Synonymous
Golfer arm, Golf arm, Epicondylitis humeri ulnaris, Epicondylitis medialis humeri, Golf elbow
Definition
The so-called golfers elbow can medically be described as an epicondylitis humeri ulnaris (epicondylitis humeri medialis). Patients, who suffer from a golfers elbow, have pains on the inside of the elbow, in the area of the bone projection where the tendons insert. Therefore a so-called inflammation of the tendons` insertion (=tendonitis of the insertion), at which mainly the flexing / bending musculature of the forearm is concerned, is meant by a golfers elbow. The reason for the chronic inflammation at the epicondylus medialis humeri is not yet cleared, one assumes, however, that overstraining in the profession or also sports (e.g. golf) seems to trigger it mechanically. This explains the origin of the name "golfers elbow".
Patients quite frequently complain about the pains radiating up to the fore and / or upper arm, so that under circumstances the complete arm can be sore. As a rule, there is a local stabbing pain on palpation at the bone insertion of the musculature, as well as pains on the inside of the elbow, which are caused by closing the fist and bending, particularly against resistance.
Summary
The golfers elbow is a localized inflammation in the area of the bending musculature of the forearm and the hand. From a medical point of view it is about a so-called epicondylitis (humeri medialis).
On the one hand, she is part of the tendopathy of the tendon (= illness of the tendons, tendon sheaths and ligaments), on the other hand it is also part of the myotendinosis (illness of the unity of muscle = myo and tendon = tendo). Therefore, the epicondylitis (humeri medialis) is an illness of the tendons and ligaments under participation of the adjacent musculature.
Tendopathies (= tendon inflammations) can possibly cause painful changes at tendons in the area of a muscle origin, at the insertion of muscles, ligaments or capsule. A tendopathy can therefore appear almost in the entire body.
When you suffer a tennis elbow due to overstraining your musculature characteristic pain occurs, which might possibly limit the ability to use the arm tremendously. The tennis elbow occurs to men and women in about the same ratio and the same years of age, namely in the middle ages.
The golfers elbow can be treated both conservatively and operatively.
As a rule, one tries to treat the syndrome conservatively at first. This implies methods of treatment such as:
- immobilization / fixation
- electromechanical stimulation
- cortisone injections
- ointment
- bandage
- shock wave therapy
- medical treatment
If the conservative methods do not work out, an operation can become necessary. For that purpose the muscles, which are needed for stretching the arm ("extensors of the forearm") will be loosened.
Causes
The name "golfers elbow" does not mean that only golfers or athletes suffer from this illness. The "tennis arm" actually only occurs quite seldom among athletes, as a rule only if a wrong technique is used.
Since the golfers elbow is caused by chronically mechanical overstraining, craftsmen, mechanics, street and construction workers or secretaries are much more frequently concerned with this. ´
In the course of the illness painful wear illnesses in the insertion area of the bend musculature of the wrist occur. The golfers elbow frequently appears also within older patients. Examinations might show very serious degenerative (arthritic) changes within the elbow joint.
Diagnosis
Due to the severe, sometimes stabbing pains, which more and more frequently appear when performing everyday activities and are partly so severe that carrying simple objects alone becomes tormenting, the patient goes to see a doctor. Patients frequently also complain about the pain radiating up to the forearm musculature.
At the clinical examination a severe pain on palpation and tenderness to touch has to be aroused on the concerned tendon insertions. A pain-related movement restriction in the elbow joint which is, however, proportionally seldom triggered by degenerative / wear-related changes is found.
In the context of the medical examination the doctor runs so-called resistance tests. The patient must make a fist and push up or down against resistance. At an illness of the tennis or golfers elbow the resistance test shows pain reinforcement within the elbow joint.
The complete forearm musculature is often strongly tense and there can also possibly occur slight disturbances of sensation, which manifest themselves by a prickling, for example. As a rule, they are not caused by a cervical syndrome (cervical tension syndrome) or local nerve damages.
By putting pressure on the origin zones of the flexing musculature of the finger and the hand a severe, stabbing pain appears. Caused by the pains of the patient a movement restriction of the elbow joint can be found again and again, too. This can be explained by degenerative changes only in quite rare cases, though and is rather pain-related.
When doing an ultrasound scan the doctor can recognize a swelling in the area of the tendons` insertion, whereas at an x-ray examination of the elbow joint pathologic changes can only seldom, and mostly in farther progressed stages, be found.
In the chronic stage calcification herds in the area of the tendon insertion or little irregularities of the periosteum (periosteum irregularities) as well as outgrowths of the bone can be seen on the X-ray.
The doctor must distinguish between for example the epicondylitis humeri ulnaris (golfers elbow) and the epicondylitis humeri radialis (= tennis elbow).
To be able to distinguish these from each other for certain, these following tests will help the doctor.
