The ailment referred to as "golfer's elbow," or medial epicondylitis, produces discomfort and inflammation in the tendons that join the muscles of the forearm to the inside side of the elbow. This particular form of tendinitis is brought on by overuse or repeated strain on the wrists and fingers. Anybody who engages in sports like golf, tennis, baseball, weightlifting, or carpentry that require grasping, twisting, or swinging the arm may develop medial epicondylitis. It can also result from inadequate warm-up or conditioning, bad equipment, or incorrect technique.
Microtears or degeneration of the tendons that join the forearm flexor muscles to the bony hump on the inside of the elbow known as the medial epicondyle are the cause of medial epicondylitis. Flexor muscles aid in the bending of the fingers and wrist. These muscles can become sore and irritated if they are overused or stretched. Additionally, the inflammation may impact the surrounding nerves, resulting in tingling or numbness in the fingers. The following are a few things that may be involved with medial epicondylitis:
Repeated or forceful wrist and finger motions, such as gripping a golf club, a tennis racket, a hammer, or a mouse
Sudden or excessive stress on the elbow, such as throwing a ball, lifting a heavy object, or falling on the arm
Poor posture or alignment of the arm, wrist, and elbow, which can increase the tension on the tendons
Age-related wear and tear of the tendons, which can reduce their elasticity and strength
Previous injury or inflammation of the elbow, which can weaken the tendons or make them more prone to re-injury
The main symptom of medial epicondylitis is pain on the inner side of the elbow, which may radiate to the forearm and wrist. The pain may be worse when bending the wrist, squeezing the hand, or making a fist. Other symptoms may include:
Tenderness and swelling on the inner elbow
Stiffness and reduced range of motion of the elbow
Weakness and difficulty in gripping or holding objects
Numbness or tingling in the ring and little fingers, especially when the elbow is bent
The course and extent of the damage determine how quickly or gradually the symptoms of medial epicondylitis appear. The severity of the symptoms might also differ, ranging from minor to severe. The symptoms might make it difficult to do everyday tasks including typing, cooking, writing, or participating in sports.
A physician will inquire about the aetiology and progression of the illness, the kind and frequency of activities that may have worsened the problem or caused it, and any prior elbow injuries or treatments in order to make a diagnosis of medial epicondylitis. Additionally, the doctor will look for any indications of deformity, edema, discomfort, or inflammation in the elbow. The following tests might be carried out by the physician to evaluate the stability and functionality of the elbow:
Valgus stress test: The doctor will apply pressure to the outside of the elbow while the arm is slightly bent and the palm is facing up. This test will stretch the medial ligament and tendons, and cause pain if they are injured.
Resisted wrist flexion test: The doctor will ask the patient to bend the wrist against resistance while the elbow is straight and the palm is facing down. This test will contract the flexor muscles and tendons, and cause pain if they are injured.
Resisted finger flexion test: The doctor will ask the patient to curl the fingers against resistance while the elbow is straight and the palm is facing down. This test will also contract the flexor muscles and tendons, and cause pain if they are injured.
The doctor may also order some imaging tests, such as X-rays, ultrasound, or MRI, to rule out other possible causes of elbow pain, such as fracture, arthritis, nerve compression, or tumor. These tests can also show the extent and location of the damage to the tendons.
The treatment of medial epicondylitis depends on the severity and duration of the symptoms, and the patient’s goals and preferences. The treatment options may include:
Rest: The first step in treating medial epicondylitis is to rest the affected arm and avoid any activities that may worsen the pain or inflammation. This may include using a sling, a splint, or a brace to immobilize the elbow and reduce the stress on the tendons.
Ice: Applying ice to the elbow can help to reduce the swelling and pain. Ice should be applied for 15 to 20 minutes every few hours, with a cloth or towel between the ice and the skin to prevent frostbite.
Medication: Ibuprofen or naproxen, two over-the-counter anti-inflammatory medications, can help reduce pain and inflammation. However, due to the possibility of adverse effects or interactions with other medications, these pharmaceuticals should only be used sparingly and under a doctor's supervision. In rare instances, the physician could recommend harsher medications to treat the pain, including corticosteroids or opioids, or provide an injection of corticosteroids to the elbow to lessen inflammation. These therapies, however, should only be used seldom and only to provide temporary relief since they may have harmful side effects or problems including infection, nerve damage, or ruptured tendon.
Physical treatment: Following the reduction of pain and inflammation, physical therapy can assist in regaining the elbow's strength, range of motion, and functionality. Exercises, stretches, massages, ultrasounds, electrical stimulation, and other modalities can all be used in physical therapy to help tendons and muscles repair and recover. Using the right equipment, maintaining good posture, and changing grips are just a few examples of the activities or approaches that physical therapy may help the patient change and perhaps reverse.
Surgery: In rare circumstances, surgery can be necessary to remove any bone spurs or scar tissue that might be obstructing the elbow's range of motion, or to treat a serious or persistent tear of the tendons. In order to repair the torn ends of the tendons, surgery may be required to make an incision on the inside of the elbow and either remove the damaged portion of the tendons or sew them back onto the bone. When conservative measures have failed to produce sufficient alleviation or improvement, surgery is typically the last option. Following surgery, patients often have a prolonged and more rigorous course of physical therapy as well as an immobilization period.
To prevent medial epicondylitis, it is important to take some precautions and follow some tips, such as:
Warming up properly before engaging in any physical activity, especially those that involve the use of the arms or wrists, such as golf, tennis, or weightlifting.
Using appropriate equipment and technique, such as choosing a golf club, a tennis racket, or a weight that fits the size and strength of the arm, and avoiding swinging or lifting too hard or too fast.
Strengthening the muscles and tendons around the elbow, especially the flexor and extensor muscles, to provide support and stability to the joint.
Stretching the muscles and tendons around the elbow regularly, to improve the flexibility and mobility of the joint.
Avoiding overuse or overexertion of the elbow, and taking breaks and rest periods between activities.
Seeking medical attention promptly if the elbow is injured or painful, and following the doctor’s advice and treatment plan.
