Medial Elbow Tendinopathy (Golfer’s Elbow)

Golfer’s elbow, also known as medial epicondylitis, medial epicondylalgia, or medial epicondylosis, involves the common flexor/pronator tendon at the tenoperiosteal junction near the medial epicondyle. It is associated with repetitive movements into wrist flexion, such as swinging a golf club, pitching a ball, or work-related grasping, shuffling papers and lifting heavy objects. Concomitant ulnar neuropathy is often an associated finding.
                                 Man Playing Golf
                 Positive tests of provocation include palpation tenderness on or near the medial epicondyle, pain with resisted wrist flexion performed with the elbow extended, and pain with passive wrist extension performed with the elbow extended.

Etiology of Symptoms

                     The most common cause of epicondylalgia is excessive repetitive use or eccentric strain of the wrist or forearm muscles. The result is microdamage and partial tears, usually near the musculotendinous junction when the strain exceeds the strength of the tissues and when the demand exceeds the repair process. Initially, there may be signs of inflammation followed by the formation of granulation tissue and adhesions. With repetitive trauma, fibroblastic activity and collagen weakening occur. Recurring problems are seen because the resulting immobile or immature scar is redamaged when returning to activities before there is sufficient healing or mobility in the surrounding tissue. Hypersensitivity over the radial and ulnar nerves has been reported to occur in women with lateral epicondylalgia, indicating a possible link between mechanical irritation and nerve sensitization.

Special test For Golfer’s Elbow

                        Medial Epicondylitis (Golfer’s Elbow) Test. While the examiner palpates the patient’s medial epicondyle, the patient’s forearm is passively supinated and the examiner extends the elbow and wrist. A positive sign is indicated by pain over the medial epicondyle of the humerus.

Structural and Functional Impairments

  • Gradually increasing pain in the elbow region after the excessive activity of the wrist and hand
  • Pain when the involved muscle is stretched or when it contracts against resistance
  • Decreased muscle strength and endurance for the demand
  • Decreased grip strength, limited by pain
  • Tenderness with palpation at the site of inflammation, such as over the lateral or medial epicondyle, head of the radius, or in the muscle belly

Activity Limitations and Participation Restrictions

  1. Inability to participate in provoking activities, such as racket sports, throwing, or golf.
  2. Difficulty with repetitive forearm/wrist tasks, such as sorting or assembling small parts, typing on a keyboard or using a computer mouse, gripping activities, using the hammer, turning a screwdriver, shuffling papers, or playing a percussion instrument.

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