Tests
Epicondylitis humeri radialis (tennis arm / elbow)
Pain in the area of the outer elbow caused by:
- Turning the forearm
- Stretching the wrist against resistance
- Stretching the middle finger against resistance
- Stretching the elbow and passive flexion/ bending of the hand
Epicondylitis humeri ulnaris (golfers elbow)
Pain in the area of the inner elbow caused by:
- Flexion / bending of the wrist
- Turning the forearm against resistance
- Lifting up heavy things
Therapy
Ergotherapy
Since there are innumerable overload moments at most work places, which arouse one-sided strains and monotonous forced postures, ergotherapists can cause pain relief by few but specific changes.
Pains of a golfers elbow can tremendously be reduced by using a foldable PC keyboard or a so-called ergonomically formed keyboard as well as a computer mouse worked ergonomically, for example.
Also notice the literature recommendation diagnosis mouse arm.
In craftsman business, for example, the in screws by hand screwing can be replaced by an electric screwdriver.
Immobilization by a plaster
Such an immobilization is only necessary in exceptions. By the total fixation it can come to additional stiffenings in the area of the elbow and / or wrist. This would have effects on muscles, tendons and ligaments, which could further be shortened under circumstances, too.
Physiotherapy
Taught by physical therapists the patient can independently carry out so-called crossfriction at home at the tendon insertions, which seem pain-relieving. By this crossfriction stretching attractions are put crossways to the tendon.
Medicinal therapy
Ointment bandages might help at easier forms.
At more severe forms the doctor can infiltrate. With this, as a rule, a combination preparation is injected from local anesthesia with cortisone. The aim is to ease the pain in order to stretch the tendons quite well during this time by means of physiotherapy or also independently.
If you have to deal with a chronic golfers elbow, then cortisone preparations can achieve good treatment successes at short notice. A giving preparations containing cortisone too frequently should not be taken into consideration since cortisone can damage the tendons and bones over a longer time period, though.
Physical therapy
The soft laser can be used for therapeutical support. An activation of metabolism is triggered through it. A local pain relief shall be achieved and abbreviated tendon insertions shall be calmed and stretched.
By the ultrasound treatments warmth and vibration are conducted in the depth. By the vibrations a kind of micro massage, which at first can seem pain emphasizing to the patient in the therapeutical beginning, is aroused.
Aims of a special electrotherapy, the so-called iontophoresis, is to put medicine to the tendon insertion and therefore in the depth.
Sports therapy
Especially in initial stages only a short break is frequently necessary. Before starting again with the practice of "his / her" kind of sport, you should attend a "training advice" together with an experienced coach. Most of the times checking the training device also gets necessary (in the area of the tennis arm: racket and stringing) such as in the case of the tennis elbow.
Think of it: If you will perform all activities like you did till now, the renewed appearance of the pains is very probable.
Bandages
Bandages frequently help the patients to avoid the coming back of the illness. Orthopedics-technical solutions like elbow-bandages or elbow- clasps are being used in the area of the golfer, or tennis elbow to aid the prevention / precautions. At acute troubles elbows-clasps and elbow-bandages are only little helpful, though.
Acupuncture
The acupuncture has proved itself here in many cases. On the one hand, it serves the pain relieve, on the other hand, it can also stop the inflammation process, if the person stops the pain-producing activity, such as playing tennis. Unfortunately, this is not always possible, particularly in cases where the activities, which are causing the pain, are part of everyday life.
Further treatment attempts
Furthermore there is the possibility of a x-ray treatment in case that the conservative methods mentioned above do not work out.
The X-rays get only turned towards the elbow alone. The radiation exposure is lower at a 3 – 4 times repeated execution than at an x-ray of the elbow joint in 2 levels.
Extracorporeal shock wave therapy (ESWT):
In the context of the extracorporeal shock wave therapy ultrasound impulses are conducted on the painful tendon insertions. It is about one specific ultrasonic apparatus which is similar to an apparatus, which destroys kidney stones.
Success occurs approximately with 80% of all patients, there might be some complications during the treatment, though. Examples for those complications are: pain in the area of the epicondyles, as well as bruises due to injuries of small blood vessels.
Further therapy forms are:
- The magnetic field therapy and
- The pulsating signal therapy
- Till now, an obviously positive effect could not scientifically be ascribed to both therapy forms yet.
Operative therapy
Should there still be no recovery or even deterioration noticeable after an approximately six-month conservative therapy, it is recommended to think about an operative therapy together with your attending doctor.
Forecast
The forecast can be considered to be good and successful since most patients, who suffer a golfers elbow can be healed conservatively, i.e. healed without an operation being necessary.
However, it might happen that the illness appears over a long period of time and can only be taken care of and healed by operating the arm. In rare cases even an operation can also not cause any durable relief of the pains.
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