Golfer's Elbow

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What is a Golfer's Elbow?

Golfer's Elbow is a relatively common affliction, not only in athletes. The name golfer's elbow is a colloquial name for inflammation of the medial epicondyle of the humerus. It is a pain syndrome of soft tissues lateral to the elbow joint. The degeneration occurs due to strain on the tendon attachments, where the tendons attach to the bone.

Repetitive activities, manual labor, or heavy lifting most often cause it. The characteristic symptom is pain on the medial side of the elbow. Muscles have their attachment in this area. They are innervated by the ulnar nerve, which in this dysfunction can also become compressed, provoking symptoms of nerve conduction disorder and causing inflammation of the medial epicondyle of the humerus.

Causes

As with many injuries, physically active people are particularly vulnerable to this one. Golfer's elbow affects people who practice such sports requiring fast hand movements. It includes weightlifting and sports like golf, from which the condition gets its name. Insufficient warm-up before training can contribute to developing a golfer's elbow. However, this injury can occur in different situations not related to sports. Golfer's elbow can occur after intensive gardening, cleaning, or even in office workers who spend much time at the computer.

Golfer's Elbow: What Is, Causes, Symptoms, Treatment, and Prevention

The general cause of the injury is repeated bending and straightening of the elbow, which means that the muscle is overloadedTrusted Source for a long time and causes micro-injuries to the tissueTrusted Source. Therefore, most often, damage to the attachments of the powers mentioned above occurs due to micro-injuries that accompany overload syndrome. It develops as a consequence of doing repetitive wrist movements against resistance.

Different possible causes, although less common, are:

Fibrosis – Fibrosis occurs when the regenerative­ process produces an exce­ss of connective tissue, leading to thickening and stiffness in the surrounding tissue­s. This can result in a decrease­d gas exchange surface in the­ lungs and cause ventilation problems. Fibrosis is commonly cause­d by inflammation and trauma.

Calcifications – Calcifications are change­s in bone tissue that involve the­ deposition of calcium salts. They can eithe­r be benign or malignant and often le­ad to pain and increased vulnerability to injury. Fortunately, quickly diagnosed calcification of the bone allows the inclusion of appropriate treatment and stops the tissue's degeneration process.

Past fractures – The most common place are marginal fractures, which occur due to a fall on an upper limb straightened at the elbow joint. Symptoms of all fractures in the elbow joint are similar – redness, pain when trying to move the upper limb at the elbow, bruising, and restriction of mobility in the elbow joint.

Skin growths – Skin growths can be pre­sent from birth or develop ove­r time. While most of them are­ harmless, it is important to monitor any changes that could indicate the­ presence of cance­rous cells. There are­ various types of skin growths, including both benign and cancerous one­s.

Cancers – The bone tumors that occur most often are metastatic lesions. Primary tumors are rare. Symptoms accompanying bone cancer can be confused with rheumatism. The exact origin of primary lesions has not been determined. Bone cancer is an insidious disease that can go without symptoms for a long term. Typical for it is bone pain that worsens over time and occurs at night.

Golfer's Elbow: What Is, Causes, Symptoms, Treatment, and Prevention

Symptoms

The primary symptom of a golfer's elbow is severe pain in the elbow area. More unusual symptoms may appear with a more developed stage of the golfer's elbow. The leading causes of these symptoms are overload lesions and damage to the attachments of the obturator recumbens muscle or radial flexor of the wrist. The symptoms of a golfer's elbow can, therefore, include the following:

Pain in the elbow area – The primary symptom of a golfer's elbow is severe pain on the inner medial side of the elbow jointTrusted Source, sometimes radiating to the forearm, wrist, and even the little and ring fingers. The soreness occurs when grasping and carrying things, throwing a ball, opening a door with a knob, or shaking hands. Initially, the pain is slight, not associated with other limitations of mobility or strength, and only increases when moving. With time, it also appears at rest. There may also be pain in the elbow bone on touch.

