to be ineffective then other, more invasive, treatment options such as corticosteroid injections and potential surgery may be investigated.
Much like lateral epicondylitis the reason that medial epicondylitis can be so debilitating, is because it affects the tendon of the muscles that allow us to move our hands. Because we use our hands all the time once inflammation is present it can be difficult to rest enough to allow the necessary healing to occur. With this in mind, preventing the onset of inflammation is a much better option than trying to manage it. So 4 tips to minimise the risk of medial epicondylitis are:
1. Stretch the forearm, before and after, engaging in any work or activity that involves a lot of repetitive use of the hands. Hold each stretch for 15 seconds and repeat x 2.
2. Try to avoid activities that require repetitive movements of the wrist. If you can’t avoid these (i.e. painters, carpenters, using power tools) then wear a counterforce brace.
3. If you work on a computer, ensure your workstation is ergonomically set-up to keep your wrists in a neutral position.
4. Maintain good strength in the forearms and elbows by regularly performing resisted wrist flexion exercises. Use a light weight (1-2kg) or theraband (red, green or blue) and perform 3 sets of 10 repetitions.
So that’s a brief overview of how medial epicondylitis or golfers elbow occurs and how to avoid it. If you have questions or comments feel free to e-mail us at firstname.lastname@example.org and we will happily answer them for you.
If you think you may still be suffering from golfers elbow and want relief now, then call us on (08) 9486 8653 and we will arrange an appointment for you.