• Medial Epicondylitis

    (Golfer's Elbow)

    Definition

    Medial epicondylitis is pain over the bone on the inner side of the elbow. The piece of bone that can be felt on the inner side of the elbow is called the medial epicondyle. When the tendons attached to this bone are overstretched or torn, they can become painful. This is called tendinopathy.
    Medial epicondylitis is commonly called golfer's elbow, but it is not restricted to people who play golf. It can occur in tennis players and other people who repeatedly grip objects tightly.
    Medial Epicondylitis
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    Causes

    Golfer's elbow is caused by overusing the flexor muscles of the forearms. Overusing these muscles can stretch or tear the tendons attached to the medial epicondyle.
    Causes include:
    • Improper golf swing technique or grip of golf clubs
    • Wrong model of golf clubs
    • Improper technique for hitting a tennis ball
    • Improper size of tennis racquet or tension of racquet strings
    • Doing certain arm motions too much, such as:
      • Golf swings
      • Tennis strokes (forehand or serve)
      • Painting
      • Raking
      • Pitching
      • Rowing
      • Using a hammer or screwdriver

    Risk Factors

    A risk factor is something that increases your chance of getting a disease, condition, or injury. Risk factors for medial epicondylitis include:
    • Playing golf or tennis
    • Work that requires repetitive gripping or clenching of the fingers (especially when the hand is bent up or down at the wrist)
    • Muscle imbalance
    • Decreased flexibility
    • Advancing age

    Symptoms

    Symptoms include:
    • Pain or tenderness on the inner side of the elbow
    • Pain increases when:
      • Shaking hands
      • Turning doorknobs
      • Picking up objects with your palm down
      • Hitting a forehand in tennis
      • Swinging a golf club
      • Applying pressure to this area
    • Possibly pain extending down the forearm
    • Tightness of forearm muscles
    • Stiffness or trouble moving the elbow or hand

    Diagnosis

    The doctor will ask about your symptoms, medical history, recent physical activity, and how the injury occurred. You may not remember the event that caused the injury because golfer's elbow pain develops over time. The doctor will examine your elbow for:
      Pain on the inner side of the elbow when:
      • Doing certain arm motions
      • Pressing on the medial epicondyle
    • Stiffness of elbow and pain with wrist movement
    X-rays are not usually necessary, but the doctor may decide to x-ray your elbow to:
    • Make sure the bones of the elbow are normal
    • Look for a calcium deposit in the injured tendons
    MRI is occasionally used for diagnosis, but there is only limited evidence supporting this use.

    Treatment

    Treatment includes:

    Rest

    Do not do activities that cause pain. Do not play sports, especially golf and tennis, until the pain is gone.

    Cold

    Apply ice or a cold pack to the inner side of the elbow for 15-20 minutes, four times a day for several days after the injury. Wrap the ice or cold pack in a towel. Do not apply the ice directly to your skin.

    Medication

    The following drugs can help to reduce inflammation and pain:
    • Aspirin
    • Ibuprofen (Motrin, Advil)
    • Naproxen (Aleve, Naprosyn)
    • Acetaminophen (Tylenol)
    • Topical pain medicines (such as creams, patches) applied to the skin
    If you still have tenderness in the elbow while taking these drugs, do not return to physical activity. Check with your doctor.

    Compression

    Wear a counter-force brace on your forearm if recommended by your healthcare professional. This brace limits the force generated by your forearm muscles when you use them.

    Heat

    Apply heat to the elbow only when you are returning to physical activity. Then use it before stretching or getting ready to play sports.

    Stretching

    When the acute pain is gone, start gentle stretching as recommended by a healthcare professional. Stay within pain limits. Hold each stretch for about 10 seconds and repeat six times.

    Strengthening

    Begin strengthening exercises for the flexor muscles of the forearm as recommended.

    Gradual Return to Your Sport

    Begin arm motions of your sport or activity (such as golf swings, tennis strokes, painting) as recommended.

    Cortisone Injection

    The doctor may inject cortisone into the elbow near the medial epicondyle to reduce pain and inflammation.

    Prevention

    Take these steps to reduce your risk of getting golfer's elbow:
    • Keep your arm muscles strong so they can absorb the energy of sudden physical stress.
    • After a short warm-up period, stretch your arm muscles before physical activity.
    • Learn the proper technique for activities that require forearm motion.
    • If you play golf, ask a golf specialist to check your:
      • Swing technique
      • Grip
      • Model of golf clubs
      If you play tennis, ask a tennis specialist to check your:
      • Technique for hitting a forehand
      • Racket size and tension of racket strings

    RESOURCES

    American Academy of Orthopaedic Surgeons http://www.aaos.org

    American Orthopaedic Society for Sports Medicine http://www.sportsmed.org

    CANADIAN RESOURCES

    Canadian Orthopaedic Association http://www.coa-aco.org

    Canadian Orthopaedic Foundation http://www.canorth.org

    References

    American Academy of Orthopaedic Surgeons website. Available at: http://www.aaos.org.

    American Orthopaedic Society for Sports Medicine website. Available at: http://www.aossm.org/tabs/Index.aspx.

    Assessment and treatment guidelines for elbow injuries. The Physician and Sportsmedicine. 1996;24:42.

    Human Tendons. Human Kinetics; 1997.

    Managing golf injuries. The Physician and Sportsmedicine. 1999;29:41.

    Nicholas Institute of Sports Medicine and Athletic Trauma website. Available at: http://www.nismat.org/.

    Petersen B, Rovati S. Diclofenac epolamine (Flector) patch: evidence for topical activity. Clin Drug Investig. 2009;29(1):1-9.

    Shiri R, Viikari-Juntura E. Lateral and medial epicondylitis: role of occupational factors. Best Pract Res Clin Rheumatol. 2011;25(1):43-57.

    10/26/2010 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Massey T, Derry S, Moore R, McQuay H. Topical NSAIDs for acute pain in adults. Cochrane Database Syst Rev. 2010;(6):CD007402.

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