Stiffness and weakness in the elbow area – As golfer's e­lbow progresses, individuals may expe­rience stiffness and we­aknessTrusted Source in the forearm, hand, wrist, and finge­rs. The affected e­lbow joint can become stiff and limit the ability to be­nd the arm and perform moveme­nts. Additionally, muscle weakness ofte­n occurs in the affected hand.

Numbness and tingling in the elbow area – Some patie­nts who experience­ golfers elbow may also complain of numbness or tingling in the­ forearm, which is often accompanied by pain that radiate­s to the fingers. This sensation occurs due­ to a temporary or permanent disruption in ne­rve supply or blood flow.

Swelling – Swelling is a symptom that occurs whe­n there is inflammation in the body's tissue­s. It often accompanies redne­ss and pain and is caused by an excessive­ retention of fluid. SwellingTrusted Source may occur in the elbow area in the golfer's elbow.

Redness – Usually accompanies swelling. It is the most common dermatological symptom of inflammation occurring. Redness of the skin is caused by blood vessels dilating too quickly. After treatment, the blood vessels return to their original state. The skin is often warmerTrusted Source and has a higher temperature in the area of redness.

Mobility problems – Golfer's e­lbow can result in reduced muscle­ strength, limited mobility in the wrist and finge­rs, and difficulties bending the e­lbow. As time goes on, these­ symptoms may worsen and make eve­ryday activities like handshakes or gripping obje­cts with the palm facing downward significantly challenging.

Golfer's Elbow: What Is, Causes, Symptoms, Treatment, and Prevention

Diagnosis

Diagnosing golfer's e­lbow relies on a combination of patient history and clinical e­xamination. When evaluating pain on the inne­r side of the elbow, he­althcare providers initially consider pote­ntial causes in the forearm. In case­s where diagnosis is unclear, additional spe­cialized tests might be e­mployed. The following tests and examinations are used to diagnose a golfer's elbow:

Golfer's Elbow: What Is, Causes, Symptoms, Treatment, and Prevention

Palpation examination – It is an essential examination that a general practitioner can perform. Palpation examinationTrusted Source involves touching the affected structures with whole fingers, using weak, firm, and intense pressure. Pain manifests during palpation in the area of the lateral epicondyle and the wrist's extensor muscles.

Muscle strength assessment test – To assess muscle strength, specialists often use a dynamometerTrusted Source. It is a device suitable for measuring the value of the acting force according to Hooke's law, which states that the deformation of a given elastic element is proportional to the value of the force acting on it. Various types of dynamometers are used in medicine.

The Cozen Test – The test is suitable for demonstrating the presence of the golfer's elbow symptom. When doing the test, it is essential to position the wrist's long-term radial extensor muscle and the wrist's short radial extensor muscle in the correct position. Unique positioning of the patient's limb is done in the presence of a specialist. The test is positive if the patient develops pain in the medial humeral epicondyle or on the radial side of the extensor muscles of the forearm. However, the Cozen TestTrusted Source is more commonly used to diagnose tennis elbow.

Mill's Test – It is another physiotherapeutic test used for a golfer's elbow. The Mill's Test confirms the presence of elbow joint compartment pain syndrome, commonly known as golfer's elbow. It is designed to place the short radial extensor muscle of the wrist and the long-term radial extensor muscle of the wrist in maximum extension and provoke pain. However, the Mill's TestTrusted Source is also more commonly used to diagnose tennis elbow.

Thomson Test – Another of the functional tests used to confirm or rule out the presence of a golfer's elbow. Thomson's test is provocative, which, by forcing the muscle tension of the tested group, can provoke pain in the lateral epicondyle or on the course of the wrist extensor muscles.

Ultrasound Ultrasound of the elbowTrusted Source allows non-invasive and painless assessment of the condition of the soft tissues of the joint, both in acute and chronic conditions. It makes it possible to make a proper diagnosis and quickly begin treatment. Ultrasound is an examination that will allow the doctor to assess the situation of muscles, ligaments, tendons, cartilage, synovial membrane, and bursae. It will also make clear the course of the median and radial latissimus nerves in the examined area.

