Medial epicondylitis (tennis elbow, golfer’s elbow)

• What is Medial epicondylitis (medial tennis elbow, Golfer’s elbow)
• Statistics on Medial epicondylitis (medial tennis elbow, Golfer’s elbow)
• Risk Factors for Medial epicondylitis (medial tennis elbow, Golfer’s elbow)
• Progression of Medial epicondylitis (medial tennis elbow, Golfer’s elbow)
• Symptoms of Medial epicondylitis (medial tennis elbow, Golfer’s elbow)
• Clinical Examination of Medial epicondylitis (medial tennis elbow, Golfer’s elbow)
• How is Medial epicondylitis (medial tennis elbow, Golfer’s elbow) Diagnosed?
• Prognosis of Medial epicondylitis (medial tennis elbow, Golfer’s elbow)
• How is Medial epicondylitis (medial tennis elbow, Golfer’s elbow) Treated?
• Medial epicondylitis (medial tennis elbow, Golfer’s elbow) References

What is Medial epicondylitis (medial tennis elbow, Golfer’s elbow)

Tennis elbow is an overload or overuse condition in which the muscles of the forearm are affected – in particular the muscles that flex the wrist – the ‘forehand’ muscles in tennis or the muscles of the dominant arm in golf.

Although the condition is termed ‘golf elbow’ since it is common in golfplayers, only a small proportion of patients actually get the condition from playing golf.

The forehand muscles are attached to the medial epicondyle of the humerus. Hence the other term for it is medial epicondylitis – since the ‘common flexor attachment’ is involved due to the repetitive strain.

Statistics on Medial epicondylitis (medial tennis elbow, Golfer’s elbow)

Golfer’s elbow is less common than tennis elbow. It is common in sportsmen and middle aged people, though it occurs in younger and older persons as well.

Risk Factors for Medial epicondylitis (medial tennis elbow, Golfer’s elbow)

 

• Golf – with golf there is repetitive use of the muscles causing flexion of the wrist.
• Tennis – similarly, in tennis, repetitive use of the ‘forehand’ muscles causing flexion of the wrists can lead to this condition, especially with putting more top-spin on the ball.
• Other sports and occupational activities may be a cause – involving a lot of flexion of the wrist – gripping, grasping etc
• A direct blow to the elbow may also cause it.
  

  Progression of Medial epicondylitis (medial tennis elbow, Golfer’s elbow)

   

• The pain may develop gradually or occasionally it may be sudden.
• At the moment the small tear occurs the patient may feel nothing, though several days later an ache develops.
• The pain is worse with activities such as turning on taps, turning door handles, shaking hands.
• The pain often subsides with time if the person abstains from the activity.
  

  How is Medial epicondylitis (medial tennis elbow, Golfer’s elbow) Diagnosed?

  No investigations are needed for the diagnosis of golfer’s elbow – the diagnosis is clinical.

  Prognosis of Medial epicondylitis (medial tennis elbow, Golfer’s elbow)

  This is not a serious condition, though it can be reasonably disabling in the sense that it limits certain activities, and the person’s work. It usually lasts for months – as long as 24 months, though this depends on treatment and whether the exacerbating activity is stopped.

  How is Medial epicondylitis (medial tennis elbow, Golfer’s elbow) Treated?

  The mainstay of therapy is:

   

• Abstaining from exacerbating activities;
• Anti-inflammatory medications (e.g. Non-steroidal anti-inflammatories, Cox-2 inhibitors – though prolonged use may lead to gastritis);
• Gradual stretching and strengthening exercises – such as:
  – Wringing exercises – e.g. rolling up a hand towel, then ‘wringing’ the towel, by first flexing the wrist for 10 seconds, and then extending the wrist for 10 seconds.
  – Weights: sitting with the arms rested, a weight is grasped with the palm facing upwards, and raised by flexing the wrist then extending – gradually increasing the weight.
• Injection of a corticosteroid and local anesthetic (1ml each) may be tried into the lateral epicondyle – up to 2 injections 2-4 weeks apart may be tried.
• After resolution of the condition – the person can gradually return back to the offending activity, though with caution. A non-stretch band or a brace placed 3cm below the elbow may help.
  

  Medial epicondylitis (medial tennis elbow, Golfer’s elbow) References

  1. Kumar P, Clark M. CLINICAL MEDICINE. WB Saunders 2002;
  2. Moore, KL, Clinically orientated anatomy 3rd ed; Williams and Wilkins, 1992;
  3. Murtagh, J. General Practice. Second Ed. McGraw-Hill, 1998.