Medial epicondylitis is most commonly referred to as “Golfer’s Elbow” and is a painful condition where the tendons that attach to the inside of the elbow become inflamed due to repetitive use of the hand, wrist, forearm and elbow. It often occurs with repetitive activities such as, swinging a golf club or tennis racket, work or leisure activities requiring twisting and gripping such as shoveling, gardening and swinging a hammer. It can also appear in other sports-related activities such as throwing and swimming. Medial epicondylitis is most commonly seen in men over the age of 35, but can be seen in any population.
Medial epicondylitis affects the group of muscles that are responsible for bending the wrist, fingers and thumb and that rotate the wrist and forearm. The tendons that connect those muscles to the medial epicondyle (bump on inside of elbow). Tendons are made up of collagen fibers that are lined up next to each other. The repetitive forces pull on those tendons creating pain and tenderness. Without treatment those tendons can eventually pull away from the bone. Acute injuries to your elbow can create an inflammatory response which can cause redness, warmth and stiffness in your elbow.
Medial epicondylitis is most often caused by an abnormal arrangement of collagen fibers. This condition is called tendinosis. During tendinosis the body doesn’t create inflammatory cells as it does during an acute injury. Instead, fibroblasts are created which help make up scar tissue to fill in the spaces between the collagen fibers. This increase in scar tissue can lead to increased pain and weakness in the tissues. Physical therapy is the most common non surgical treatment for medial epicondylitis. Your therapist will perform an evaluation where he/she will ask you several questions about your condition, pain level and other symptoms you may be experiencing. He/she will perform motion and strength testingon your entire upper extremity. Your physical therapist will also palpate your arm to determine which tendon(s) may be inflamed. He/she will use special tests designed to differentially diagnose your condition from others that may have similar presentations, such as Cubital Tunnel Syndrome.
After you have been evaluated by your physical therapist, he/she will formulate an individualized treatment plan that can include any of the following:
1. Pain Management: this can include Mechanical Diagnosis & Therapy, ice, ice massage, moist heat, electrical stimulation and ultrasound.
2. Range-of-Motion Exercises: stretches and mobility exercises to help maintain proper movement in your elbow, forearm, wrist and hand.
3. Strengthening Exercises: progressive resistive exercises to help build strength in your arm, elbow, forearm, wrist and hand. These can include weights, medicine balls and/or resistance bands. This will also include your Home Exercise Program.
4. Manual Therapy: used to ensure full, pain-free movement is achieved and can include joint mobilizations, manual muscle stretches and soft tissue massage.
5. Neuromuscular Re-education (Functional Training): used to help you return to your prior level of function for both home and work activities. Will include retraining proper movement patterns with necessary modifications based on current level of function and patient limitations.
6. Patient Education: used to help retrain patient on proper postural control during everyday activities including dressing, self-care, work and sports activities. This can include helping return a patient to their specific sport, such as making adjustments to their golf swing or throwing technique.
Once you’ve completed your care under the direct supervision of a physical therapist you’ll want to do everything you can to prevent this from reoccurring. This can occur by maintaining proper awareness of your risk for injury during your daily movements. Key things to keep in mind:
1. Maintain proper form during all repetitive movements both at work and home.
2. Continue your Home Exercise Program in order to maintain proper strength in your shoulder, elbow, forearm, wrist and hand.
3. Use proper posture and body mechanics with lifting or carrying to avoid any undue stress on your joints and tendons.
This information was written by Plymouth Physical Therapy Specialists, an outpatient physical therapy group with fourteen locations in the surrounding Plymouth, Michigan area. At Plymouth Physical Therapy Specialists, they are committed to using evidence-based treatments in their practice. This means that their therapists utilize the most current and clinically relevant treatments in their approach to rehabilitation. For more information click here.