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Questions and Answers
Golfer's elbow is more common in men than women.
Golfer's elbow is more common in men than women.
False
What activities commonly cause golfer's elbow?
What activities commonly cause golfer's elbow?
Repetitive use of the hand, wrist, forearm, and elbow.
What is commonly referred to as golfer's elbow?
What is commonly referred to as golfer's elbow?
Which symptoms are associated with golfer's elbow?
Which symptoms are associated with golfer's elbow?
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At what ages is golfer's elbow most commonly observed?
At what ages is golfer's elbow most commonly observed?
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Golfer's elbow is characterized by excessive vascular ________.
Golfer's elbow is characterized by excessive vascular ________.
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What is a common physical examination test for golfer's elbow?
What is a common physical examination test for golfer's elbow?
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X-rays are typically abnormal in cases of golfer's elbow.
X-rays are typically abnormal in cases of golfer's elbow.
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What type of exercises can help treat golfer's elbow?
What type of exercises can help treat golfer's elbow?
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What is another name for medial epicondylitis?
What is another name for medial epicondylitis?
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Which activities can lead to golfer's elbow?
Which activities can lead to golfer's elbow?
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Golfer's elbow affects men and women equally.
Golfer's elbow affects men and women equally.
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What is a common symptom of golfer's elbow?
What is a common symptom of golfer's elbow?
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What age group is most commonly affected by golfer's elbow?
What age group is most commonly affected by golfer's elbow?
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What part of the elbow is associated with golfer's elbow?
What part of the elbow is associated with golfer's elbow?
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Golfer's elbow is characterized by excessive vascular granulation and an impaired tendon healing response termed ___.
Golfer's elbow is characterized by excessive vascular granulation and an impaired tendon healing response termed ___.
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Golfer's elbow is significantly more common than lateral epicondylitis.
Golfer's elbow is significantly more common than lateral epicondylitis.
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What is a special test used to diagnose golfer's elbow?
What is a special test used to diagnose golfer's elbow?
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Name one treatment method for golfer's elbow.
Name one treatment method for golfer's elbow.
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Study Notes
Medial Epicondylitis
- Medial Epicondylitis is commonly called golfer's elbow or thrower's elbow
- Occurs when the flexor tendons on the inside of the forearm become irritated, inflamed, and painful.
- Repetitive use can cause it
- A degenerative condition involving vascular, chemical, and cellular events that lead to impaired tendon healing
- Diagnosed in people who repeatedly swing a golf club or other activities that require gripping, twisting, or throwing
- Characterized by excessive vascular granulation and an impaired tendon healing response
Symptoms & Causes
- Often caused by overuse
- More common in men over 35
- Affects men and women equally
- Dominant extremity affected in 75% of cases
- Most common age 30s to 60s, specifically 30s to 40s
- Muscles affected are those that flex the wrist, fingers, and thumb, as well as those that pronate the wrist and forearm
- Muscles attach to the humerus bone and spread across the elbow and wrist
- Pain occurs on or near the medial epicondyle, where the tendons connect
Classification of Injury
- Reactive tendinopathy: Rapid increase in loading
- Tendon disrepair: Occurs following reactive tendinopathy with continued excessive loading
- Degenerative tendinopathy: Chronic overloading
Contributing Factors
- Poor play technique (e.g., excess wrist action, jerky strokes, poor ball contact)
- Improper equipment (e.g., incorrect grip size, tight strings, heavy or unbalanced tools)
Diagnosis
- Pain along medial elbow
- Radiation of pain to the proximal forearm
- Increased pain with resisted pronation and wrist flexion
- Tenderness 5-10mm distal and anterior to medial epicondyle
- Normal range of motion (ROM)
- Normal sensation
- Resisted wrist flexion, forearm pronation, and grip may be weak
- Valgus stress may cause ligamentous pain
- X-rays usually normal
- Concomitant ulnar neuritis (inflammation of the ulnar nerve) possible
Special Tests
- Golfer's Elbow Test:
- Examiner places one hand on the medial epicondyle or common flexor tendon.
- The other hand passively supinates the arm, extends the elbow, and extends the wrist.
- A positive test causes pain or discomfort along the medial epicondyle or common flexor tendon.
- Elbow Valgus Stress Test:
- The elbow is held at 20° flexion, one hand supporting the elbow with the humerus externally rotated.
- The other hand applies valgus stress to the forearm.
- A positive test causes pain or laxity compared to the unaffected arm.
- This test is also used for little leaguer's elbow.
- Tinel's Test:
- Used to diagnose various neuropathies, especially carpal tunnel syndrome.
- Performed by tapping or pressing against the cubital tunnel.
- A positive test replicates symptoms if an ulnar neuropathy is present.
