Golferâ€™s elbow is a painful condition of the elbow joint that can affect carpenters, golfers, swimmers, hurlers and people whose occupations involve manually working with their hands.
Pain is experienced on the inside area of the elbow where the tendons of the Pronator teres (muscle that rotates wrist inwards) and Flexor Carpi Radialis (muscle that bends/flexes the wrist) attach to the Medial Epicondyle bone.
With constant repetitive motions of the elbow such as constant wrist bending and forearm rotation these muscles become overloaded causing tensile stress within the muscle tendons.
This leads to repetitive microtrauma to the muscle tendons at their attachment to the medial epicondyle bone.
In some cases people can experience pain and fatigue into the forearm, wrist and hand with pins and needles into thumb and fingers. This can be due to compression of the median nerve which travels beneath the pronator teres muscle and becomes compressed when the muscle is in a tightened state.
Signs and symptoms:
- Pain and tenderness located on the inside (medial) aspect of the elbow joint
- It can be described as a general achy pain that becomes a sharp pain when aggravated during activity.
Achy pain may radiate into the forearm
- Actions that aggravate pain
- Shaking hands, hitting a golf ball, throwing a ball, swimming backstroke, serving or hitting a forehand shot in racquetball ball or tennis
- Turning the wrist and forearm inwards such as when using a screwdriver or when twisting a doorknob
- Resisted bending of the wrist joint such as when a carpenter uses a hammer
- Stretching the wrist backwards into extension
Treatment and management:
I often find that when a patient presents with golferâ€™s elbow that the area of pain - i.e. the tendon attachment point - is stuck in a state of inflammation and is not progressing towards its fibroblastic and remodeling stages of the natural healing process.
This is often because the patient is unable to take time off work or from their chosen hobby to rest the forearm. Hence the tendons of pronator teres and flexor carpi radialis need to be gently treated with transverse friction treatment coupled with the application of ice.
An initial homecare treatment plan of ice application alongside stretching exercises of the wrist flexor & pronator muscles.
This is then followed by exercises that are designed to strengthen the wrist and forearm muscles in a graded format with pain symptoms being a measure for progression.
TomÃ¡s Ryan (BSc., Ph.Th., MIAPT) is a registered physical therapist with The Irish Association of Physical Therapy and is based in Clonmel and Thurles. Contact 0504 26672 or email your queries to firstname.lastname@example.org