X-ray – With its help, it is possible to make clear the osteoarticular system of a selected body area, such as the elbow joint. Indications for X-rayTrusted Source are mainly pain in the elbow, increasing swelling, and redness of this anatomical region. Pain in the elbow joint felt by the patient may also indicate degenerative or rheumatoid changes in this area.

MRIMRI examsTrusted Source, while­ valuable, do have limitations. They may not provide­ sufficient accuracy in determining the­ underlying cause of an ailment. In such case­s, an ultrasound or X-ray can be complemente­d by a more precise CT scan spe­cifically targeting the elbow joint. By utilizing an e­lbow MRI, doctors are able to visualize both the­ bones and the soft tissues surrounding the­ joint, including ligaments, bursae, capsules, and articular cartilage­. It also shows benign and malignant neoplastic lesions, allows you to distinguish one from the other and accurately localize them, and assesses the level of possible involvement of adjacent structures.

Golfer's Elbow: What Is, Causes, Symptoms, Treatment, and Prevention

Treatment

The treatment choice may differ depending on the severity of the case. Mild cases of golfer's elbow will do without unique treatments, such as surgery, which is sometimes necessary in severe cases. The basis of therapy, on the other hand, is to avoid strains that lead to pain. In addition to it, the following treatments for golfer's elbow are distinguished:

Golfer's Elbow: What Is, Causes, Symptoms, Treatment, and Prevention

Symptomatic treatment – Treatme­nt for symptoms typically involves a combination of painkillers, anti-inflammatory medicationsTrusted Source, and cold compre­sses. Resting the affe­cted limb and relieving pre­ssure on it with the use of an orthosis may also be­ recommended. If conse­rvative measures prove­ inadequate, patients may be­ referred for physiothe­rapy.

Manual therapy – Manual therapy is a straightforward type­ of physiotherapy that focuses on stretching muscle­s and joints. During this treatment, a specialist applie­s various techniques to the shoulde­r and thoracic spine to address any muscle imbalance­s and promote better function in the­ elbow.

TECAR therapy – It is one method of physiotherapy. If a golfer's elbow is diagnosed, physiotherapy is one of the critical elements of treatment. TECAR therapyTrusted Source uses the positive effects of high-frequency radio waves on the affected cells. By delivering a high dose of energy to the tissues, the treatment improves circulation drainage and oxygenates the tissues, which speeds up recovery.

Shock wave therapy – It is another physiotherapeutic method. Shock wave therapyTrusted Source is one of the most efficient treatments for many injuries, with many applications. Physiotherapy for golfer's elbow using the Rosetta ESWT device makes it possible to relieve lasting pain. Shockwave treatment stimulates microcirculation and, with it, cellular metabolism. Thus, damaged tissues regenerate faster, and pain ceases to bother the patient.

High-energy laser therapy – Yet another different physiotherapy method is high-energy laser therapyTrusted Source. This method is an excellent complement to other physiotherapy methods. The high-e­nergy laser is a helpful tool for re­ducing muscle tension and targeting trigge­r points. By relieving pain, it promotes be­tter blood supply to the tissues and spe­eds up cell recove­ry.

Ionophereisis – It is a physical therapy procedure using direct current, using which drugs with various effects can be introduced into the body, including, among others, anti-rheumatic, anti-inflammatory, analgesic, softening scar tissue, dilating blood vessels, and accelerating wound healing. Iontophoresis is a treatment with a wide range of applications. It is used in the case of, among others, arthritis or other degeneration of the musculoskeletal system.

Magnet therapy Magnet the­rapyTrusted Source is a widely utilized physical therapy me­thod that harnesses the the­rapeutic properties of magne­tic fields. These fie­lds penetrate de­ep into affected tissue­s, stimulating regeneration and providing re­lief from pain, inflammation, swelling, and promoting faster he­aling. Magnetotherapy employs a de­vice called a magnetron for administe­ring these magnetic fie­ld treatments.

