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Physiotherapy Management on Golfer’s Elbow

What is Golfer’s Elbow?

Golfer’s elbow is a condition that causes pain at the bony bump on the inner side of the elbow and may radiate to the forearm region. Medically it is termed as medial epicondylitis, which is less commonly found compared to tennis elbow. Pain can be felt during long sessions of not only golf swinging but other sports which include squeezing or pitching a ball, rowing, hammering, painting, shaking hands, turning a doorknob, lifting weights or using tools such as screwdrivers.

Causes of Golfer’s Elbow

It is caused by stressed or repetitive arm movements, often forceful wrist and finger motions. Gripping objects too tightly or for too long with your hand turned up or in a supinated position will create problem that would lead to golfer’s elbow. Over-using of the forearm muscles can put too much strain and lead to minor tears in tendons that attach the muscles to the epicondyles. If these activities continue without allowing the tears to heal, the tendon may become inflamed and this wear and tear process will lead to tissue degeneration. Degenerated tissues or tendons usually have an abnormal arrangement of collagen fibres which loses its strength and become fragile.

Other than that, faulty technique or mechanics, or improper equipment used, as well as lack of warming up or poor exercise conditioning leads to this problem.

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http://balancehp.com.au/wp-content/uploads/2014/02/elbow4.png http://cartwrightphysicaltherapy.com.au/blog/medial-epicondylitis-golfers-elbow

Signs & Symptoms of Golfer’s Elbow

  • Pain and tenderness over the inner side of the elbow or epicondyle during use of the affected muscles (pronation, wrist flexion and elbow flexion). Pain may appear suddenly or gradually.
  • May have a slight swelling.
  • Activities worsen the symptoms.
  • Stiffness at the elbow and difficult to form a fist.
  • Muscles weakness especially of the hand and wrist.
  • Numbness, pins and needles or tingling of the fingers. It may radiate into one or more fingers normally the fourth and the little finger.
 golfer-elbow3

Diagnosis is made by;

  1. Getting a detailed medical history such as the type of pain, nature of pain, regular activities that are affected and previous injuries help in diagnosing the problem.
  2. A thorough physical examination done by a doctor or a Pressure is applied to the affected area to evaluate the pain and the patient will be asked to move the elbow, wrist and fingers in different motions.o
  3. Confirmatory clinical or special tests done resulting in positive findings
  4. Doctors will be able to rule out arthritis or fractures through X-ray and ultrasound to confirm tendon tear or inflammation

Intervention

  • NSAID (non-steroidal anti-inflammatory drugs) such as ibuprofen to reduce pain and swelling
  • Injection of corticosteroid at the inflamed and tender area
  • Surgery is indicated if the symptom persists for more than a year

How can physiotherapy help?

Physiotherapy targets to relief pain and facilitate recovery as follows;

  • Rest or put your golf game or other repetitive activities on hold until the pain is gone. This will aid in reducing elbow pain
  • Icing or ice massage to reduce swelling
  • Protect the area by bandaging or bracing to reduce load on your elbow
  • Facilitation of tissue repair using modalities such as ultrasound or laser treatment
  • Kinesiotaping helps by relieving pressure, relaxing muscles and may increase circulation
  • Stretching, gradual strengthening and flexibility exercise are effective for restoration of normal joint range of motion and normal muscle strength
  • Gradually return to the activities

Equipment change or modification of activities that cause the pain     

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http://www.summitmedicalgroup.com/library/adult_health/sma_medial_epicondylitis_exercises

References

  1. Brown, J. All about Golfer’s Elbow. 2009
  2. Cartwright, T. Cartwright Physicaltherapy Web. Medial Epicondylitis (Golfer’s Elbow) The most common undiagnosed injury in tennis players – medial epicondylitis. Jul 29, 2012
  3. Campbell,J.D. Golf Injuries American Orthopedic Society for Sports Medicine. 2008
  4. Carson WG. Overuse injuries of the elbow in the throwing athlete. Baker CL, ed. The Hughston Clinic Sports Medicine Book. Baltimore, Md: Williams & Wilkins? 1995. 32431
  5. Gabel GT, Morrey BF. Medial epicondylitis. Morrey BF, ed. The Elbow and Its Disorders. 3rd ed. Philadelphia, Pa: WB Saunders? 2000. 53742
  6. Gabel GT, Morrey BF. Operative treatment of medical epicondylitis. Influence of concomitant ulnar neuropathy at the elbow. J Bone Joint Surg Am. 1995 Jul. 77(7):10659. [Medline].
  7. Kohn, HS. Prevention and treatment of elbow injuries in golf. Clin Sports Med 1996;15:65-83
  8. Ludwig, K et al. Injuries and overuse syndromes in golf. AJSM 2003;31:438-443.
  9. Porter, S. Tidy’s Physiotherapy (15th Edition) Churchill Livingstone 2013
  10. Park GY, Lee SM, Lee MY. Diagnostic value of ultrasonography for clinical medial epicondylitis. Arch Phys Med Rehabil. 2008 Apr. 89(4):73842. [Medline].
  11. Walker, B. Golfers Elbow, Elbow Tendonitis and Elbow Pain. Brian Mackenzie’s Successful Coaching,(ISSN 1745-7513/ 44/ July-August), 2007. p. 3-4 http://www.brianmac.co.uk/articles/scni44a2.htm
  12. Young, C.C. Medscape. Web. Medial Epicondylitis. Web. Updated Aug. 16, 2011. http://emedicine.medscape.com/article/97217-overview.

Source image

1.     (2014) Mckesson Corporation and/or one of his subsidiaries. http://www.summitmedicalgroup.com/library/adult_health/sma_medial_epicondylitis_exercises/

Semakan Akhir : 5 January 2017
Penulis : Shahreen binti Hairi Hariharan
Akreditor : Daaljit Singh a/l Harbachan Singh