Description:
Also known as Climbers’ Elbow, ME is a condition which is associated with the overuse of the muscles which attach at the inside of the elbow. The pathological process of tendon injury is similar to that of tennis elbow but less common. This blog post will look at the anatomy, mechanism of injury, signs and symptoms as well as the management of Medial Epicondylalgia.
Anatomy:
Tendons attach muscle to bone. There are 5 key muscles which play a role in wrist flexion (bending) and forearm pronation (turning the forearm downward). These muscles attach to the inner aspect at the front of the elbow. The attachment of these muscles to the bone is thought to be via the common flexor tendon.
Mechanism of injury:
Golfers elbow is thought to be caused by the repetitive overuse the muscles which are responsible for flexing the wrist and pronating the forearm. This injury is not only seen in golfers but also tennis players who play single forehanded shots, in rock climbers and in handymen. The mechanism in golf is thought to be due to eccentric wrist flexion and forearm pronation (contraction of wrist flexors and forearm pronators whilst in a stretched position). This in conjunction with gripping of the club places significant load through the common flexor tendon. In rock climbing, the injury is associated with recurrent strain the tendon is placed under during finger gripping, wrist flexion and forearm pronation.
Risk factors
Occupation/sports which involve repetitive movements that overload the wrist flexor, finger flexor and forearm pronator muscles.
Between the ages of 35-50
Statin use for cholesterol
Diabetes
Signs and symptoms
Pain isolated to the inner elbow.
Pain on resisted wrist flexion.
Pain and weakness with gripping.
Stiffness at the wrist.
Physiotherapy management
Physiotherapy has been shown to successfully manage golfers’ elbow. The aim of rehabilitation is to reduce pain and gradually work on regaining mobility and strength to return to sport or work without pain. To prevent reoccurrence, it may be advised to consult a golf or tennis coach to assist with form and technique.
Physiotherapy management
Soft tissue massage of associated muscles.
Active range of motion exercises.
Strengthening of wrist and elbow musculature
Bracing to alleviate load placed through muscle.
Gradual return to play.
If you think you may be battling with golfers elbow, do not hesitate to call our rooms for a thorough assessment and management plan.
References
Amin NH, Kumar NS, Schickendantz MS. Medial epicondylitis: evaluation and management. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2015 Jun 1;23(6):348-55.
Ciccotti MC. Diagnosis and treatment of medial epicondylitis of the elbow. Clin Sports Med. 2004.
MARKSCHICKENDANTZ M. 28 Medial: Flexor-Pronator Tendon Injury. Shoulder and Elbow Injuries in Athletes: Prevention, Treatment and Return to Sport. 2017 Oct 17:461.
Michael C. Ciccotti , MA, RA, Michael A. Schwartz, MD, Michael G. Ciccotti, MD. Diagnosis and treatment of medial epicondylitis of the elbow. Clin Sports Med 23 (2004) 693-705
Todd S. Ellenbecker RNPR. Current Concepts in Examination and Treatment of Elbow Tendon Injury. Sports Health; 5(2): 186–194.