Do you have an elbow pain? Medial side? If yes, you may have a medial epicondyle tendinopathy also know as a golfer’s elbow.
Golfer’s elbow is a common sport’s tendinitis injury from the overload, which has pain at the point of the forearm tendons (flexor group) attach to the inside of elbow’s bony. Sometimes the pain may radiate down on the ulnar side of the forearm (inner side), wrist and fingers. This condition develops from irritation of the tendons especially the inside of the forearm and then inflammation and painful. This symptom is usually found in golfers due to this sport requires the movement of the flexor pronator muscles.
Symptoms
- Tenderness and pain on the inner side of elbow. Sometimes the pain may down to the forearm (inner side) and wrist. In some case, the pain can radiate up to the arm too. Some movement pattern may activate the pain.
- Weakness in the wrist and hand (weakness of hand grip)
- Stiffness around the elbow
- May experience some sensations radiating down to the forearm such as numbness or tingling down to fingers (ring and little fingers)
- Resisted flexion of the wrist or pronation can aggravated the pain. May feel worse when do some activities such as shake hands, swing a racket or golf club, lift somethings, picking up an item with palm down, flex your wrist and turn a doorknob
Causes
Normally, golfer’s elbow is caused by overusing the muscles and repetitive activities such as flexing, gripping, or swinging. All of those activities can cause frequently tears on the flexor carpi radialis and pronator teres. But it can also tear in the palmaris longus, flexor digitorum superficialis and flexor carpi ulnaris too. Mostly this conditions may affected golfers but it can lead to the other things include playing sports that use a racket, playing sports that needs a lots of throwing movement, repetitive movement such as painting and weight training.
Nonsurgical treatment
Physical therapy management
- Starts with ‘PRICEMM’ (P = prevention/protection, R = rest, I = ice, C = compression, E = elevation, M = modalities and M = medication):
- Stop doing some activities especially the offending activities (not suggest to stop all activities because it will affect to the muscle atrophy
- Apply ice around the pain area 3-4 times per day (15-20 minutes)
- Take non-steroidal anti-inflammatory medication (NSAID)
- Wearing support such as elbow brace or night splint
- Using physical therapy modality (ultrasound and high-voltage galvanic stimulation)
Manual therapy:
- Mobilization (gentle joint movement)
- Soft-tissue massage
- Stretching elbow, forearm, hand and also shoulder and thoracic spine due to these areas can be affected by muscle imbalances along the chain of muscles and connective tissue involving the elbow.
- Muscle Energy Techniques (METs) for improving range of motions
Exercise:
- Start with isometric exercise (muscle contractions) and stretching
- Resistance exercises to strengthened weaker muscles by using weights, balls, or resistance bands).
Example exercise:
- Ball squeezes: put the ball in the affected hand’s palm and then squeeze and release the ball.
- Resisted forearm pronation and supination: hold a weight in the affected hand, rest the arm on the table for stability and then rotate the hand downward and upward.
- Resisted wrist flexion: hold a weight in the affected hand, rest the arm on the table with the palm facing upwards and then bend your wrist and hand upward.
- Wrist flexor stretching: stretch the affected arm out in front of your body, with your palm facing upwards then using the other hand, pull the affected hand back and towards your body.
Chinese medicine treatment
- Acupuncture: Using a filament needles (very thin) into specific points of the body, which these points are parallel with 12 invisible pathways (Traditional Chinese Medicine refers to as ‘Meridians’). The needle can unblock the flow of energy (Qi) and bring back the normal flow of energy that can heal the symptoms.
- Cupping: using a fire into the cup and placing cups on the skin to create suction. Cups are left on the skin for creating distinctive circular-shaped marks, which help to increase blood flow and promotes healing. Normally, cups are left on the skin for 5-20 minutes.
- Tuina (Chinese medical massage): massage soft tissue and manipulate the musculoskeletal, which can establishes a flow of Qi to heal body by itself
References
Chavisa Wasinchutchwal (PT)