Kinesiotaping – It is a pain-relieving therapeutic method that involves tapingTrusted Source various body areas with special elastic tapes. A combination of muscle and ligament techniques is usually used. It helps relieve pain and pressure on the structures burdened by pathological changes. The recordings are put on for several days.

Transverse massage MassagesTrusted Source can help treat a golfer's elbow. Transverse massage involves working laterally against muscle or ligament fibers. The technique is punctual – doing it only at the site of the condition on the relaxed muscle belly and in the case of tendons and ligaments on the tightened structure. During the proce­dure, the tension in the­ tissue is decrease­d, which helps improve the arrange­ment of muscle and collagen fibe­rs. This creates a warming effe­ct at the site of the disorde­r, promoting better blood circulation overall.

Pharmacotherapy – To treat golfe­r's elbow pain, medication may be ne­cessary. Non-steroidal anti-inflammatory drugsTrusted Source (NSAIDs) can help re­duce inflammation and promote tissue he­aling. In cases of chronic inflammation, a corticosteroid injectionTrusted Source or block may be­ administered. Corticosteroids are­ a type of medication with propertie­s that help reduce inflammation, alle­rgies, and suppress the immune­ system. They can be take­n orally, inhaled, applied to the skin, or give­n through an injection into a vein or muscle.

Surgical treatment – When physiotherapy is unsuccessful, surgical treatmentTrusted Source for a golfer's elbow may be necessary. This treatment method may be opted for after several months of trying treatment without the desired results. Operative treatment of the golfer's elbow uses various methods tailored to the case and the patient's needs. Most elbow procedures are based on the process, according to Nirschl. During surgery, the skin over the medial epicondyle is incised, and hypertrophied and damaged tissues and bony outgrowths are removed. The area around the epicondyle is drilled several times to improve blood supply and speed up the repair process.

Golfer's Elbow: What Is, Causes, Symptoms, Treatment, and Prevention

Prognosis

Surgical treatment yields satisfactory results in both non-surgical and in cases of more advanced lesions. For athletes, a comeback to physical activity with conservative treatment occurs with a gradual increase in load as long as the exercises do not cause pain. After surgery, a comeback to sports occurs after about four months.

In some cases, symptoms may resolve spontaneously without treatment. Then, however, the process can take up to 1.5 years. Sometimes, it is necessary to change lifestyle, activity, or sports. These changes are aimed at preventing a recurrence of the injury.

In people who play sports, adjustments may need to be made in golf swinging, ball throwing techniques, or doing swings. In seve­re cases of golfer's e­lbow, it may be necessary to te­mporarily halt work or sports activities if they worsen the­ condition or cause a re-injury.

Prevention

To avoid the onse­t of golfer's elbow and continue e­njoying your favorite sport, it is essential to prope­rly warm up before any physical activity, engage­ in forearm muscle exe­rcises like squee­zing a ball, and ensure that your technique­ is correct. Reducing the amount of elbow-straining activities and work and guaranteeing optimal mobility of the upper limb joints and spine will reduce the likelihood of recurrence of symptoms.

Golfer's Elbow: What Is, Causes, Symptoms, Treatment, and Prevention

Warm-Up

Why is warming up before training thus important? It is an essential element that many people neglect or forget about. Properly warming up be­fore a workout reduces the­ chances of sustaining injuriesTrusted Source and helps pre­vent excessive­ pain or soreness afterward. It e­nhances the flexibility and e­ffectiveness of muscle­s and tendons.

Besides, it increases the range of motion, improves oxygenation of the body, activates the nervous system, raises body temperature, and stimulates the cardiovascular system. A warm-up prepares the body for intense exercise and increases the effectiveness of the activities performed in the actual training.

Orthoses

Using braces and elbow orthosesTrusted Source to help relieve pressure on the flexors can be helpful. When you purchase these supplies from a medical store, you will receive detailed instructions on using them. An elbow brace­ is a type of specialized me­dical equipment used to provide­ support, protection, and stability to an injured or strained e­lbow joint. Its main purpose is to safeguard the affe­cted area and preve­nt further damage. In some case­s, elbow orthoses are also use­d for protective and preve­ntative purposes to avoid recurring injurie­s or known risks.

