Medial epicondylitis (commonly called golfer's elbow or thrower's elbow) is a condition that develops when the tendons on the inside of the forearm become irritated, inflamed, and painful due to repetitive use of the hand, wrist, forearm and elbow. It is often diagnosed in people who perform repetitive motions, such as swinging a golf club or tennis racket, or activities requiring gripping, twisting, or throwing. Even using a computer or performing yard work can cause the condition. It is most common in men over the age of 35. A physiotherapist can help decrease the pain caused by medial epicondylitis, and improve the affected elbow's motion, strength, and function.
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Medial epicondylitis is a condition that occurs when the tendons on the inside of the forearm become irritated, inflamed, and painful due to repetitive use of the hand, wrist, and forearm. A tendon is a soft tissue that attaches a muscle to a bone. The group of muscles affected by medial epicondylitis are those that function to flex (bend) the wrist, fingers, and thumb and pronate (rotate palm-down) the wrist and forearm. The muscle group comes together into a common sheath and attaches to the humerus bone of the upper arm. This bony prominence, called the medial epicondyle, is located along the inside of the elbow. Pain occurs on or near the medial epicondyle, at the area where the tendon connects to the bone. Repetitive forces can cause the tendon to become tender and irritated, and without treatment, can cause it to even tear away from the bone. In addition, as the muscle groups travel across both the elbow and the wrist, they function to stabilize at the elbow allowing for wrist movement. As this is a 2-joint tendon, it is more vulnerable to injury.
Persons with medial epicondylitis may experience:
Your physiotherapist will perform an evaluation and ask you questions about pain or other symptoms you are feeling. Your physiotherapist may perform strength and motion tests on your wrist, forearm, and elbow; ask about your job duties and hobbies; evaluate your posture; and check for any muscle imbalances and weakness that can occur anywhere along the path from your shoulder blade to your hand. Your physiotherapist will gently touch your elbow in specific areas to determine which tendon or tendons may be inflamed. Special muscle tests, such as bending the wrist or rotating the forearm with resistance, also may be performed to ensure a proper diagnosis.
It is important to get proper treatment for medial epicondylitis as soon as it occurs, as tendons do not have a good blood supply. An inflamed tendon that is not treated can begin to tear, causing a more serious condition.
When a diagnosis of medial epicondylitis is made, you will work with your physiotherapist to devise a treatment plan that is specific to your condition and goals. Your individual treatment program may include:
Your physiotherapist will help you identify and avoid painful movements to allow the inflamed tendon to heal. Ice, ice massage, or moist heat may be used for pain management. Therapeutic modalities, such as iontophoresis (medication delivered through an electrically charged patch), and ultrasound may be applied. Bracing or splinting may also be prescribed. In severe cases, it may be necessary to rest the elbow and not perform work or sport activities that continue causing pain, which may slow the recovery process.
Your physiotherapist may use manual techniques, such as gentle joint movements, soft-tissue massage, and elbow, forearm, and wrist stretches to help the muscles regain full movement. Your therapist may also do manual stretching and manual techniques to your shoulder and thoracic spine, as your tendons along the medial elbow can be affected by muscle imbalances all the way up the chain.
You will learn mobility exercises and self-stretches to help your elbow and wrist maintain proper movement.
Your physiotherapist will determine which strengthening exercises are right for you depending on your specific condition, as your pain subsides. You may use weights, medicine balls, resistance bands, and other types of resistance training to challenge your weaker muscles. You will receive a home-exercise program to maintain your arm, forearm, elbow, and hand strength long after you have completed your formal physical therapy.
Education is an important part of rehabilitation. Your physiotherapist may suggest adjustments to how you perform various tasks, and make suggestions to improve your form and reduce any chance of injury. Adjustments made in your golf swing, throwing techniques, or work tasks can help reduce pressure placed on the tendons in the forearm region.
As your symptoms improve, your physiotherapist will help you return to your previous level of function. Functional training will include modifications in specific movement patterns, promoting less stress on the medial tendons. As mentioned previously in patient education, you and your physiotherapist will decide what your goals are, and safely get you back to your prior performance levels as soon as possible.
Understanding the risk of injury and being aware of your daily movements can help prevent the development of medial epicondylitis. Individuals should: