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MEDIAL EPICONDYLITIS​

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Medial epicondylitis (Golfer’s elbow) is defined as a pathologic condition that involves the pronator teres and flexor carpi radialis origins at the medial epicondyle. However, abnormal changes in the Flexor carpi ulnaris and Palmaris longus origins at the elbow may also be present. Repetitive trauma resulting in micro tears is a causative factor.It is associated with repetitive movements into wrist flexion.

It is often diagnosed with tenderness at medial epicondyle, positive special test and decreased grip strength.

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IMPAIRMENTS

                                                                             

BODY STRUCTURES

  1. Microdamage and partial tears near musculotendinous junction.

  2. Inflammation of periosteum with formation of granulation tissue and adhesions.

  3. Inflammation of adventitious bursa

  4. Calcified deposits

  5. Lesion affecting the tendinous origin of common wrist flexors

 

BODY FUNCTIONS

  1. Pain in elbow region

  2. Swelling

  3. Tenderness

  4. Muscle spasm

  5. Decreased muscles strength and endurance

  6. Decreased grip strength

  7. Affected basic activities of daily living

  8. Positive provocation test

 

GOALS
 

  • Short term 

  1. Patient and family education

  2. Ergonomic advice

  3. Reduce pain

  4. Reduce swelling

  5. Reduce spasm

  6. Improve muscles strength

  7. Improve endurance

  8. Improve grip strength

  9. Achieve full range of motion

  10. Achieve functional activities

 

  • Long term

  1. Maintain range of motion

  2. Maintain muscle strength

  3. Maintain upper extremity function

  4. Maintain cardiovascular conditioning

 

MANAGEMENT​

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Patient education

  • Advice and techniques on prevention of painful activities

  • Elimination of lifting heavy weight

  • Activity modifications as avoid grasping heavy objects in pronation

  • Use of both upper extremities while lifting

  • Correction of mechanics

 

Reduce pain and swelling

  • Rest the muscles by immobilization with splint

  • Counterforce bracing only during aggravating activity

  • Cryotherapy

  • Cross fibre massage within tolerance at site of lesion

  • Transverse friction massage

  • Ultrasound

  • Whirlpool in Extremity tank

  • High voltage galvanic stimulator is effective

  • Mobilisation with movement

  • Dry Needling is very effective which can relieve pain, and can relax the taut bands in order to facilitate other therapeutic approaches.

  • Kinesio taping reduces pain, improve grip strength and functional status.

 

Improve ROM

  • Stretching of wrist flexors

  • Multiple-angle muscle setting (submaximal isometrics)

  • Soft tissue mobilization with perpendicular to the tissue involved

  • Phonophoresis or Iontophoresis may be helpful in which hydrocortisone or lidocaine is used.

  • Shoulder and scapular ROM exs with resistance applied proximal to the elbow.

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Improve strength

  • Gentle strengthening program for grip strength, wrist extensor, wrist flexors, biceps, triceps and rotator cuff strengthening.

  • Isotonic eccentric hand exercises

  • Wrist curls

  • Wrist flexion-extension resistive training and elbow flexion-extension resistive training with weights and theraband through painfree ranges.

  • Dynamic exercises for muscular endurance initially with low intensity resistance for multiple repetitions then progress to more intense resistance.

  • Plyometric exercises if goal include returning to sport activities or require elbow and forearm power.

 

Precautions 

  • Avoid smoking (slows healing) 

  • No stress on elbow

  • If the game caused injury, modify the swing to avoid overwork at elbow.

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REFERENCES

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S.Brent Brotzman, Kevin E. Wilk, Clinical Orthopaedic Rehabilitation, 2nd Edition, Page no 112-115

Carolyn Kisner, Lynn Allen Colby, Therapeutic Exercises Foundation and Techniques, 5th Edition, Page no- 575

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