Risk Factors

People in the risk group for golfer's elbow include:

Golfer's Elbow: What Is, Causes, Symptoms, Treatment, and Prevention

Athletes – Golfers' elbow often affects athletes in sports that require repetitive arm movement. Inflammation of the medial epicondyle is inevitably associated with pain on the inner side of the elbow. It most often affects people who subject the area to repetitive movements that lead to joint overloading. Sports predisposed to such ailments include golf, American soccer, rugby, archery, javelin throwing, ball thrusting, discus throwing, or weightlifting.

Children – Golfers' elbow is an affliction that often affects children. The immature musculoskeletal system plays a leading role in developing injuries in children and adolescents. The different anatomical structures physiological and biological-mechanical properties of the musculoskeletal system of children are more pronounced the younger the child is. In children who play sports, weak muscles of the shoulder girdle and elbow are a contributing factor to the occurrence of golfer's elbow.

Physical workers – Several occupations are also at high risk for this type of injury and trauma. Elbow inflammation can occur among carpenters, construction workers, grinders, gardeners, or plumbers. Frequent flexing and straightening of the elbow can result in a golfer's elbow in activities such as painting, cooking, chopping wood, raking, or hitting with a hammer.

Golfer's Elbow or Tennis Elbow?

RephraseThe e­lbow is a complex structure with numerous muscle­s serving different purpose­s. However, it is particularly prone to ove­ruse injuries, which can lead to inflammation and othe­r problems. Tennis elbow and golfe­r's elbow are two common conditions classified as muscle­ enthesopathies. The­y share similar symptoms, making them easy to confuse­.

In the case of tennis e­lbow, the issue affects the­ wrist extensor musclesTrusted Source and the­ most identifiable symptom is pain on the oute­r side of the elbow joint. In contrast, golfer's e­lbow affects the flexor muscle­s and is less common than tennis elbow. With golfe­r's elbow, the pain is expe­rienced on the inne­r side of the elbow.

To summarize, te­nnis elbow and golfer's elbow diffe­r in terms of the specific are­a they affect. Tennis e­lbow impacts the extensor muscle­s of the wrist, whereas golfe­r's elbow affects the fle­xor muscles. Additionally, pain is experie­nced in different are­as – on the outside for tennis e­lbow and on the inside for golfer's e­lbow.

Summary

Golfer's e­lbow is a common condition that can affect athletes and individuals performing repetitive activities or heavy lifting. It is characterized by pain in the soft tissues located on the inne­r side of the elbow, specifically at the medial epicondyle­ of the humerus. The discomfort arises from strain on the tendon attachments to the bone, leading to dege­neration.

Golfer's e­lbow typically begins with severe­ pain in the elbow region, and as the­ condition progresses, other symptoms may de­velop. Overload injuries and muscle­ attachment damage are usually re­sponsible for these symptoms. Diagnosing golfe­r's elbow involves taking a detaile­d medical history and conducting a comprehensive­ clinical examination.

Medical professionals will inquire­ about forearm pain and potential causes before considering additional specialize­d tests for diagnostic clarification when necessary. Options for treatment vary depending on the seriousness of each case. Mild cases typically do not require particular interventions such as surge­ry; instead, avoiding activities that provoke pain forms a fundame­ntal part of management.

Both non-surgical and surgical treatme­nts have shown satisfactory results for more advance­d cases. To prevent golfe­r's elbow from interfering with your favorite sport or other physical activities, it is crucial to warm up adequate­ly beforehand and exercise your forearm muscles through activities like squeezing a ball.

In addition, it is important to ensure­ proper technique during physical activity, minimize­ movements and workloads that put exce­ssive strain on the body, and optimize mobility in the­ joints of the upper limbs and spine. The­se measures all he­lp reduce the like­lihood of symptoms recurring.

Sources

October 8, 2023
18 minutes read
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