Basically, golfer's elbow can be divided into an acute and a chronic form. While the symptoms of the acute form last less than six weeks, the symptoms in patients with chronic golfer's elbow last for more than six weeks. This distinction is important as it can have an impact on treatment.
A distinction must be made between golfer's elbow and tennis elbow, which is one of the most common diseases of the elbow. In tennis elbow, also known as epicondylitis humeri radialis or lateral epicondylitis, attachment tendons are also irritated due to mechanical overuse or incorrect strain at work or in sport. However, the extensor muscles rather than the flexor muscles are affected. Diagnosis and treatment are similar, however.
The symptoms usually begin gradually. The bony prominence on the inside of the elbow, the epicondyle, is sensitive to touch in patients with golfer's elbow and hurts when pressure is applied to it. This localized pain can radiate via the lateral forearm muscles to the hand, or more precisely to the carpus and metacarpus, especially during physical exertion.
Pain also occurs when the wrist or fingers are bent or stretched independently, i.e. actively or passively. It also hurts when the forearm is turned inwards against resistance or the hand is clenched into a fist.
If the patient does not rest the affected arm, the symptoms can become more severe and increasingly restrictive in everyday life. Some sufferers also develop a feeling of weakness in the wrist. Due to the reduced strength in the hand and fingers, they may no longer be able to grip properly. As the disease progresses, the elbow, forearm and hand can become painful even at rest.
Even if the name golfer's elbow might suggest it: It's not just golfers who are affected by this tendon insertion inflammation. It also occurs in other high-risk sports such as
- Baseball pitchers,
- handball players,
- tennis players and
- strength athletes
occur.
However, people who experience one-sided strain and movements or poor posture at work or in everyday life, such as carpet layers or tilers, also have an increased risk of developing golfer's elbow. In addition, work or intensive use of a computer, computer mouse or cell phone can also be responsible for such irritation or inflammation.
Golfer's elbow is not only caused by golfing.
The activities and sports mentioned are characterized by rapid, alternating rotational movements of the forearm and hand with intensive gripping. The resulting forces cause local overloading of the elbow joint, i.e. the ulnar epicondyle. If this one-sided incorrect loading continues, fine tears are likely to develop in the connective tissue. The subsequent repair processes cause vessels and nerves, among other things, to grow in. This in turn leads to painful inflammation of the attachment tendons.
However, it is not only certain types of sport and one-sided strain that cause micro-damage to the tissue. Traumatic events can also trigger the disease.
If you present at the doctor's surgery with the symptoms described above, the doctor will carry out a thorough physical examination and perform certain tests. He will pay attention to whether you feel pain
- to the touch,
- with pressure and/or
- certain movements or even at rest.
at rest.
He will also check whether there is any swelling, whether you can move your forearm, hand and fingers freely and whether you can apply the same force with both hands.
Although the main focus is on examining the affected arm, the spine can also be the cause of such complaints. The physical examination is therefore also extended to other parts of the body.
Together with the information you provide about your sporting and professional activities or anyhistory ofan accident(medical history), a diagnosis of golfer's elbow can be made in many cases after the physical examination.
If there is any doubt about the cause of your symptoms, imaging procedures can provide further information. An X-ray examination is suitable for ruling out tendon calcification as the cause. An ultrasound examination can detect fluid in the area where the tendon originates. Magnetic resonance imaging (MRI) plays a particularly important role in the diagnosis of golfer's elbow. With MRI, possibly with the aid of a contrast agent, tendon thickening, tendon changes and other changes in the soft tissue (such as the muscles) can be detected.
Magnetic resonance imaging (MRI) plays an important role in the diagnosis of golfer's elbow.
The following diseases, which can have similar symptoms to golfer's elbow, should be ruled out (so-called differential diagnoses):
- Nerve compression syndrome (pain caused by pressure on a nerve)
- Cervical spine syndrome (cervical syndrome)
- Plica syndrome (pain caused by a pinched or inflamed fold of mucous membrane in the joint)
- Arthritis (inflammation) in the elbow joint
- Osteoarthritis (wear and tear) in the elbow joint
Specialists for the diagnosis and treatment of golfer's elbow are
They will be able to differentiate between golfer's elbow and other possible causes of the symptoms and have an overview of the therapeutic options.
As a first measure, you should stop the activities that have caused your symptoms. You must refrain from sporting and other strenuous activities for around six to twelve weeks. The primary aim of the therapy is then to reduce the existing pain and, in the longer term, to control the force exerted on the elbow so that the symptoms do not recur.
Immobilizing the arm for a few days or wearing a bandage helpsto relieve the pain during the acute phase. Non-steroidal anti-inflammatory drugs ( NSAIDs ), a specific group of pain-relieving medication that includes ASA, can be taken for up to around six weeks. Cooling the painful area can also provide relief in the acute phase. If the pain becomes chronic, however, treatment with heat can help.
Once the pain has subsided, the elbow and forearm muscles should be stretched and strengthened to prevent the pain from recurring. Various techniques are available for this purpose and for the treatment of chronic complaints, although their effect is not always guaranteed, for example
- Physiotherapy
- Manual therapies
- Physical therapies such as therapeutic ultrasound/sonophoresis, shock wave therapy, laser therapy or radiotherapy (radiation therapy)
- Acupuncture
- Kinesiotape (physio tape, muscle tape): highly elastic adhesive tape for taping the forearm
In chronic cases, injecting cortisone into the area around the inflamed tendon insertions can help in the short term. Given over a longer period of time, however, cortisone tends to have the opposite effect. Injections of platelet-rich plasma or autologous blood can also be tried.
In most cases, golfer's elbow can be treated using these conservative methods. However, if no healing has been achieved after six months of conservative therapy, surgical treatment can be attempted. This involves removing pathologically altered tissue in the area where the tendon originates or loosening any "adhesions" in the affected muscles. The arm is then immobilized for one to two weeks and then mobilized for early function. Sport is usually possible again after three to six months.
Conservative treatment of golfer's elbow is usually sufficient.
In around 80 % of patients, golfer's elbow heals completely or at least improves significantly with conservative treatment. Although surgical treatment can be attempted, the chances of success are rather uncertain.
After successful treatment, it is important to prevent a recurrence of the symptoms. With the help of the above-mentioned methods of manual and physical therapy as well as special exercises and strength training
- Tension at the tendon attachment points is reduced,
- incorrect and one-sided movement patterns are trained away and
- strengthen the muscles.
Taping with kinesio tape or wearing a bandage stabilizes the elbow joint. An epicondylitis brace helps to reduce the strain on the tendon attachment points.
