Before starting on this section, it is vital that you can answer the following questions:

  1. Where are the medial and lateral epicondyles of the elbow found?
  2. What do tendons attach together, and what are the two tendons in the elbow joint?
  3. Which parts of the humerus do the extensor and flexor muscles of the forearm attach to?

Not quite sure what the answers are? Do not worry, click on the button below!

After completing the “Golfer’s Elbow” section, you will be able:

  • To apply knowledge of the elbow joint to explain the pathophysiology
  • To explain the clinical presentation and immediate management
  • To describe the diagnosis
  • To discuss the management
  • To validate knowledge by completing the quiz

 

Golfer’s elbow = Medial epicondylitis

Sport Risk Factors

Golf, and throwing sports such as baseball, American football.                           * TIP: Golfer’s elbow = golf! *

Vinette

Rory McIlroy, 4-time major champion, has developed pain and inflammation on the medial aspect of his elbow which has been getting progressively worse over the last few months since the start of the golf season.

Pathophysiology

  • Flexor muscles of the forearm originate from the medial epicondyle

1. Repetitive/overuse strain of the flexor muscles of the forearm

2. This causes tears in the common flexor tendon

3. This causes pain and inflammation of the tendon around its origin, the medial epicondyle of the humerus.

Clinical Presentation 

  • Pain and inflammation is felt at the medial epicondyle 
    • Exacerbating (worsens) during pronation and forearm flexion
  • +/- ulnar neuropathy as ulnar nerve runs behind the medial epicondyle

 * TIP: ANALOGY: As carrying a tray (WRIST FLEXOR) causes pain. Imagine Rory McIlroy is in pain from carrying a tray of different golf clubs/balls. *

Immediate Management

  • Rest from actions causing or exacerbating pain

Diagnosis

  • Clinical diagnosis and examination
    • Active wrist flexion against resistance whilst pressing down on the medial epicondyle, triggers the characteristic pain felt by a patient with golfer’s elbow

Management

* Management follows the progression from conservativemedical surgical. *

 1. REST + REVIEW (conservative)

  • REST – Resolves through restriction of activities which overload the tendons. (cases last 6-24 months) (90% recover within 1 year)
  • REVIEW – Refer/review to physiotherapy for further management – most effective non-surgical treatment.

 2. SHORT-TERM RELIEF (medical)

  • Analgesia or corticosteroid injection provides short-term relief
  • Avoid ulnar nerve when injecting a corticosteroid into the elbow.

 3. SURGERY (surgical)

  • Surgical tendon release is the surgery of choice.
  • Only indicated in severe cases that are unresponsive to conservative and medical management

Click here for the NICE Guidance.

  • Tennis conservative
    1. Rest + Review (conservative)
  • Tennis medical
    2. Short-term relief (medical)
  • tennis surgery
    3. Surgery (surgical)

References

Baldwin A, Hjelde N, Goumalatsou C, Myers G. (2016). Oxford Handbook of Clinical Specialities. 10th ed. Oxford: Oxford University Press.

Geeky Medics. (2017). Elbow examination – OSCE Guide. Available at: https://geekymedics.com/elbow-examination/ [accessed 1 March 2017].

Kumar P, & Clark M. (2016). Kumar & Clark’s Clinical Medicine. 9th Ed. Edinburgh: Elsevier.

 

Image References

Rory McIlroy.   Pathophysiology.   Clinical Presentation.   Immediate Management.   Diagnosis.   Management 1,2+3.