GOLFERS ELBOW AND PHYSIOTHERAPY MANAGEMENT
- 1. Golfers elbow PT management By Dr S.Zafar Dept of physiotherapy SMAS GALGOTIAS UNIVERSITY Greater Noida India
- 2. Golfers elbow Golfer's elbow is a condition that causes pain where the tendons of your forearm muscles attach to the bony bump on the inside of your elbow. The pain might spread into your forearm and wrist. The pain of golfer's elbow can come on suddenly or gradually. The pain might worsen with certain movements, such as swinging a golf club.
- 3. On Examination Palpating the epicondyle spot by the therapist to check the tenderness if positive, pain will be felt by the patient on this spot.
- 4. GOLFERS ELBOW • Medial Epicondylitis; • Definition: Medial golfers elbow involves primarily the flexor origin at the medial epicondyle. • The pain of golfer's elbow occurs primarily where the tendons of the forearm muscles attach to the bony bump on the inside of the elbow (medial epicondyle). • Etiology: It is an overuse syndrome in the throwing sports, where it may be related to repetitive valgus stress along with pronation and wrist flexion. Golfing with excessive driving, or by mishitting the ground. Racket sports due to the wrist action. Also in baseball pitching, and in pull-through phase of swimming strokes. Occupations that require a strong hand grip and an adduction movement of the elbow. It occurs in middle aged subjects involved in these activities.
- 5. EVALUTION • 1-Tenderness on palpation felt under the medial epicondyle. • 2-Pain on resisted pronation of the forearm. • 3-Pain on stretching the flexor muscles group by fully extending the forearm from supine position, and then passively hyper extending the wrist. • 4-Pain on resisted wrist flexion and ulnar deviation.
- 6. Clinical Presentation • Age above 30 years ,both gender are affected. • Pain on medial area of elbow joint • Tenderness • Spasm • stiffness • Pain on movement of the wrist, elbow joint. Pain when shaking hands . • Weak grasping. • Numbness and tingling from your elbow up and into your pinky and ring fingers. • Pain when flexing your wrist. • Numbness or tingling ;-These sensations might radiate into one or more fingers — usually the ring and little fingers.
- 7. causes • Degenerative changes • Over & repeated uses wrist & elbow . Repetitive flexing , gripping or swinging can cause pulls or tiny tears in the tendons. • Any repetitive hand, wrist or forearm motions can lead to golfers elbow. • Carpenter, plumber, mechanics, housewife's, cooking. Infact its sometimes called pitcher’s elbow. people may also get it by using tools like screwdrivers and hammers ,raking or painting.
- 8. Causes • Racket sports. Improper technique with tennis strokes, especially the backhand, can cause injury to the tendon. Excessive use of topspin and using a racket that's too small or heavy also can lead to injury. • Throwing sports. Improper pitching technique in baseball or softball can be another culprit. Football, archery and javelin throwing also can cause golfer's elbow. • Weight training. Lifting weights using improper technique, such as curling the wrists during a biceps exercise, can overload the elbow muscles and tendons. • Forceful, repetitive occupational movements. These occur in fields such as construction, plumbing and carpentry
- 9. Risk factor • Age 30 Years or older • Performing repetitive activity at least two hours a day • Obese • A smoker
- 10. Investigation • X-Ray elbow joint ;- nothing is seen in x-ray • MRI scan of elbow can detect the inflammation and tear of common flexor of the fore arm. • Thickening and increased signal intensity on both T1 and T2 weighted sequences of the common flexor tendon • soft tissue edema around the common flexor tendon.
- 11. Differential diagnosis • For a clinical differential diagnosis of medial elbow pain, consider: • occult fracture • medial osteoarthrosis • medial collateral ligament injury
- 12. Treatment • Conservative ;- 1 st line of treatment • Medicine • Analgesic • Antacid • Multivitamin • Analgesic Ointment • Physiotherapy • Rest ,bracing ,Splint
- 13. Treatment • Conservative 2nd line of treatment • Steroid injection • Rest • Physiotherapy • 2. Surgical treatment • Surgical stitching /tightening of ligament and tendon ,removal of osteophytes from the medial condyle area which causes the pain.
- 14. Physiotherapy Assessment • Pain • Tenderness • Swelling • Weakness in hand gripping • ROM Pain full • Supination & pronation
- 15. Physiotherapy goal of treatment • To gain patients confidence level. • To decrease psychological stress. • To reduce pain • To strengthen the muscles tone • To change the modification in working style to prevent further tear and pain. • Return to sports activity /previous work.
- 16. Physiotherapy Treatment • Ultrasonic therapy with 1 MHZ for 7 minutes in continuous in case of acute condition, in chronic condition pulse mode of ultrasonic therapy 3 MHZ is applied over the medial compartment of the elbow joint. It reduces the tenderness. • Ice massage is also applied over the medial border of the elbow joint ,it reduces pain , inflammation, tenderness &swelling. • Laser therapy with intensity of 1-4 joule energy with power 905 NM in pulse /continuous with 1 m exposer at each point to the medial epicondyle 3-4 days weekly treatment for 3-4 weeks also decrease the pain and swelling followed by hot packs in sitting /supine position. while treating with laser therapy the patient and the therapist both were will use protective gougles. Laser rays is harmful for eyes and cause cataract. • Exponential shock wave therapy is the latest mode of treatment to the medial epicondylitis.
- 17. Physiotherapy treatment • Strengthening exercise with dumble. • Change life style and carrying weight use back pack instead of carrying bags. • use of brace at the elbow joint.
- 19. Preventive Measure of golfers elbow • You can take steps to prevent golfer's elbow: • Strengthen your forearm muscles. Use light weights or squeeze a tennis ball. Even simple exercises can help your muscles absorb the energy of sudden physical stress. • Stretch before your activity. Walk or jog for a few minutes to warm up your muscles. Then do gentle stretches before you begin your game. • Fix your form. Whatever your sport, ask an instructor to check your form to avoid overload on muscles. • Use the right equipment. If you're using older golfing irons, consider upgrading to lighter graphite clubs. If you play tennis, make sure your racket fits you. A racket with a small grip or a heavy head may increase the risk of elbow problems. • Lift properly. When lifting anything — including free weights — keep your wrist rigid and stable to reduce the force to your elbow. • Know when to rest. Try not to overuse your elbow. At the first sign of elbow pain, take a break.