22/06/2025
๐๐ค๐ก๐๐๐ง'๐จ ๐๐ก๐๐ค๐ฌ (Medial Epicondylitis)
Golferโs elbow, or medial epicondylitis, is a condition characterized by pain and inflammation at the medial epicondyle of the humerus, where the tendons of the forearm muscles attach. It is an overuse injury caused by repetitive stress on the flexor-pronator muscle group of the forearm, primarily affecting people who perform repeated wrist flexion or forearm pronation.
Despite its name, golferโs elbow is not exclusive to golfers and can affect anyone involved in activities requiring repetitive wrist and finger motions.
๐ผ๐ฃ๐๐ฉ๐ค๐ข๐ฎ ๐๐ฃ๐ซ๐ค๐ก๐ซ๐๐
โขMedial epicondyle โ Bony prominence on the inner side of the elbow.
โขCommon flexor tendon โ Shared tendon of several forearm muscles that insert at the medial epicondyle.
๐๐ช๐จ๐๐ก๐๐จ ๐๐ฃ๐ซ๐ค๐ก๐ซ๐๐:
-Flexor carpi radialis
-Flexor carpi ulnaris
-Palmaris longus
-Flexor digitorum superficialis
-Pronator teres
๐พ๐๐ช๐จ๐๐จ
-Repetitive wrist flexion and forearm pronation
-Excessive gripping or lifting, especially with poor technique
-Poor conditioning or sudden increase in activity
๐๐๐จ๐ ๐๐๐๐ฉ๐ค๐ง๐จ:
-Golf, baseball (especially pitchers), tennis (topspin strokes)
-Weightlifting
-Occupations like carpentry, plumbing, typing, or painting
-Age 30โ50 (most commonly affected group)
๐พ๐ก๐๐ฃ๐๐๐๐ก ๐๐๐๐ฉ๐ช๐ง๐๐จ
Symptoms:
1) Pain and tenderness at the medial epicondyle
2) Pain may radiate to the forearm or wrist
3) Weak grip strength
4) Stiffness in the elbow
Pain exacerbated by:
1) Wrist flexion against resistance
2) Pronation of the forearm
3) Gripping objects
Signs:
1) Localized tenderness over medial epicondyle
2) Pain with resisted wrist flexion and forearm pronation
3) Pain during stretching of wrist flexors (passive wrist extension)
๐ฟ๐๐๐๐ฃ๐ค๐จ๐๐จ
โขClinical Diagnosis is usually sufficient:
-History of repetitive activity
โขPhysical examination:
-Golferโs elbow test (pain with resisted wrist flexion)
-Pain on palpation over medial epicondyle
๐๐ฃ๐ซ๐๐จ๐ฉ๐๐๐๐ฉ๐๐ค๐ฃ๐จ (if needed):
-Ultrasound: Can detect tendon degeneration or tears
-MRI: To rule out other causes of pain or evaluate chronic cases
-X-ray: To exclude fractures, arthritis, or calcifications
๐ฟ๐๐๐๐๐ง๐๐ฃ๐ฉ๐๐๐ก ๐ฟ๐๐๐๐ฃ๐ค๐จ๐๐จ
-Ulnar collateral ligament sprain
-Ulnar nerve entrapment
-Cervical radiculopathy (C6-C7)
-Medial elbow instability
-Flexor-pronator strain
๐๐๐ฃ๐๐๐๐ข๐๐ฃ๐ฉ
โขConservative Treatment: Most cases resolve with conservative management
1. Rest & Activity Modification
-Avoid aggravating activities
-Ergonomic modifications
2. Ice Application
15โ20 min, 3โ4 times/day to reduce inflammation
3. Pain Management
-NSAIDs (e.g., ibuprofen, naproxen)
-Topical analgesics
4. Physiotherapy
-Stretching exercises: Wrist flexor and pronator stretches
-Strengthening exercises: Eccentric loading of the flexor group
-Isometric contractions to maintain muscle activation
Therapeutic modalities:
-Ultrasound therapy (UST)
-TENS for pain control
-Dry needling or IASTM (if chronic)
5. Bracing
Counterforce brace or elbow strap to reduce strain on tendon insertion
โข๐๐ฃ๐๐๐๐ฉ๐๐ค๐ฃ ๐๐๐๐ง๐๐ฅ๐ฎ
-Corticosteroid injection: For persistent cases (short-term relief)
-PRP (Platelet-Rich Plasma) injections: Emerging evidence in chronic tendinopathy
โข๐๐ช๐ง๐๐๐๐๐ก ๐๐ง๐๐๐ฉ๐ข๐๐ฃ๐ฉ
-Indicated in refractory cases (6โ12 months) of failed conservative treatment:
-Debridement of degenerated tendon tissue
-Reattachment of healthy tendon to bone
๐๐๐๐๐๐๐ก๐๐ฉ๐๐ฉ๐๐ค๐ฃ ๐๐ง๐ค๐ฉ๐ค๐๐ค๐ก (๐๐๐ฎ๐จ๐๐ค๐ฉ๐๐๐ง๐๐ฅ๐ฎ)
1. Acute phase (0โ2 weeks):
-Rest, ice, pain control
-Gentle ROM exercises
2. Subacute phase (2โ6 weeks):
-Begin stretching (wrist flexors/pronators)
-Isometric exercises โ progress to eccentric strengthening
-Grip strengthening
3. Chronic/Return to Activity phase (6โ12 weeks+)
-Functional and sport-specific training
-Plyometric and proprioceptive drills
๐๐ง๐ค๐๐ฃ๐ค๐จ๐๐จ
-Good with proper treatment
-Most cases resolve in 6โ12 weeks
-Chronic cases may take 3โ6 months
-Prevention with proper technique and strengthening is key
๐๐ง๐๐ซ๐๐ฃ๐ฉ๐๐ค๐ฃ
-Proper warm-up before activity
-Strengthening of forearm muscles
-Avoid overuse and ensure proper technique
-Use ergonomic tools and supports if occupational risk is present...
070076 72293
Dr.Shivam Shukla
