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Medial Epicondylitis (Golfer's Elbow)

Medial Epicondylitis (Golfer's Elbow)

Medial Epicondylitis is also known as “golfer’s elbow” or “pitcher’s elbow.” A staged process of pathologic change in the tendon can result in structural breakdown and irreparable fibrosis or calcification. Patients typically report persistent medial-sided elbow pain that is exacerbated by daily activities.

Athletes may be particularly symptomatic during the late cocking or early acceleration phases of the throwing motion; the pathology occurs in baseball pitchers as a result of high-energy valgus forces created by the overhead throw. It has also been reported with tennis, bowling, archery, weightlifting, javelin throwing, racquetball and American football. However, 90 to 95% of all cases do not involve sportsmen. Occupations such as carpentry, plumbing and meat cutting have also been implicated. The pathology may also be produced by sudden violence to these tendons in a single traumatic event.

 

Most of the time, golfer's elbow is not caused by inflammation. Rather, it is a problem within the cells of the tendon. In tendinopathy, wear and tear is thought to lead to tissue degeneration. When this happens, the collagen loses its strength. It becomes fragile and can break or be easily injured. Each time the collagen breaks down, the body responds by forming scar tissue in the tendon. Eventually, the tendon becomes thickened from extra scar tissue.

As medial epicondylopathy is a tendinosis of the flexor group tendons attached to the medial epicondyle of the humerus, the most sensitive region will be located near the origin of the wrist flexor group. The patient usually complains about pain of the elbow distal to the medial epicondyle
of the humerus with radiation up and down the arm, most common on the ulnar side of the forearm, the wrist and occasionally in the fingers. Local tenderness over the medial epicondyle and the conjoined tendon of the flexor group, without evidence of swelling or erythema, are also characteristics that can occur. Other symptoms are stiffness of the elbow, weakness in the hand and the wrist and a numb or tingling feeling in the fingers (mostly ring and little finger). The pain is evoked by resisted flexion of the wrist and by pronation. The pain can begin suddenly or can develop gradually over time and can be accompanied by a weakness of hand grip.

Non-surgical Treatment

• Physical Therapy

        - Establish full painless ROM

        - Concentric and Eccentric Exercises

        - Return to Activity with Assessment of technique

• Steroid injection

 

Surgical Possibilities

• Mini-open Muscle Resection Procedure Under

   Local Anesthesia

• Fascial Elevation and Tendon Origin Resection

At Home Exercise Videos

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