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Physiotherapy and Golfers Elbow

Golfer's elbow, also known as medial epicondylitis, is a similar condition to the condition which occurs on the outside of the elbow, tennis elbow. Both these conditions are thought to be secondary to overuse of the tendinous structures of the forearm muscles. Typical sufferers can be anyone who performs repetitive arm actions but sporting activities which can be affected are racket sports, throwing, golf and weight lifting. Golfer's elbow is less common than tennis elbow and is often found in the dominant arm where the greatest forces are generated. The tendon of the forearm flexing and rotating muscles inserts into the bony lump on the inside of the elbow, the medial epicondyle.

Physiotherapy examination will show that the pain comes on with flexion of the wrist and palpation over the medial epicondyle will elicit tenderness or pain. The physiotherapist will check the elbow ligaments for laxity and test the forearm and elbow muscle strength. Overuse in activity or sporting endeavours is the commonest precipitating cause, with an increased intensity or duration of training a particular risk. Insufficient flexibility, strength or endurance in the forearm muscles or an incorrectly sized grip of a racket may also be risk factors.

Physiotherapy management of acute golfer's elbow involves reducing pain and inflammation by icing the area, compression, ultrasound and gentle range of movement exercises combined with rest from the aggravating activity. Modification of the precipitating activity should be examined and the physio may need to encourage this firmly to ensure compliance. Athletes rarely stop the activity completely so therapy may be needed before and after the sporting sessions. Bracing or splinting of the elbow may be useful to reduce the forces through the forearm muscles and so the affected tendinous area.

Once the acute phase has settled the physio will encourage active muscle work of the area to maintain range and teach the patient stretches to allow the healing tendon to settle in a lengthened position. The patient may have to maintain a long term regime of flexibility and strengthening exercises to return to their activity and control the symptoms. Injections can be used for the acute phase but may have little effect on long term outcome. Severe cases can require surgical release of the flexor tendon origin, with good results in many patients. Shock wave therapy is being used increasingly to treat this and tennis elbow but the overall efficacy of this treatment is not yet clear.

 

Author: Jonathan Blood-Smyth

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