As we bid adieu to the Pittsburgh Penguins of 2011-12, I’d like to bring awareness to an injury that could affect anyone of the the Penguins players, coaches and staff during this extra long off-season: golfer’s elbow.
Yes, the elbows of the likes of James Neal, Tyler Kennedy, Evgeni Malkin and Arron Asham no longer have to incur the trauma of Flyers players head-butting their sensitive mid-arm areas.
However, a new enemy may lurk on the horizon. Golfer’s elbow, also called medial epicondylitis, is an overuse injury to the tendons that connect the forearm muscles to bone located on the inner aspect, the pinky finger side, of the elbow. The name golfer’s elbow comes from the high prevalence of the issue among golfers, and though it is similar in concept, it is not the same as tennis elbow, or lateral epicondylitis.
The golf swing is a common cause of medial epicondylitis however, other repetitive activities, such as throwing, chopping wood with an ax, running a chain saw, using hand tools and other actions that stress use of the wrist flexor forearm muscles can cause symptoms of golfer’s elbow.
Even simple tasks such as typing can cause this type of pain. Wrist flexors are the muscles that pull the palm of the hand toward the forearm. The muscles attach to bone via a thick band of fibrous tissue, called a tendon. When the wrist muscles contract when you flex your wrist, twist your forearm down like pouring out a glass of water, or grip with your hand and the tendon is pulled.
When these muscles are overused, the tendons repeatedly pull and tug at their point of attachment on the bone, the medial epicondyle.
As result, the tendons become inflamed (tendinitis). Repeated, tiny tears in the tendon tissue cause pain and over time, the tendonitis becomes a tendonopathy, when the continued damage and stress to the tendons causes the tendons to weaken and break down.
The symptoms of medial epicondylitis are basically pain on the inside of the elbow, usually during or after intense use.
Pain increases during wrist flexion and often radiates to the forearm on the pinky side. Other symptoms include pain while grasping objects, wrist weakness and/or pain during wrist flexion, and weakness and/or pain with wrist pronation. Pronation is the twisting action of the wrist when pouring a glass of water out.
The first step in treatment of tendinitis is to stop the activities that cause the pain and follow the RICE method (rest, ice, compression and elevation) to help decrease inflammation and swelling as well as providing temporary pain relief.
This conservative treatment usually resolves tendinitis in a few days to a few weeks. However, if the activities that aggravate the pain are continued and the problems become chronic, it may develop into a tendinopathy, and may take 2-to-6 months or as much as a full year to recover.
Physical therapy may help to heal medial epicondylitis and other tendinopathies, by using ultrasound, medications, massage, bracing or splinting. Rehabilitation will include strengthening and flexibility exercises. Recurrence of this condition is common, so return to activity should not occur too quickly, and preventive exercises that strengthen the muscles should be done consistently, even after pain resolves.
Medications used to treat golfer’s elbow are primarily anti-inflammatory and in certain cases a cortisone steroid injection may help relieve the pain. In rare cases, surgery may be recommended as a final option and last resort.