By Michael Yorfido, PT Student McMaster
Photography (c) Steve Horvath for ISM Rehab
What is Medial Epicondylalgia (Golfers Elbow)?
A common repetitive strain condition of the wrist flexor tendons (most commonly the pronator teres and flexor carpi radialis tendons) at their attachment to the medial epicondyle of the humerus. It occurs with overuse and is common in sports, such as baseball pitching, driving golf swings, swimming, or occupations that require a strong hand grip and excessive pronation of the forearm. (1) What are some symptoms of Medial Epicondylalgia?
Pain - Pain on inside of elbow and the pain can spread down the inside of forearm. Weakness - Weakness in the hand and wrist, especially with gripping activities. Numbness or tingling - Numbness or tingling into the pinky and ring finger. Tenderness - Tenderness to palpation on the medial elbow and the neck Stiffness - Elbow stiffness, especially first thing in the morning. You may experience neck stiffness as well. (1) |
What kinds of treatments are available for my Medial Epicondylalgia?
Ultrasound (2)
Friction Massage (2)
Strengthening, endurance, coordination, and flexibility exercises (with initial focus on the eccentric phase of exercise) (3)
Mulligan’s mobilization with movement (4)
Manipulations of the cervical spine (4)
Education regarding prevention
Cryotherapy, thermotherapy, sound agents, and TENS for symptomatic relief of pain
Counterforce bracing is frequently used to reduce forces along the Pronator Teres and Flexor Carpi Radialis (3)
Education on corticosteroid injection (3)
Ultrasound (2)
Friction Massage (2)
Strengthening, endurance, coordination, and flexibility exercises (with initial focus on the eccentric phase of exercise) (3)
Mulligan’s mobilization with movement (4)
Manipulations of the cervical spine (4)
Education regarding prevention
Cryotherapy, thermotherapy, sound agents, and TENS for symptomatic relief of pain
Counterforce bracing is frequently used to reduce forces along the Pronator Teres and Flexor Carpi Radialis (3)
Education on corticosteroid injection (3)
Phases of Treatment
Phase 1:
Reduce inflammation and swelling around the elbow (rest, ice, compression and elevation). It is not advised to stop all activity as it can lead to muscle wasting, but reducing activities that aggravate pain is advised.
Phase 2:
In this stage the aim is to regain full, painless wrist and elbow range of motion (passive range of motion and mobilizations). Followed by stretching and strength training.
Stage 3:
In this stage the physiotherapist may look at the equipment or techniques that may have induced medial epicondylalgia and advise on ways to minimize the risk or recurrence. (5)
Phase 1:
Reduce inflammation and swelling around the elbow (rest, ice, compression and elevation). It is not advised to stop all activity as it can lead to muscle wasting, but reducing activities that aggravate pain is advised.
Phase 2:
In this stage the aim is to regain full, painless wrist and elbow range of motion (passive range of motion and mobilizations). Followed by stretching and strength training.
Stage 3:
In this stage the physiotherapist may look at the equipment or techniques that may have induced medial epicondylalgia and advise on ways to minimize the risk or recurrence. (5)
Summary
At ISM Rehab we have an excellent multidisciplinary healthcare team which includes physiotherapists and assistants, registered massage therapists, physician assistants, orthopaedic surgeons, and physiatrists who can provide you with client-centered, holistic care. We also have industry leading orthopaedic counterforce braces that can provide relief for your medial epicondylalgia, in conjunction with our award winning physiotherapy services.
At ISM Rehab we have an excellent multidisciplinary healthcare team which includes physiotherapists and assistants, registered massage therapists, physician assistants, orthopaedic surgeons, and physiatrists who can provide you with client-centered, holistic care. We also have industry leading orthopaedic counterforce braces that can provide relief for your medial epicondylalgia, in conjunction with our award winning physiotherapy services.
References
(1) Medial Epicondylitis [Internet]. Physiopedia. [cited 2018Apr3]. Available from: https://www.physio-pedia.com/Medial_Epicondylitis
(2) Dingemanse R, Randsdorp M, Koes BW, Huisstede BM. Evidence for the effectiveness of electrophysical modalities for treatment of medial and lateral epicondylitis: a systematic review. Br J Sports Med. 2014 Jun 1;48(12):957-65.
(3) Bisset LM, Vicenzino B. Physiotherapy management of lateral epicondylalgia. Journal of physiotherapy. 2015 Oct 1;61(4):174-81.
(4) Herd CR, Meserve BB. A systematic review of the effectiveness of manipulative therapy in treating lateral epicondylalgia. Journal of Manual & Manipulative Therapy. 2008 Oct 1;16(4):225-37.
(5) Physio P. Diagnosis: Medial Epicondylalgia [Internet]. POGO Physio Gold Coast. POGO Physio Gold Coast; 2017 [cited 2018Apr3]. Available from: https://www.pogophysio.com.au/blog/diagnosis-medial-epicondylalgia/
(1) Medial Epicondylitis [Internet]. Physiopedia. [cited 2018Apr3]. Available from: https://www.physio-pedia.com/Medial_Epicondylitis
(2) Dingemanse R, Randsdorp M, Koes BW, Huisstede BM. Evidence for the effectiveness of electrophysical modalities for treatment of medial and lateral epicondylitis: a systematic review. Br J Sports Med. 2014 Jun 1;48(12):957-65.
(3) Bisset LM, Vicenzino B. Physiotherapy management of lateral epicondylalgia. Journal of physiotherapy. 2015 Oct 1;61(4):174-81.
(4) Herd CR, Meserve BB. A systematic review of the effectiveness of manipulative therapy in treating lateral epicondylalgia. Journal of Manual & Manipulative Therapy. 2008 Oct 1;16(4):225-37.
(5) Physio P. Diagnosis: Medial Epicondylalgia [Internet]. POGO Physio Gold Coast. POGO Physio Gold Coast; 2017 [cited 2018Apr3]. Available from: https://www.pogophysio.com.au/blog/diagnosis-medial-epicondylalgia/