Golfer's Elbow

WHAT IS IT?

• Inflammation (ITIS) of the wrist and finger tendons that attach to the bone at the inside of the elbow (MEDIAL EPICONDYLE)

HOW DO THE MUSCLES AND TENDONS WORK?

• flex the wrist and fingers to grasp or make a fist
• turn forearm down (pronate)

WHAT HURTS?

• tender medial epicondyle (near the funny bone), may have diffuse discomfort down the forearm and into the fingers
• pain on grasping, squeezing e.g. golf grip, tennis racquet, shaking hands, steering car, carrying briefcase, writing
• pain lifting objects
• pain when bending and straightening elbow, and when rotating forearm
  • early stage: pain after play
  • middle stage: pain during play
  • late stage: pain at rest, at night
• pain is NOT limited to golfers!!!

WHAT SHOWS UP ON X-RAY?

• usually nothing
• calcium deposit in advanced stage only occasionally
• carrying angle (angle between upper arm and forearm normally 5-20 degrees) measurement

WHAT CAUSES IT?

• overuse, sport or daily activity related
• weak grip strength
• improper technique of swing or stroke
• equipment error - grip size or weight of club or racquet
• direct trauma
• cervical spine nerve pinching or adverse tension
• untreated past injury of the upper extremity or fracture
• elbow hyperextension, "double jointed"
• carrying angle > 20 degrees

WHY DOES IT HURT?

• muscle and tendon overexertion causes pulling of tendon from bone
• microtearing of tendon, haemorrhage, inflammation, scarring, degeneration and shortening of the tendon
• becomes easier and easier to tear, unless treated
• poor nutrition from the nerve to the medial epicondyle also causes tendon degeneration and pain

WHAT DO I DO?

• rest from painful activities
• analyze cause, address biomechanical causes with appropriate mobilizing and stretching of shortened structures and strengthening of supportive structures as outlined by your physiotherapist

NO TWO PEOPLE ARE ALIKE ** NO TWO EXERCISE PROGRAMS ARE ALIKE

• correct equipment errors
• correct style errors
• compressive bracing prevents tendon pulling from bone and absorbs vibration
• ice cube massage, 10 minutes, three times a day
• deep transverse friction massage breaks down scarring, relieves pain, and assists tendon healing
• anti-inflammatory medication if necessary prescribed by your physician
• therapeutic modalities: ULTRASOUND, INTERFERENTIAL CURRENT
• cortisone injection (only as required in few cases)

HOW DO I PREVENT IT?

• avoid overuse by gradually increasing in intensity and frequency of play/activity
• avoid technique and equipment errors
• maintain flexibility and strength of forearm muscles
• maintain mobility of potentially restrictive structures
• many cases should be able to return to activity without a brace, a brace may be used on initial stages of returning to the aggravating activity

WHAT ELSE CAUSES PAIN IN THIS AREA?

• joints of the lower cervical and upper thoracic spine
• muscles from the shoulder
• elbow ligaments
• stress fracture
• adverse neural tension in the upper extremity
• periostitis (bone inflammation)
• systemic medical disorder such as rheumatoid arthritis

Together, our staff of registered orthopaedic physiotherapists offers many years of experience in the field of orthopaedics and sports medicine. Our treatment philosophy remains constant: to offer one-on-one treatment that focuses on your specific needs via manual therapy, active exercise, education and prevention. We are confident that our staff can provide you with the services you need should you require them. We are a client-focused practice that is committed to your health care needs.

YOUR PHYSIOTHERAPIST CAN HELP YOU WITH THE REST…