Medial Epicondylitis (Golfer's Elbow) Lecture PDF

Medial Epicondylitis Golfer's Elbow Dr. Sahar Mowad Abd elmutilibe Lecture in Orthopedic Physical Therapy Department  commonly called golfer's elbow or thrower's elbow.  It is a condition that develops when the flexor tendons on the inside of the forearm become i...

Medial Epicondylitis Golfer's Elbow Dr. Sahar Mowad Abd elmutilibe Lecture in Orthopedic Physical Therapy Department  commonly called golfer's elbow or thrower's elbow.  It is a condition that develops when the flexor tendons on the inside of the forearm become irritated, inflamed, and painful. Repetitive use of the hand, wrist, forearm, and elbow causes golfer's elbow.  degenerative condition consisting of a timedependent process including vascular, chemical, and cellular events that lead to a failure of the cell-matrix healing response in human tendon  diagnosed in people who repeatedly swing a golf club or other activities that require gripping, twisting, or throwing. Using a computer or performing hard work also can cause the condition. an extra-articular tendinous injury characterized by excessive vascular granulation and an impaired tendon healing response termed “angiofibroblastic hyperplasia Overuse disease and reported a lack of large numbers of lymphocytes, macrophages, and neutrophils. Instead, tendinosis appears to be a degenerative process characterized by large populations of fibroblasts, disorganized collagen, and vascular hyperplasia  common in men over the age of 35  5 to 10 times less common than lateral epicondylitis  affects men and women equally  dominant extremity in 75% of cases  age 30s to 60s, most commonly in 30s to 40s.  The group of muscles affected by golfer's elbow is those that flex (bend) the wrist, fingers, and thumb and pronate (turn or hold) the wrist and forearm so that the palm faces downward.  The muscle group comes together into a common sheath and attaches to the humerus bone (the bone in your upper arm). As the muscles in this group spread across the elbow and the wrist, they stabilize the elbow and allow for wrist movement. A bony bump, called the medial epicondyle, is located along the inside of the elbow. Pain occurs on or near this bump, where the tendons of your forearm muscles connect to the bone Repetitive forces can cause the tendon to become tender and irritated. Without treatment, these forces can cause the tendon to tear away from the bone. Because it is a two-joint tendon, it is more vulnerable to injury. :Clinical picture Pain along the inside of the forearm with wrist, hand, or elbow movements. Pain or numbness and tingling that radiates from the inside of the elbow into the hand and fingers when 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 which refers to a rapid increase in loading Tendon disrepair often follows a reactive tendinopathy if the tendon continues to be excessively loaded Degenerative tendinopathy represents the response of the common elbow flexor tendon to chronic overloading. Poor play technique: much wrist action, jerky strokes, and poor ball contact. Improper equipment: incorrect grip size, strings are too tight or racquets, tool that are too heavy or unbalanced. Diagnosis Pain along medial elbow Radiation to proximal forearm Increased pain with resisted pronation and wrist flexion Tenderness 5-10mm distal and anterior to medial epicondyle Normal ROM Normal Sensation Resisted wrist flexion, forearm pronation, grip may be weak Valgus Stress è Ligamentous pain X-rays usually normal Concomitant ulnar neuritis Special Tests Golfer’s Elbow Test. The examiner places one hand on the medial epicondyle or common flexor tendon. The examiner uses the other hand to passively supinate the arm and extend the elbow and wrist. A positive test is pain or discomfort along the medial epicondyle or common flexor tendon. Elbow Valgus Stress Test. The elbow is held in 20° flexion, one hand supporting the elbow with the humerus somewhat externally rotated. The other hand is on the forearm applying valgus stress. A positive test is pain or laxity compared to the unaffected arm. Note this test can also be used for little leaguers elbow. Tinel’s Test. This special maneuver is used to diagnose a series of neuropathies, most commonly carpal tunnel syndrome. For cubital tunnel, tapping or pressing against the cubital tunnel can recreate the symptoms if an ulnar neuropathy is present. Treatment Range-of-motion Manual therapy exercises Gentle joint movements. Soft-tissue massage. mobility exercises Elbow, forearm, and wrist stretches. self-stretches Manual stretching and other techniques on your shoulder and thoracic spine. Treatment Strengthening exercises Patient education Isometric exercises Functional training (muscle contractions). Resistance exercises to challenge weaker muscles (using weights, medicine balls, or resistance bands). Treatment Operative  open debridement of PT/FCR, reattachment of flexor-pronator group indications  up to 6 months of nonoperative management that fails in a compliant patient  symptoms severe and affecting quality of life Outcomes  good to excellent outcomes in 80% (less than lateral epicondylitis)  worse outcomes when ulnar nerve symptoms present pre-operatively rehabilitation  short period of immobilization x 1-2 weeks in sling  avoid volar flexion of wrist immediately postoperatively  ROM exercises after 2 weeks  strengthening at 6-8 weeks  return to sport at 3-6 months How to prevent medial epicondylitis Stretch before physical activity. Practice correct form Give your arm a break Build arm strength.