Middle epicondylitis injury is commonly known as golfer’s elbow or golf elbow. This name does not mean that only golfers suffer from this injury, but hand movement while playing golf is one of the most common causes. Many repetitive and continuous hand activities can also lead to injuries known to Golfer’s elbows:
- Constant throwing
- Chopping wood with an axe
- Working with a chainsaw
- Regular use of many hand tools
Any repetitive activity that puts pressure on a similar muscle in the forearm can cause Golfer’s elbow symptoms. Tennis players’ elbows are another complication of inflammation of the bony areas of the elbows. Frequent movements, such as holding objects and hitting a racket, can cause the muscles to stretch and put too much pressure on the tendons. This constant pressure eventually causes tiny tears in the tissues.
Diagnosis of Golfer's Elbows
Your doctor will probably first thoroughly review your medical history. You should answer your doctor’s questions about how the pain feels, how the pain affected your activities, the type of activity you have, and the injuries you have suffered in the past.
If you have a golfer’s elbow, you will usually feel pain in this condition. Physical examination is usually the best and most helpful way to diagnose golfers’ elbow complications. Your doctor may move your wrists and forearms so that you feel a stretch in your forearm muscles.
X-rays can show the presence of calcium deposits and bone spurs at the junction of the medial epicondylitis with the flexor tendon of the forearm. An x-ray can help your doctor diagnose other problems associated with a golfer’s elbow.
MRI scans use magnetic waves to create images of the entire surface of the elbow sections. MRI images show tendons in addition to bones.
Ultrasound test (ultrasound)
In this test, high-frequency sound waves produce images of all structures under the skin. As the tiny bundle of the ultrasound device moves over the target area, the created images appear on the monitor. This test can sometimes show collagen erosion.
Symptoms of Golfer's Elbow Injury
- Pain and tenderness in the inner area of the elbow
- Elbow pain starts on the inside of the elbow and probably spreads along the forearm to the wrist.
- Bending the wrist, twisting the forearm, and holding objects may worsen elbow pain.
- You may feel that your hand is less mighty when you have things with your hands or fist your fingers.
The Cause of Golfer's' Elbow Injuries
- Excessive use and pressure on the muscles and tendons of the forearm and elbow.
- Repeating a specific type of movement too many times can put a lot of pressure on the elbow and the tendons attached to it; for example:
- Gardening (tree pruning)
- Working with hammers and nails
Inflammation of the Tendon
In the event of an acute injury, your body will show an inflammatory reaction. Specific inflammatory cells attach themselves to the affected area to help heal the area.
- Inflammation of the tendon is called tendonitis.
- Inflammation around the epicondyle area is called medial epicondylitis.
In these cases, a specific problem causes the tendon tissue to erode over time. The body does not produce inflammatory cells but fibroblast cells in these cases. This causes the collagen in the tissues to lose its strength and become brittle, resulting in easy damage. Every time the collagen tissue in the tendon breaks down, our body responds by forming extra tissue in the tendon. Eventually, the tendon thickens due to different tissue formation due to collagen breakdown in the tendon.
Treatment of Golfer's Elbows
There are two different approaches to treating golfer elbows: non-surgical and surgical treatments.
The key to non-surgical procedures for golfers’ elbows is to prevent further collagen breakdown, and the goal of treatment is to help the tendon heal.
Anti-inflammatory drugs. If the problem is caused by inflammation, taking anti-inflammatory drugs such as ibuprofen can be effective.
Cortisone injection. Cortisone is a powerful anti-inflammatory drug. The effects of this drug are temporary but may last for several weeks to several months. Your doctor may prescribe cortisone injections if the inflammation does not go away with anti-inflammatory medications.
Shock therapy. Shock therapy is a non-surgical treatment for tendon damage. This method uses a device that generates shockwave pulses sent to the affected area. In addition to relieving pain, this treatment also improves range of motion and elbow function.
Elbow strap or tipping elbow
Your physiotherapist may apply adhesive tape to your elbows and forearms to relieve pressure on your tendons and muscles. You may also use an elbow brace, a narrow band that wraps around the forearm to reduce stress on the tendon at the junction with the bone.
No matter the severity of the patient’s complication, physiotherapy exercises significantly affect restoring muscle strength and improving joint range of motion. Physiotherapy includes the following exercises:
- Isometric wrist stretching exercise: Bend your wrist backward and press in the opposite direction at the same time with the other hand.
- Isometric Wrist Flexibility Exercise: Bend your wrist forward and press in the opposite direction at the same time.
- Wrist resistance stretching exercise: Place your forearm on a fixed table and move the wrist from neutral to up and back while holding a lightweight.
- Straight wrist stretch: Keep your hand straight in front of your body with the palm facing upwards and pull your fingers and wrist towards the body with the other hand.
Ultrasound therapy is sometimes used to treat chronic elbow pain. Although experts believe that high-frequency sound waves can accelerate the healing process by warming the tissues and increasing blood circulation, the evidence for the effectiveness of this method is still unclear, and research is underway.
It is rare for a doctor to recommend surgery to treat a golfer’s elbow, but surgery will be recommended if the symptoms last for more than six months and the patient’s everyday life is disrupted.
In such cases, superficial surgery is performed as an injection under the skin of the elbow. During this surgery, the flexor tendon (the tendon that connects the internal epicondyle to the bone in the upper arm) is removed from the pressure, and the space around the elbow is cleared of lesions. This surgery is usually performed under local anesthesia under arthroscopic surgery.
- Rehabilitation after surgery
Immediately after surgery
Your elbow is placed in a temporary splint, and with the help of this splint, your elbow is fixed in a bent position at a 90-degree angle.
Cold therapy and electrotherapy (electrical stimulation)
During the first physiotherapy session after surgery, these two methods may be used to control pain and swelling.
Your physiotherapist may also use massage or other manual therapy techniques to relieve muscle spasms and cramps.
Gradually you can do more dynamic stretching and strengthening exercises. Of course, you have to be careful not to do these movements too fast and do enough and not put too much pressure on yourself. (These exercises begin approximately two weeks after surgery)