What is Golfers Elbow?
Golfers elbow, is a fairly common type of elbow pain. Learn more about it, its causes, and how to treat it.
One of the most common problems in this area is medial epicondylitis . It is a type of inflammation that occurs in the flexor tendons of the forearm. For you to understand better: the arm bone, called the humerus, has two protrusions or bumps in the region near the elbow. These protrusions are called medial and lateral epicondyles. Medial epicondylitis , as its name implies, is inflammation of the medial epicondyle tendons.
The pain of the "golfer's elbow" may appear suddenly or gradually and is characterized by:
Pain and tenderness on the inside of the elbow;
Possible weakness in hands and wrists;
The elbow can become stiff and hurt when you close your wrist;
Numbness or tingling that radiates to one or more fingers, usually the annular and pinky (About 50% of the cases of medial elbow epicondylalgia have neurological symptoms associated with the compression of the ulnar nerve);
There may also be pain when you close your hand with your fingers inward;
These tendons are responsible for those bending movements that we are accustomed to perform every day, such as flexing our fingers, folding our wrists and turning our palms down, for example. Medial epicondylitis is also known by the informal name of " golfers elbow " because due to the movements required in this activity, the incidence in the practitioners of the sport is quite great. Medial epicondylitis occurs in about 0.5% of the general population, mainly in people aged between 45 and 55 years and who are active.
An elbow pain with the very similar name is lateral epicondylitis , which is known by Tennis Elbow Pain. In this case, the pain becomes more concentrated in the lateral region of the elbow, due to the movements of extension of the arm realized during the games of tennis and other physical and sporting activities.
What are the causes and symptoms of Golfers Pain?
Golfers Pain can have several causes. The repetitive overload on the tendons of the site is one of the main reasons. Sports such as golf, bodybuilding and tennis cause this overload several times during physical activity and can cause this type of epicondylitis . Activities that require repetitive efforts in this area also give rise to the problem. Another common cause is trauma in the region by strokes, beats and accidents, which can injure muscles and tendons.
The symptoms of Golfers Pain are easy to see, so its diagnosis is also usually rapid. When the medial epicondylitis appears, the affected person feels a sharp pain in the inner part of the elbow, just where the medial epicondyle is. The pain or discomfort may radiate throughout the forearm, but on a more extreme note, it will still have its most painful point near the medial bone at the elbow.
It is usually possible to diagnose Golfers Pain only with clinical examination and observation of the patient's symptoms. Ultrasound and even magnetic resonance imaging may be necessary when the patient does not respond to initial treatments, doubts in the diagnosis or if there is a need to exclude the presence of other associated lesions.
Complications of Golfers Pain
In addition, Golfers Pain may also be associated with other problems, such as ulnar nerve neuropathy, a compression of this nerve, also known as ulnar tunnel syndrome, which is located just after the medial epicondyle. It usually causes tingling in the fingers of the hand, especially between the fourth and fifth finger. In more severe cases it can cause loss of strength in the region.
The disease may also be associated with medial instability of the elbow. It usually occurs mainly in people who engage in sports activities such as throwing, which requires repetitive movement of valgus and can cause injury to the athlete's elbow.
Sometimes, Golfers Pain may result in a complication. It is the involvement of the ulnar nerve because the proximity to it is great. This nerve is just the one that causes us a sensation of shock when we hit the elbow in an object or mobile.
The patient who had Golfers Pain if present with frequent tingling in the hand, especially in the annular and minimal fingers, possibly presents a problem with the ulnar nerve. In that case, new physical exams should be done to evaluate the need for surgery where a debridement (cleansing) of the tendon is performed and decompression of the nerve.
How is the treatment of Golfers Pain
The treatment of medial epicondylitis is based on three important factors: pain control, rehabilitation of the musculature that was reached and prevention to reduce the risks of the problem occurring again. Usually the treatment achieves the desired results and has a success rate ranging from 88% to 96% depending on the case.This will depend on the causes, the treatment chosen and also the patient's commitment to do what the doctor asks for.
Pain control can be achieved in several ways. The main therapy is physiotherapy. In addition, experts indicate the use of anti-inflammatory medications that may be oral or topical, immobilization of the affected site and orthoses. To choose the best curative method, the physician takes into account not only the profile of the case but also the patient's health history. Sometimes infiltrations can be indicated, usually when other previous treatments used are not effective, but since they present some risks, they should be discussed between doctors and patients and are not usually performed routinely.
At the same time, the causes of medial epicondylitis are evaluated in order to avoid the activities that caused it, whether at work, at home or in sports activities.This avoids aggravation of the problem and increases the chances of rehabilitation treatment
Rehabilitation begins after recovery from the acute painful phase. To rehabilitate the tendons of the medial epicondyle, a series of exercises based on elongation of the flexor muscles is advised, with the activation of the antagonist musculature for the result to be more effective. The exercises also aim at strengthening the muscles. Rehabilitation is achieved simply, but its full evolution can take up to a year depending on the case.
A new option for these cases is shock wave therapy , which has been showing good results in the treatment of various musculoskeletal conditions , such as Golfers Pain and Tennis Elbow Pain, plantar fasciitis , myofascial pain syndrome and other pain.
Often, the pain of the medial epicondylitis ends up resulting in a nociceptive increase, that is, other associated pains end up arising due to the disuse and musculoskeletal contractures, such as myofascial pain. Thus, an effective treatment can be done with the association of pharmacological treatment + acupuncture + infiltrations + physiotherapy.
Prevention should be done to avoid a recurrence of the problem and recurrence of pain. It mainly takes into account the causes of the onset of medial epicondylitis .For those who are athletes, for example, there is an assessment and adequacy of both the technique used in sports activities and the sports material used to practice the sport.
Since medial epicondylitis occurs by excessive use of the muscles that flex the wrist, it is important not to overload them. At the first signs of pain on the inside of the elbow, you should decrease activity and seek a doctor. The pain of the "golfer's elbow" does not have to keep you off the field or away from your favorite pursuits. With proper rest and treatment, you can return to a normal life.
When surgery is necessary for Golfers Pain?
When all of this pain relief, rehabilitation and prevention treatment does not arrive at the expected result, surgery may be necessary. It is a very rare situation because generally the measures taken for rehabilitation, when carried out correctly, usually resolve. However, there are rare and few cases that need surgery!
The surgery requires some exams. Its purpose is to remove diseased tissues. If there is any change in the ulnar nerve, it should also be treated. The most common is the decompression of the ulnar tunnel region. This nerve can be transferred, that is, transposed to an anterior region below or above the muscles of the forearm. The surgery can be done by antroscopy or open pathway.