THE CLINICAL SYNDROME

• In the same way that tennis elbow is brought on by repetitive microtrauma to the flexor tendons of the forearm, golfer's elbow, also known as medial epicondylitis, is brought on by the same type of trauma.

• Microtears at the origin of the pronator teres, flexor carpi radialis, flexor carpi ulnaris, and palmaris longus are the first step in the pathophysiology of golfer's elbow.

• If you continue to overuse or misuse the flexors in your forearm, you run the risk of developing secondary inflammation that becomes chronic over time.

• The bony origin of the flexor tendon of the flexor carpi radialis, as well as the humeral heads of the flexor carpi ulnaris and pronator teres, can be the most common source of pain associated with golfer's elbow.

• This location is found at the medial epicondyle of the humerus.

• Pain in the golfer's elbow can also come from the ulnar head of the flexor carpi ulnaris, which is located on the medial aspect of the olecranon process.

  • This causes the condition much less frequently.

  • The pain and immobility caused by golfer's elbow may be made worse by the presence of other conditions, such as bursitis, arthritis, or gout.

• Golfer's elbow is a painful condition that affects people who engage in activities that require them to repeatedly bend their elbows, such as carrying heavy suitcases, throwing baseballs or footballs, or playing golf.

• These activities all have one thing in common: a repetitive bending of the wrist, which puts strain on the flexor tendons.

• This strain can be caused by either an excessive amount of weight or a sudden stop in motion.

• There is a strong correlation between tennis elbow and golfer's elbow, which can be caused by many of the same activities.

SIGNS AND SYMPTOMS

• The pain associated with golfer's elbow is centered around the medial epicondyle region of the elbow.

• This pain is always present, and it is made significantly worse by any activity that requires active contraction of the wrist.

• Patients report being unable to perform tasks as simple as holding a coffee cup or using a hammer.

• It is common to experience problems sleeping.

• During the course of the physical examination, the flexor tendons at or just below the medial epicondyle are found to have a degree of tenderness.

• Patients suffering from golfer's elbow frequently present with a thickening of the affected flexor tendons that resembles a band.

• The range of motion in the elbow is unaffected, but there is a decrease in grip strength on the affected side.

• Patients who suffer from golfer's elbow have a test result that is positive for golfer's elbow.

• In order to carry out this examination, first the patient's forearm is held in place, and then the patient is asked to actively flex their wrist.

• The examiner then makes an effort to extend the patient's wrist against their will.

• Pain that comes on suddenly and is severe is a strong indicator of golfer's elbow.

TESTING

• In order to rule out joint mice and other hidden bony diseases, plain radiographs should be taken of every patient who presents with elbow pain.

• Due to the clinical presentation of the patient, it is possible that additional testing is required.

• These tests could include a complete blood count, uric acid level, erythrocyte sedimentation rate, and testing for antinuclear antibodies.

• The use of ultrasound imaging will be helpful in determining the severity of the tendinopathy and locating any other hidden factors that may be contributing to the patient's pain symptomatology.

• If it is suspected that the joint is unstable or if the symptoms of golfer's elbow continue to be present, magnetic resonance imaging of the elbow should be performed.

• In order to diagnose entrapment neuropathy at the elbow and differentiate golfer's elbow from cervical radiculopathy, electromyography, also known as an EMG, may be necessary.

• The injection technique that will be described later can be utilized both as a diagnostic tool and a treatment strategy.

DIFFERENTIAL DIAGNOSIS

• C6-7 radiculopathy can occasionally be mistaken for golfer's elbow; however, patients who are suffering from cervical radiculopathy typically experience pain in the neck as well as pain in the proximal upper extremity in addition to symptoms below the elbow.

• As was mentioned earlier, an EMG can differentiate between golfer's elbow and radiculopathy.

• There are a number of conditions that can mimic golfer's elbow, including bursitis, arthritis, and gout, which can make diagnosis difficult.

• It is possible for the olecranon bursa, which is located in the posterior aspect of the elbow joint, to become inflamed as a result of direct trauma to the joint or from excessive use of the joint.

• Bursae in the antecubital and cubital regions, in addition to those located between the insertion of the biceps and the head of the radius, can also become inflamed and develop bursitis if they are not properly maintained.

TREATMENT

• The initial treatment for the pain and functional disability associated with golfer's elbow consists of a combination of physical therapy and nonsteroidal anti-inflammatory drugs (NSAIDs) or cyclooxygenase-2 inhibitors.

• Both of these classes of medications are anti-inflammatory.

• The application of heat and cold to specific areas of the body may also be beneficial.

• Avoid engaging in any activity that requires a repetitive motion and has the potential to make the patient's symptoms worse.

• Patients who do not respond to these treatment modalities may benefit from an injection with a local anesthetic and steroid as the next logical step in the treatment process.

• In order to administer an injection for golfer's elbow, the patient must first be positioned in the supine position with the affected arm fully adducted at the patient's side, the elbow fully extended, and the dorsum of the hand supported by a towel that has been folded in order to relax the tendons that are being treated.

COMPLICATIONS AND PITFALLS

• The most significant risks associated with this method of injection are those connected to the trauma that is caused to the tendon that is already damaged and inflamed; if the tendon is injected directly, it may rupture.

• Therefore, before the clinician continues with the injection, they should make sure that the needle position is confirmed to be outside of the tendon.

• Infection is yet another potential risk associated with the injection method; however, this should be an extremely remote possibility if the aseptic technique is strictly adhered to.

• It is possible to avoid injury during injection by paying close attention to the anatomical features that are clinically significant; in particular, the ulnar nerve is vulnerable to injury at the elbow.

• After receiving an intraarticular injection in the elbow joint, approximately one quarter of patients experience a temporary increase in the level of pain they are experiencing.

• Patients should be made aware of the possibility that this will occur.