Golfers elbow, more technically called medial epicondylitis, is a similar type of condition to tennis elbow or lateral epicondylitis, but is less common. Since there is little or no inflammation present in these syndromes, they are known as tendinopathies, where degeneration of the tendon occurs and gives symptoms. Typical aggravating factors are racquet sports, golf and sports which involve throwing, although other sports people may be affected such as weight lifters, archers and cricket bowlers.
The muscles which flex and rotate the forearm originate over the medial epicondyle, the bony prominence on the inside of the elbow, with the tendon anchored into the bone by the tendinous insertion. The pain occurs close to this and may be due to a degenerative process occurring in the tendon, as little inflammation has been noted in these cases.
The flexor tendons are put under stress by activities which force the forearm outwards away from the body and these stresses occur as the wrist is cocked prior to throwing, in the early acceleration of the throw and in the golf swing from high backswing to just before the ball is hit. The dominant hand is affected in golfers and in tennis players those who impart a heavy topspin to the ball are more likely to suffer.Golfers elbow is not as common as tennis elbow but is the commonest cause of medial elbow pain with about half as many women affected as men. The third to fifth decades of life are the commonest periods for pain onset and 60% of golfers elbow occurs in the dominant hand. An acute onset of pain is reported in a third of patients, with the other two-thirds developing over a period of time.
Pain and ache over the front of the medial epicondyle is the typical symptom, worse with repeated flexion of the wrist and improved with resting. Shoulder, elbow, forearm or hand pain can occur, with weakness or pins and needles in the lower arm. Osteopathy examination includes the bony tendon insertions, the elbow joints and the muscles, with palpation of the funny bone area behind the elbow where the ulnar nerve lies. Nerve involvement can give weakness in the forearm muscles and sensory symptoms, so an exclusion neurological examination is performed by the osteo.
Conservative, non-surgical, treatment is the mainstay of management. This includes osteopathy, anti-inflammatory drugs, wrist splints and steroid injections. Patient education is important and activity modification is the first line of treatment, reducing the frequency of aggravating episodes. Altering the mechanics of the golf swing or other activity is vital if the area is to be allowed to settle. The patient avoids certain activities with the affected muscles and avoids leaning on the elbow.
Cryotherapy (cold therapy), gentle stretching, ultrasound, frictions and anti-inflammatory drugs are the main treatments for acute golfers elbow. Once it has settled down into the sub acute condition then the aim is to increase flexibility by stretches, improve the strength of the muscles and go back to normal daily jobs. Bracing can be used either to rest the musculature (wrist brace) or to realign the forces through the tendons (counterforce bracing). In the case of chronic golfers elbow the treatment can be the above plus gradual weaning out of the splint and paced return to sport.
Doctors inject corticosteroid medication into the sites of chronic golfers elbow but this treatment appears to be more useful in the earlier, acute cases. Other therapies, such as shockwave or laser, have been used but do not seem to be effective. Once osteo has been attempted for some time without improvement then a surgical approach may be considered, cutting out the abnormal tissue from the tendon. The ulnar nerve can be transposed around to the front of the joint from its position in the groove posteriorly.
Advice from a professional instructor is well worthwhile as they can instruct on technique of the golf swing, aerobic fitness, muscle strength work and flexibility. Warming up prior to activity and stretching afterwards, with good sporting technique and sound choice of equipment are the basic requirements. Monitoring of patients by the osteopath, especially if they are sports people, may be essential to avoid overdoing and training or performing through pain. - 14130
The muscles which flex and rotate the forearm originate over the medial epicondyle, the bony prominence on the inside of the elbow, with the tendon anchored into the bone by the tendinous insertion. The pain occurs close to this and may be due to a degenerative process occurring in the tendon, as little inflammation has been noted in these cases.
The flexor tendons are put under stress by activities which force the forearm outwards away from the body and these stresses occur as the wrist is cocked prior to throwing, in the early acceleration of the throw and in the golf swing from high backswing to just before the ball is hit. The dominant hand is affected in golfers and in tennis players those who impart a heavy topspin to the ball are more likely to suffer.Golfers elbow is not as common as tennis elbow but is the commonest cause of medial elbow pain with about half as many women affected as men. The third to fifth decades of life are the commonest periods for pain onset and 60% of golfers elbow occurs in the dominant hand. An acute onset of pain is reported in a third of patients, with the other two-thirds developing over a period of time.
Pain and ache over the front of the medial epicondyle is the typical symptom, worse with repeated flexion of the wrist and improved with resting. Shoulder, elbow, forearm or hand pain can occur, with weakness or pins and needles in the lower arm. Osteopathy examination includes the bony tendon insertions, the elbow joints and the muscles, with palpation of the funny bone area behind the elbow where the ulnar nerve lies. Nerve involvement can give weakness in the forearm muscles and sensory symptoms, so an exclusion neurological examination is performed by the osteo.
Conservative, non-surgical, treatment is the mainstay of management. This includes osteopathy, anti-inflammatory drugs, wrist splints and steroid injections. Patient education is important and activity modification is the first line of treatment, reducing the frequency of aggravating episodes. Altering the mechanics of the golf swing or other activity is vital if the area is to be allowed to settle. The patient avoids certain activities with the affected muscles and avoids leaning on the elbow.
Cryotherapy (cold therapy), gentle stretching, ultrasound, frictions and anti-inflammatory drugs are the main treatments for acute golfers elbow. Once it has settled down into the sub acute condition then the aim is to increase flexibility by stretches, improve the strength of the muscles and go back to normal daily jobs. Bracing can be used either to rest the musculature (wrist brace) or to realign the forces through the tendons (counterforce bracing). In the case of chronic golfers elbow the treatment can be the above plus gradual weaning out of the splint and paced return to sport.
Doctors inject corticosteroid medication into the sites of chronic golfers elbow but this treatment appears to be more useful in the earlier, acute cases. Other therapies, such as shockwave or laser, have been used but do not seem to be effective. Once osteo has been attempted for some time without improvement then a surgical approach may be considered, cutting out the abnormal tissue from the tendon. The ulnar nerve can be transposed around to the front of the joint from its position in the groove posteriorly.
Advice from a professional instructor is well worthwhile as they can instruct on technique of the golf swing, aerobic fitness, muscle strength work and flexibility. Warming up prior to activity and stretching afterwards, with good sporting technique and sound choice of equipment are the basic requirements. Monitoring of patients by the osteopath, especially if they are sports people, may be essential to avoid overdoing and training or performing through pain. - 14130
About the Author:
Andrew Mitchell, clinical director of the Osteopath Network, writes papers about musculo-skeletal conditions and osteopath in Exeter. The Osteopath Network has more than 550 clinics located throughout the UK and offers treatment at weekends and after hours.
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