Treatment
-
Range-of-Motion & Manual Therapy:
- Gentle joint movements
- Soft-tissue massage
- Mobility exercises (elbow, forearm, and wrist stretches)
- Self-stretches
- Manual stretching and techniques on the shoulder and thoracic spine
-
Strengthening Exercises:
- Patient education
- Isometric exercises
- Functional exercises
-
Other:
- Rest, ice, and compression
- Medications (NSAIDs)
- Injections (corticosteroids)
- Surgery in rare cases
Medial Epicondylitis
- Also known as Golfer's Elbow or Thrower's Elbow
- It is an inflammatory condition affecting the flexor tendons on the inside of the forearm.
- Repetitive use of the hand, wrist, forearm, and elbow can cause Golfer's Elbow.
- It is a degenerative condition that includes vascular, chemical, and cellular events leading to tendon healing failure.
- Commonly diagnosed in individuals who participate in activities involving gripping, twisting, or throwing, like golf.
- Using a computer or performing strenuous work can also cause Golfer's Elbow.
- An extra-articular tendinous injury characterized by excessive vascular granulation and impaired tendon healing (angiofibroblastic hyperplasia)
- Characterized by a lack of large lymphocytes, macrophages, and neutrophils.
- Tendinosis is a degenerative process with large populations of fibroblasts, disorganized collagen, and vascular hyperplasia.
Epidemiology
- More common in men over 35.
- 5 to 10 times less common than lateral epicondylitis.
- Affects men and women equally.
- Affects the dominant extremity in 75% of cases.
- Most common age group is 30s to 60s, particularly in 30s to 40s.
Anatomy
- The affected muscles flex the wrist, fingers, and thumb, and pronate the wrist and forearm.
- These muscles converge into a common sheath and attach to the humerus (upper arm bone).
- They stabilize the elbow and allow for wrist movement.
- The medial epicondyle is a bony bump on the inside of the elbow, where the tendons of forearm muscles connect to the bone.
- Repetitive stress can cause tendon irritation, tenderness, and even tearing away from the bone.
Clinical Presentation
- Pain along the inside of the forearm during wrist, hand, or elbow movements.
- Pain, numbness, or tingling radiating from the inside of the elbow into the hand and fingers during gripping or squeezing.
- Tenderness to touch and swelling along the inside of the forearm.
- Weakness in the hand and forearm when gripping objects.
- Elbow stiffness.
Classification of Injury
- Reactive tendinopathy: Rapid increase in loading.
- Tendon disrepair: Often follows reactive tendinopathy with continued excessive loading.
- Degenerative tendinopathy: Response of the common elbow flexor tendon to chronic overloading.
Contributing Factors
- Poor play technique: Excessive wrist action, jerky strokes, and poor ball contact.
- Improper equipment: Incorrect grip size, excessively tight strings, heavy or unbalanced racquets or tools.
Diagnosis
- Pain along the medial elbow.
- Radiation of pain towards the proximal forearm.
- Increased pain with resisted pronation and wrist flexion.
- Tenderness 5-10mm distal and anterior to the medial epicondyle.
- Normal range of motion.
- Normal sensation.
- Weakness in resisted wrist flexion, forearm pronation, and grip.
- Valgus stress elicits ligamentous pain.
- X-rays usually appear normal.
- Concomitant ulnar neuritis is possible.
Special Tests
- Golfer's Elbow Test: Examiner places a hand on the medial epicondyle or common flexor tendon, passively supinating the arm, extending the elbow and wrist. Pain or discomfort along the medial epicondyle or common flexor tendon indicates a positive test.
- Elbow Valgus Stress Test: Elbow held in 20° flexion, one hand supports the elbow with the humerus externally rotated. The other hand applies valgus stress to the forearm. Pain or laxity compared to the unaffected arm indicates a positive test. Can also be used for Little Leaguer's elbow.
- Tinel's Test: Used to diagnose neuropathies, including carpal tunnel syndrome. Tapping or pressing against the cubital tunnel can elicit symptoms if an ulnar neuropathy is present.
Treatment
- Range-of-motion exercises: Gentle joint movements, mobility exercises, elbow, forearm, and wrist stretches.
- Manual therapy: Soft-tissue massage, manual stretching, and techniques on the shoulder and thoracic spine.
- Strengthening exercises: Isometric exercises, functional exercises.
- Patient education: Understanding the condition, proper biomechanics, and activity modifications.
- Other therapies: Ice, heat, compression, ultrasound, corticosteroid injections, and surgery (rarely).
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Description
This quiz covers the essentials of Medial Epicondylitis, also known as golfer's elbow. Explore its symptoms, causes, and the underlying mechanisms of this common condition that affects the flexor tendons in the forearm. Ideal for students of physical therapy, sports medicine, or anyone interested in musculoskeletal health.
