Golfer's Elbow and Tennis Elbow

The elbow is a major point where the long bone of the upper arm (the humerus) meets the two long bones of the forearm (the Radius and Ulna). The elbow allows the arm to bend and straighten. At the same time, the elbow allows the forearm to rotate, so that the palm of the hand can be turned either up or down. All twisting motions involving the hand (such as turning a doorknob) originate from the elbow joint.

Like other major joints, the elbow is prone to a variety of aches and pains related to overuse and traumatic injury. They include:

• Epicondylitis, an inflammation of the bony prominence where tendons connect to the humerous. It is usually associated with repeitive use of the arm, but can also be caused by a traumatic injury. Symptoms include pain and weakness of the grip.
• Medial Epicondylitis, usually referred to as "Golfer's Elbow." While a golfer's swing is a common cause of the problem, there are many other activities that can result in Golfer's Elbow such as working out at a gym or simply working in front of a computer for prolonged periods. Each of these activities use the same muscles repetitively and can result in the inflammation of muscles, ligaments and tendons.
• Bursitis and Lateral Epicondylitis (more commonly known as Tennis Elbow).

The distinguishing characteristics of these ailments are:

• Tennis Elbow - The onset of pain, on the outside (lateral) of the elbow, is usually gradual with tenderness felt on or below the joint's bony prominence. Movements such as gripping, lifting and carrying tend to be troublesome
• Golfer's Elbow - The causes of golfer's elbow are similar to tennis elbow, but pain and tenderness are felt on the inside ( median) of the elbow on or around the joint's bony prominence.
• Bursitis - Often due to excessive leaning on the joint or a direct blow or fall onto the tip of the elbow. A lump can often be seen at the back of the joint.
  

Physiology of  Golfer's Elbow

The muscles of the forearm that pull the wrist down are called wrist flexors. They begin at a common tendon attachment on the inside bump of the elbow called the medial epicondyle (below).

As the wrist is flexed or the hand made to grip, the muscles tense and pull against the tendons. Forced placed on the flexor muscles during a golf swing pulls on the tendons at the medial epicondyle. Golfer's elbow is similar to its counterpart, Tennis Elbow. The primary difference  between the two is the location of the pain and the activity that leads to injury. However, both conditions are caused by overuse of the muscles of the forearm leading to inflammation and pain around the elbow joint.

These problems, Tennis Elbow and Golfer's Elbow, are forms of tendonitis. Tendons are the ends of muscles that attach to bone. Because of the force of the muscle, the points of insertion of the tendon on the bone are often pointed prominences.

The medical names of Tennis Elbow (lateral epicondylitis) and Golfer'sElbow (medial epicondylitis) come from the names of these bony prominences where the tendons insert, and where the inflammation causes the pain. The pain of Golfer's Elbow is usually at the elbow point on the inside of the arms; a shooting sensation down the forearm is also common while gripping objects.

Symptoms of Golfer's Elbow

• Tenderness and pain at the medial epicondyle, made worse by flexing the wrist. The pain may spread down the forearm. Activities that use the flexor muscles like bending the wrist or grasping can make matters worse.
• Pain caused by lifting or bending the arm or grasping even light objects such as a coffee cup.
•  Difficulty extending the forearm fully (because of inflammed muscles, tendons and ligaments).
•  Pain that typically lasts for 6 to 12 weeks; the discomfort can continue for as littles as 3 weeks or as long as several years.

Relief of Golfer's Elbow

The best way to relieve Medial Epicondylitis is to stop doing anything that irritates your arm. A simple step for the weekend athlete, but not as easy for the manual laborer, office worker, or professional athlete.
 

The most effective conventional and alternative treatments for Epicondylitis have the same basic premise:

• Rest the arm until the pain disappears

• Then massage to relieve stress and tension in the muscles

• Exercise to strengthen the area and prevent re-injury

If you must go back to whatever caused the problem in the first place, be sure to warm up your arm for at least 5 to 10 minutes with gentle stretching and movement before starting any activity. Take frequent breaks.

For most mild to moderate cases of Epicondylitis, aspirin or ibuprofen will help address the inflammation and the pain while you are resting your injury, and then you can follow up with exercise and massage to help speed healing. For stubborn cases of Eopicondylitis your doctor may advise corticosteroid injections, which dramatically reduce inflammation, but they cannot be used long-term because of potentially damaging side effects.

Treatment of Golfer's Elbow

While exercise is appropriate for breaking down scar tissue once the area has healed, it may further irritate the area during the initial stages. Other methods can be performed, such as:

• Ultrasound that uses vibrating sound waves. Ultrasound will cause an increase in circulation to the tissue and soften the scar tissue to allow it to further break down. Ultrasound can also be used as phonophoresis to help topical pain solutions to reach farther down into the tissues by transporting them by the sound waves.

• Anti-inflammatory topical pain gels offer pain relief and help reduce inflammation.

• Cold Packs can provide pain relief.  

Glossary:

 Epicondyle - Common tendon attachment on the inside bump of elbow
 Epicondylitis - Inflammation of the bony prominence where tendons connect
        To the humerus
 Lateral Epicondylitis - Outside of elbow
 Medial Epicondylitis - Inside of elbow
 Phonophoreses - A procedure that uses ultra sound to help break up and
  flush scar tissue  
 Radius - One of the two long bones in the forearm
 Trochogynglymoid Joint - A joint that has the capacity to flex and rotate
Ulna - One of the two long bones in the forearm