What is Medial Epicondylitis (golfer’s elbow)?

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Medial epicondylitis is regularly referred to as golfer’s elbow. Because it is known as “golfer’s elbow” does not mean that only golfers get and suffer from this condition. However; the golf swing is a frequent trigger of medial epicondylitis. Many other repetitive activities can also lead to golfer’s elbow: throwing, chopping wood with an ax, running a chainsaw, and leveraging many kinds of hand tools. Any movements that emphasize the same forearm muscles over and over can produce symptoms of golfer’s elbow.

This Medial Epicondylitis guide will help you know:

  • Which parts of the elbow are interested
  • What prompts golfer’s elbow
  • How to make the pain go subside

What are regions of the elbow affected?

Golfer’s elbow triggers pain that begins within the bump of the elbow, the medial epicondyle. The muscles of the forearm that draw the hand forward are called wrist flexors. The wrist flexors are located on the palm side of your forearm. Most of the wrist flexors connected to one main tendon on the medial epicondyle. This tendon is named the common flexor tendon.

Tendons attach muscle to bone. Ligaments consist of strands of a matter referred to collagen. The collagen strands are lined up in packets next to each other.

Since the collagen strands in the tendons are lined up, tendons have significant tensile strength. This indicates they can resist high forces that pull from it on both ends of the tendon. When muscles operate as they are supposed to, they pull on one end of the tendon. The other end of the tendon draws on the bone, enabling the bone to move.

The wrist flexor muscles recoil when you flex your wrist, twist your forearm down or grip with your hand. The tightening muscles pull on the flexor tendon. The release of force that draws on the tendon can develop when you grasp a golf club while swinging a golf club or do other related activities.

Why do I golfer’s elbow?

Overusage of the tendons and muscles within the forearm and elbow are the most prevalent reason people develop golfer’s elbow. Doing some types of activities repeatedly can put excessive strain on the elbow tendons. These exercises don’t have to be a high-level sports competition absolutely. Hammering nails, shoveling snow, gardening can all produce the pain of golfer’s elbow. For example, swimmers who try to increase speed by pushing their arm through the water can also tighten and stretch the flexor tendon at the elbow.

In some instances, the indications of golfer’s elbow are caused from inflammation. In an acute injury, the body undergoes an inflammatory response. Special inflammatory cells travel to the injured tissues to help them heal. Conditions that involve inflammation are indicated by “-itis” on the end of the word. An example of this would be, inflammation in a tendon is called tendonitis. Swelling around the medial epicondyle is referred to as medial epicondylitis.

However, golfer’s elbow often is not produced by inflammation. Instead, it is an issue within the cells of the tendon. Doctors refer to this condition tendonosis. In tendonosis, wear and tear are thought to lead to tissue degeneration. A degenerated tendon usually has an abnormal arrangement of collagen fibers.

Rather than inflammatory cells, the body creates a type of cells referred to as fibroblasts. When this happens, the collagen dissipates its strength. It grows fragile and can break or be easily injured. Each time the collagen breaks down, the body reacts by forming scar tissue in the tendon. Eventually, the muscle grows thick from extra scar tissue.

The medical community doesn’t fully understand what precisely what causes tendonitis. Some experts think that the forearm tendon produces small tears with too much movement. The tears try to heal, but constant strain and becoming worn out, you can keep re-injuring the tendon. Over time the tendons doe not attempt to repair itself and the scar tissue does not has a chance to heal fully. This results in leaving the injured areas painful and weakened.

What does golfer’s elbow feel like? Symptoms to Look For:

The primary sign of golfer’s elbow is pain and tenderness at the medial epicondyle of the elbow. Pain ordinarily begins at the medial epicondyle and may radiate down the forearm. Grasping objects, Bending your wrist, or twisting your forearm down, can make the pain more severe. You can feel less energy and strength when gripping items or pressing your hand into a fist.

Diagnosis
How can my doctor be certain I have golfer’s elbow?
Your physician will first take a comprehensive medical history. You will likely need to answer questions concerning your pain levels, how your pain impacts you, your routine activities, and past wounds to your elbow.

The physical exam is often most beneficial in diagnosing golfer’s elbow. Your physician may place your wrist and arm in a particular position, so you feel a stretch on the forearm tendons and muscles. This is typically painful with golfer’s elbow. Other tests forearm and wrist strength are done to help your physician diagnose golfer’s elbow.

You may require X-rays of your elbow. The X-rays principally help your physician rule out other doubts with the elbow joint. The X-ray may reveal if there are calcium deposits on the medial epicondyle at the attachment to the flexor tendon.

Golfer’s elbow symptoms are comparable to a condition named cubital tunnel syndrome. A pinched ulnar nerve generates this ailment as it spans the elbow on its way to the hand. If your pain does not subside with treatment options provided, your doctor may recommend tests to rule out potential problems with the ulnar nerve.

When the diagnosis is not precise, the doctor may order other specialized tests, such as an ultrasound or magnetic resonance imaging(MRI) scan. An MRI scan utilizes magnetic waves to produce pictures of the elbow in slices. The MRI scan shows tendons as well as bones.

Ultrasound tests use high-frequency sound waves to produce an image of the muscles and tendons beneath the skin. As the miniature ultrasound device is rubbed over the sore area, a picture emerges on a screen. This kind of test can occasionally show collagen degeneration.

