Makindo Medical Notes

Related Subjects: |Tennis Elbow |Golfer's Elbow

⛳ Bilateral disease suggests a systemic condition such as a spondyloarthropathy. 🕑 Early diagnosis and management are essential to prevent chronic pain and functional impairment.

⛳ About Golfer's Elbow

• Golfer's Elbow (Medial Epicondylitis) → pain & inflammation over the inner elbow 🦴.
• Caused by overuse/repetitive strain of flexor-pronator tendons attaching to medial epicondyle.
• Not just golfers 🎾— carpenters, plumbers, painters, office workers also at risk.
• Significant cause of elbow pain & functional disability in athletes and non-athletes alike.

🧬 Aetiology

Repetitive loading of the flexor-pronator group (esp. Flexor Carpi Ulnaris & Pronator Teres) → microtears + degeneration at medial epicondyle.

• 🔄 Overuse injury → repetitive wrist flexion & pronation.
• 🎯 Flexor Carpi Ulnaris / Pronator Teres = most affected tendons.
• 💼 Occupational factors → carpentry, plumbing, painting, typing.
• 🏋️ Sports → golf, baseball pitching, climbing, weightlifting.

🩺 Clinical Presentation

• 💥 Medial epicondyle tenderness (classic site).
• 🤲 Pain with resisted wrist flexion / pronation.
• ⬇️ Grip weakness → difficulty lifting, writing, gripping tools.
• 🌅 Morning stiffness, improves during day.
• 🔄 Pain may radiate down forearm.

🧾 Differential Diagnosis

• 🎾 Tennis Elbow (Lateral epicondylitis – outer elbow pain).
• ⚡ Ulnar nerve entrapment → tingling in ring/little fingers.
• 💪 Triceps tendinitis → posterior elbow pain.
• 🦠 Septic arthritis → hot, swollen elbow (emergency 🚨).
• 🦴 Osteoarthritis → degenerative joint disease, stiffness.

🔎 Investigations

• 👉 Clinical exam:
  • Tender medial epicondyle.
  • Pain reproduced by resisted wrist flexion/pronation.
  • ROM assessment.
• 📡 Ultrasound → tendon thickening, tears.
• 🧲 MRI → detailed tendon/soft tissue evaluation.
• 🦴 X-Ray → rule out fractures, OA.
• ⚡ EMG → if nerve entrapment suspected.

💊 Management

• Conservative (first-line):
  • 🛑 Rest or modify activities.
  • ❄️ Ice packs for flare-ups.
  • 💊 NSAIDs (short course).
  • 👐 Physiotherapy → stretching, eccentric strengthening, manual therapy.
  • 🦾 Elbow strap/brace to offload tendon.
• Injections:
  • 💉 Corticosteroid → temporary pain relief, but caution (rupture risk).
  • 💉 PRP (platelet-rich plasma) sometimes used, evidence mixed.
• Other therapies:
  • 🌿 Acupuncture (adjunctive pain relief).
  • 🔊 Shockwave therapy (ESWT) in resistant cases.
• Surgery (rare):
  • 🔪 Arthroscopic debridement.
  • Open tendon release if >12 months conservative care fails.

📈 Prognosis

• ✅ Most recover in 6–12 months with conservative care.
• ⏳ Some develop chronic pain if untreated.
• 🔄 Prevention → ergono