Golfer’s elbow – causes, symptoms, treatment. Rehabilitation of the golfer’s elbow

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Golfer’s elbow (or tennis elbow) in most cases does not only apply to golf or tennis enthusiasts. It is a condition that most often affects desk workers, but of course also golfers, tennis players, squash and badminton players. Know the golfer’s elbow symptoms and treatments.

Golfer’s elbow – what is it?

Golfer’s elbow, or tennis elbow, is the common name for enthesopathy, a disease of the extensor muscles of the wrist at the proximal attachment site. It is a pain syndrome of the lateral part of the elbow joint, which affects 1-3% of the population and, contrary to appearances, does not apply only to athletes. The causes of the disease are still not fully understood. The disease most often occurs in people between 45 and 54 years of age.

The cause of enthesopathy in tennis players is incorrect backhand execution – the elbow then takes control of the arm, overloading the wrist extensors group. The result is an inflammation of the appendages in the area of ​​the lateral epicondyle of the humerus. Tennis elbow also happens to players with an incorrectly sized racket grip.

Golfer’s elbow – causes

Enthesopathy is a condition that affects 90% of people who do not play tennis and golf. It is caused by repetitive movements of bending and extending the wrist as well as pronation and supination of the forearm. The disease also causes overload, e.g. when lifting heavy objects incorrectly. Paradoxically, tennis elbow is one of the common diseases among office workers and people who work on a computer every day.

Many researchers recognize that the main cause of the disease is muscle overload due to long-term static or dynamic work, usually with light loads. The greatest danger is the load in the eccentric contraction of the muscles when the elbow joint bends – then there is compression between the radial head and the lateral epicondyle and impedes the blood supply.

One of the causes of golfer’s elbow may be a problem in the cervical spine, which can weaken the extensor muscles of the wrist and strain them during daily activities. Sometimes enthesopathy is caused by, for example, posterior interosseous nerve entrapment syndrome – to be sure that it is this particular cause of the disease, the Koppel-Thomas test is performed.

Golfer’s elbow – symptoms

The most characteristic symptom of a golfer’s elbow is pain on the inside of the elbow, in its medial part. This pain can spread all the way to the fingers of the hand. People with golfer’s elbow compare the pain to the feeling of lugging around shopping or shaking hands. This pain may be moderate or severely hinder daily functioning. Hypersensitivity to touch or a feeling of stiffness in the elbow may occur.

Golfer’s elbow – diagnosis

The diagnosis of golfer’s elbow consists in performing subjective and physical examinations as well as additional examinations. The doctor conducts an interview with the patient, during which he checks what ailments occur, e.g. whether the pain in the area of ​​the lateral epicondyle of the humerus increases during activities requiring the wrist extensor muscles to be tense. During the physical examination, the doctor recommends three tests, which are:

1. Test Thomsona – during the examination, the elbow is straightened and the wrist is extended, fingers are clenched. The fact that the patient has a tennis elbow is evidenced by the presence of pain in the area, e.g. lateral epicondyle of the humerus – pain occurs when the patient straightens the wrist against resistance after the therapist grasps the wrist from the palm side.
2. Milla test – the patient may be standing or lying during the examination. The physiotherapist grasps his arm in the area of ​​the lateral epicondyle of the humerus. Then he bends the elbow joint and turns the forearm – when he sets this position, he grasps the wrist and makes a bend, straightens the limb at the elbow joint. When a patient develops pain in the lateral epicondyle, this is a sign of a tennis elbow.
3. additional research – the therapist places the upper limb in the extension of the elbow joint and the wrist condition in a neutral position. When pain appears in the area of ​​the lateral epicondyle of the humerus, it may suggest, for example, that the extensor muscle of the fingers or the extensor muscle of the elbow is damaged. Additional tests are also X-rays and ultrasound or magnetic resonance imaging.

Rehabilitation of golfer’s elbow – radial shockwave therapy

One of the popular methods of rehabilitation of the disease is radial shock wave therapy (RSWT). RSWT is a shockwave produced by a generator – the device produces air that is then forced into the head of the device to launch a projectile inside it. The projectile touches the warhead transmitter and gives it some kinetic energy, making the head transmitter move. The resulting energy goes to the tissue where it meets the transmitter.

RSWT works to relieve pain. The shock wave helps to initiate the process of auto-regeneration, as it accelerates the microcirculation and cellular metabolism – and at the same time does not pose a threat to the accompanying tissues. Treatment of a tennis elbow with RSWT consists of 5 to 8 treatments – there should be a 7-day interval between each of them. When this time is shortened, tissue regeneration will take longer.

Rehabilitation of a golfer’s elbow – manual therapy

Its purpose is to diagnose and treat reversible functional disorders of the musculoskeletal system. Manual therapy is recommended for patients with impaired muscle function and base disorders, hypermoblinia or postural disorders. Manual therapy, however, is not a solution for all patients – it should not be used in people with inflammation, osteoporosis and fractures. The method uses four techniques.

1. Mill’s manipulation – it is used in patients diagnosed with injuries of the abdominal part of the lateral epicondyle on the radial extensor attachment of the wrist. Before starting the treatment, a deep transverse massage should be performed. Mill’s manipulation is not intended for patients with elbow mobility disorders.
2. Deep transverse massage – is a transverse mobilization technique designed for muscles, tendons and ligaments. The purpose of the transverse massage is to restore natural mobility and is used in conjunction with various methods of tissue mobilization. When the massage is technically correct, then the patient should not feel any pain. Deep transverse massage reduces pain and makes the analgesic effect appear quickly.
3. Functional soft tissue massage – is a form of massage that uses additional movement of the treated tissue. It offers a similar effect as deep transverse massage. When the technique is applied to a patient having a defect in the ventral lateral epicondyle at the attachment of the radial extensor muscle of the short wrist, it requires the patient to be in the supine position. One treatment takes approx. 10 minutes.
4. Medical functional training – training combines both physiotherapy and personal training. It is used by patients who still need to continue exercising after rehabilitation. During the therapy, the patient is lying down and slowly bends the wrist joint, and uses the other hand to perform passive maximal extension. In this form of training, it is possible to apply additional weight.