Understanding Cubital Tunnel Syndrome

Treatment Options
How can I make my pain go away?

Non-surgical Treatment
The key to nonsurgical treatment is to prevent the collagen from deteriorating down further. The intention is to help the tendon heal.

If the problem is produced by inflammation, anti-inflammatory medications such as ibuprofen may provide you some relief. If soreness doesn’t go away, your physician may inject the elbow with cortisone. Cortisone is a powerful anti-inflammatory medication. Its advantages are short-lived, but they can last for a period of weeks to several months.

Shockwave therapy is a newer form of nonsurgical treatment. It uses a machine to generate shock wave pulses to the sore area. Patients usually undergo the surgery once each week for upward of three weeks. It is not known exactly why it works for golfer’s elbow, but up-to-date research shows that this form of treatment can further ease the pain while increasing functionality and range of motion.

Doctors generally have their patients with golfer’s elbow work with an occupational or physical therapist. At first, your therapist will offer you tips on how to rest your elbow and how to do your activities without putting additional strain on your elbow. Your therapist may apply tape to take some of the load off the elbow muscles and tendons. You may use an elbow strap that encircles around the upper forearm in a way that alleviates the pressure on the tendon attachment.

Your therapist may employ ice and electrical stimulation to relieve pain and promote healing of the collagen. Therapy sessions may also comprise iontophoresis, which leverages a mild electrical current to advance anti-inflammatory medicine to the inflamed area. This treatment is particularly effective for patients who can’t undergo injections. Exercises are introduced to extend and reinforce the forearm muscles gradually.

SInce tendonosis is often associated with overuse, your medical provider will work with you to decrease repeated strains during activity. When symptoms are from a distinct sport or work activity, your therapist will evaluate your style and motion with the activity. Your therapist may suggest ways to protect the elbow during your activities. Your therapist can also check your sports equipment and work tools and recommend ways to alter them to keep your elbow safe.

Surgery
Sometimes nonsurgical treatment fails to stop the pain or help patients regain use of the elbow. In these cases, surgery may be necessary.

Tendon Debridement
When problems are caused by tendonosis, surgeons may choose to take out (debride) only the affected tissues within the tendon. In these cases, the surgeon cleans up the tendon, removing only the damaged tissue.

Tendon Release
A frequently used surgery for golfer’s elbow is called a medial epicondyle release. This surgery takes tension off the flexor tendon. The surgeon starts by making an incision along the arm above the medial epicondyle. Soft tissues are gently moved aside so the surgeon can see the point where the flexor tendon attaches to the medial epicondyle.

The flexor tendon is then made an incision where it attaches to the medial epicondyle. The surgeon divides the tendon and gets out any excess scar tissue. Any bone spurs discovered on the medial epicondyle are separated out. (Bone spurs are pointed lumps that can develop on the exterior of the bones.) Some surgeons suture the unattached end of the tendon to the nearby fascia tissue. (Fascia tissue wraps the muscles, organs, and glands throughout the body.)

The following images show each step:

  1. Tendons released
  2. Damaged tissue removed
  3. Bones spurs removed
  4. Tendons reattached

Your surgeon will evaluate the ulnar nerve, to ensure that it is not being pinched. If the nerve looks fine, the skin is then stitched together.

This surgery can typically be performed on an outpatient basis, which implies that you don’t have to remain overnight in the hospital. It can be completed using a general anesthetic or a local anesthetic. A general anesthetic places you in a deep sleep. A local anesthetic bars only certain nerve sensations for several hours. For surgery on the elbow, you would most likely get an axillary block to numb your arm.

Recovery
How soon can I use my elbow again?

Non-Surgical Rehabilitation
In cases where the tendon is inflamed, nonsurgical treatment is usually only needed for four to six weeks. When symptoms are from tendonosis, you can expect healing to take longer, usually up to three months. If the tendonosis is chronic and severe, complete healing can take up to six months.

Following Surgery
Recovery from surgery typically will take longer. Shortly after surgery, your elbow is installed in a removable splint that holds your elbow bent at a 90-degree angle. Electrical and ice stimulation treatments may be applied during your initial few therapy sessions to maintain control pain and inflammation from the surgery. Your therapist can also use massage therapy and other kinds of hands-on treatments to alleviate muscle spasm and pain.

You will slowly work into more active stretching and strengthening exercises. You need to be cautious to avoid excessively doing a task, too soon. Active therapy begins about two weeks following surgery. Your therapist may start with light isometric muscle building exercises. These exercises work to strengthen forearm muscles without straining the healing tissues. You will use your muscle power in active range-of-motion exercises.

At about six weeks, you begin doing more active strength training. As you progress, your therapist will provide you with exercise recommendations to assist in stabilizing and strengthening the joints and muscles of the wrist, shoulder, and elbow. You’ll also conduct exercises to improve fine motor control and dexterity of the hand. Some of the exercises you’ll do are designed to work your hand and elbow in ways that are comparable to your daily work and sports activities. Your therapist will aid you in finding ways to do your chores and assignments that won’t put unnecessary stress on your elbow.

You may require therapy anywhere from two to three months. It may demand four to six months to get back to work activities and high-level sports. Before your therapy sessions conclude, your therapist will show you some ways to avoid future problems.