Golfer's elbow - symptoms
- The primary symptom is gradually increasing pain on the medial side of the elbow joint, without restriction of its mobility, sensation and strength. The pain intensifies when performing throws and recurve the forearm with resistance.
- Maximum tenderness is felt at the site, the initial attachment of the muscles: the recurvatum obturator and ulnar flexor of the wrist.
- Depending on the severity of the lesions, the pain may be slight and appear mainly at the beginning of physical activity or very severe, preventing the continuation of activities.
- Sometimes enthesopathy of the medial epicondyle of the humerus is accompanied by compression of the ulnar nerve in the groove.
Golfer's elbow - diagnosis
The diagnosis of golfer's elbow is based on clinical examination, in some cases supplemented by additional tests. Ultrasound and MRI can help in clinically doubtful cases and with overlapping pathologies. X-rays can visualize changes such as calcifications in tendons and ligaments.
Golfer's elbow - treatment
- At all stages of treatment, physiotherapy plays an important role. The rehabilitation program includes isometric exercises. Stretching exercises of the flexor complex are important. At a later stage of treatment, more intensive exercises with resistance are introduced.
- Initially, non-operative treatment is used: modification of physical activity, orthoses, ice packs, use of anti-inflammatory agents.
- With persistent pain symptoms, platelet-rich plasma injections are performed near the affected tendons. In patients in great pain, a so-called block or corticosteroid injection can be given.
- In cases of chronic inflammation, when non-operative treatment proves insufficient, surgical treatment is recommended. Surgery involves lowering the wrist flexor attachment, removing inflamed tissues.
- After a short immobilization of the joint in a sling, rehabilitation begins, consisting of exercising movements in the elbow and wrist.
- Approximately 6 weeks after surgery, the patient begins exercises to strengthen muscle structures adapted to his ailment.
Golfer's elbow - rehabilitation
Based on our years of experience and cooperation with the best Polish athletes, we have developed advanced rehabilitation programs that will allow you to safely and quickly return to maximum fitness after surgery.
Remember that surgery is only half the battle, and the ultimate success will be determined by the rehabilitation process and your commitment. Your rehabilitation after arthroscopic treatment of tennis / golfer's elbow will take about 20 weeks. Keep in mind, however, that this period is subject to change and is adjusted on an ongoing basis according to your progress by your doctor and physiotherapist.
For your first post-surgery rehabilitation, the so-called "zero" rehabilitation, you will appear at the RSC about 7 days after surgery, right after your follow-up appointment with the doctor. Until then, you will perform the exercises included in your post-operative instructions. You will use an orthosis for about 2 weeks. You will begin regular appointments with a physiotherapist three weeks after surgery. After this time, rehabilitation will also be able to take place in the water. After four weeks, you will be able to perform most basic daily activities, including driving.
During the first weeks of intensive rehabilitation, we will focus on protecting the operated joint, reducing pain and swelling, gradually restoring full range of motion, and rebuilding muscle strength and endurance. After the first Biomechanical Functional Assessment, rehabilitation will be focused on eliminating any deficits and asymmetries and gradually implementing dynamic exercises, and from about the 16th week after surgery you will also begin classes with a motor preparation trainer.
During the rehabilitation process, you will undergo Biomechanical Functional Assessment twice, at the twelfth and twentieth week after surgery. Obtaining good results will allow you to safely return to full-load sports, thus your core rehabilitation program will come to an end.
Golfer's elbow - exercises
After a one-week period of immobilization, the patient can begin performing exercises aimed at regaining full range of motion in the elbow joint and wrist. It is essential to obtain the movements used in performing activities of daily living.
The exercise is presented by Rehasport physiotherapist Mateusz Szymanski, M.D., M.Sc.
Dorsiflexion and palmar flexion of the hand at the wrist, the movement is assisted by the non-operated hand. The patient, standing with the upper limb straight, grasps the operated hand and directs it to palmar and then dorsal flexion.
Flexion and extension at the wrist with a load of, for example, 0.5 kg. The patient, leaning his forearm against, for example, a table, holds a dumbbell and performs the above-mentioned movements. It is important not to feel pain during the exercise.
Squeezing the ball with the hand - the exercise is directed at increasing the muscle strength of the upper limb.
Performing pronation and supination from a neutral hand position. The patient places the limb in a position with the thumb pointing upward and the forearm resting on a table, for example, and performs external and internal rotation at the wrist.
Progressing a given exercise, a weight can be used. It is important not to feel pain during the exercise, gentle pulling and stretching is allowed.
Flexing and straightening the arm with Theraband resistance. Slight strain on the tape, it is important that the patient does not feel any pain while performing this exercise.
All exercises are performed for 15-20 repetitions each in 2-3 series.
Golfers' elbow - prognosis
Both non-surgical treatment and, in cases of more advanced lesions, surgical treatment give satisfactory results. For athletes, return to physical activity with conservative treatment occurs with a gradual increase in load, as long as the exercises do not cause pain. After surgery, return to sports occurs after about 4 months.
Golfer's elbow - prevention
To ensure that golfer's elbow does not prevent you from playing your favorite sport, always absolutely remember to warm up properly before physical activity, exercise your forearm muscles, such as squeezing the ball, and make sure that your technique is correct.
Golfer's elbow - where to get treatment?
If you have elbow problems it is worth consulting a specialist at Rehasport. Our orthopedists and physiotherapists in Poznań, Warsaw, Gdańsk and Konin will provide you with comprehensive assistance.
Related articles:
Learn about other possible elbow injuries.
Bibliography:
- Ortho Bullets - Medial Epicondylitis (Golfer's Elbow) - David Abbasi MD, Christopher S. Ahmad MD, American Shoulder and Elbow Surgeons
- National Library of Medicine - Golfers Elbow - John Kiel; Kimberly Kaiser.
- Healthline - Best Exercises for Treating and Preventing Golfer’s Elbow - Medically reviewed by Gregory Minnis, DPT, Physical Therapy — By Emily Cronkleton on June 24, 2019
- Medial Epicondylitis - Evaluation and Management - Amin, Nirav H. MD; Kumar, Neil S. MD, MBA; Schickendantz, Mark S. MD - Journal of the American Academy of Orthopaedic Surgeons: June 2015 - Volume 23 - Issue 6 - p 348-355 doi: 10.5435/JAAOS-D-14-00145