Golfer’s Elbow

THE CLINICAL SYNDROME

Golfer’s elbow (also known as medial epicondylitis) is caused by repetitive microtrauma to the flexor tendons of the forearm in a manner analogous to tennis elbow. The pathophysiology of golfer’s elbow is initially caused by microtearing at the origin of the pronator teres, the flexor carpi radialis and flexor carpi ulnaris, and the Palmaris longis. Secondary inflammation may occur, which can become chronic as the result of continued overuse or misuse of the flexors of the forearm. The most common nidus of pain from golfer’s elbow is the bony origin of the flexor tendon of flexor carpi radialis and the humeral heads of the flexor carpi radialis and pronator teres at the medial epicondyle of the humerus. Less commonly, golfer’s elbow pain can originate from the ulnar head of the flexor carpi ulnaris at the medial aspect of the olecranon process. Coexistent bursitis, arthritis, and gout may also perpetuate the pain and disability of golfer’s elbow.

SIGNS AND SYMPTOMS

The pain of golfer’s elbow is localized to the region of the medial epicondyle. It is constant and is made worse with active contraction of the wrist. Patients will note the inability to hold a coffee cup or hammer. Sleep disturbance is common. On physical examination, there will be tenderness along the flexor tendons at or just below the medial epicondyle. Many patients with golfer’s elbow will exhibit a bandlike thickening within the affected flexor tendons. Elbow range of motion will be normal. Grip strength on the affected side will be diminished. Patients with golfer’s elbow will demonstrate a positive golfer’s elbow test. The test is performed by stabilizing the patient’s forearm and then having the patient actively flex the wrist. The examiner then attempts to force the wrist into extension. Sudden severe pain is highly suggestive of golfer’s elbow.

The pain of golfer's elbow occurs at the medial epicondyle

TREATMENT

Initial treatment of the pain and functional disability associated with golfer’s elbow should include a combination of the nonsteroidal anti-inflammatory drugs or cyclooxygenase-2 inhibitors and physical therapy. The local application of heat and cold may also be beneficial. Avoidance of any repetitive activity that may exacerbate the patients symptomatology should be avoided. For patient’s who do not respond to these treatment modalities, the following injection technique may be a reasonable next step.

Injection for golfer’s elbow is carried out by placing the patient in a supine position with the arm fully adducted at the patient’s side and the elbow fully extended with the dorsum of the hand resting on a folded towel to relax the affected tendons.

This injection technique is extremely effective in the treatment of pain secondary to the golfer’s elbow. Coexistent bursitis and tendonitis may also contribute to elbow pain and may require additional treatment with more localized injection of local anesthetic and methylprednisolone acetate steroid. This technique is a safe procedure if careful attention is paid to the clinically relevant anatomy in the areas to be injected. The use of physical modalities including local heat as well as gentle range of motion exercises should be introduced several days after the patient undergoes this injection technique for elbow pain. A Velcro band placed around the flexor tendons may also help relieve the symptoms of golfer’s elbow. Vigorous exercises should be avoided because they will exacerbate the patient’s symptomatology. Simple analgesics and nonsteroidal anti-inflammatory drugs may be used concurrently with this injection technique. As mentioned, cervical radiculopathy may mimic golfer’s elbow and must be ruled out to effectively treat the underlying pathology.

Low intensity laser therapy as well as a coordinated wellness program is also effective in treating this disorder.

Low Intensity Laser Therapy (LILT)

The low intensity Laser (LILT) sends photons (light) into the injured tissues and can penetrate two to three inches to treat affected areas. It uses a natural enhancement of the cellular machinery that can and has been dynamically measured in published studies to promote healing without burning affected tissue .Once the photons find the injured tissues, they stimulate and energize the cells to repair and strengthen at a remarkable rate. The treatment does not hurt, takes about 30 minutes and is very cost advantageous.

Wellness Program

A wellness program whichindividualizes treatment for age, performance and function has been shown in pilot studies to improve the overall health and well being of the individuals evaluated. A well conceived dietary and supplementary regimen based on scientific age–related decline in certain necessary compounds can improve quality of life, correct the ravages of hormone imbalance, balance critical neurotransmitter function without resorting to powerful drugs for depression that often have unfavorable side-effect profiles and restore vitality and youth in daily exercise routines. Furthermore, when wellness products are utilized with success, individuals often seek less costly interventions including unnecessary surgeries and narcotic options to treat pain. For more information go to www.drpwellness.com.