Golfer's Elbow vs Tennis Elbow
Medial Epicondylitis – aka Golfer’s ElbowThe formal term for golfer’s elbow is medial epicondylitis. Whenever you see the word “medial” in relation to the human body, that typically means more towards the midline of the body as if you were standing upright with your arms straight down and palms facing forward (the anatomical position). Epicondyles are certain bumps or projections on bones, which are often associated with the attachment of muscles and their tendons. Whenever you see “itis” at the end of a medical term, it generally refers to inflammation. So, putting this all together, we end up with a condition that affects the region of these bony projections (epicondyles) that are found on the inside of the elbow (medial) and is associated with inflammation of the surrounding structures. There are lots of contours, dips, bumps, projections, lines, etc, on our bones that serve as points of attachments for various structures. So why is the medial epicondyle of the elbow a particularly vulnerable location? The main reason is that the medial epicondyle serves as the attachment point for not one muscle, but 5 key muscles that have functions at both the elbow and the wrist. This has led to the development of another term commonly used in medicine, which is the “common flexor origin” or “common flexor tendon”, which refers to the medial epicondyle of the elbow and the muscles that originate (attach) at this point. These muscles are summarized in the table below.
|Flexor carpi ulnaris||Wrist and hand bones on palmar side, but more towards the pinky||Wrist flexion and adduction|
|Palmaris longus||Palmar aponeurosis of the hand||Wrist flexion|
|Flexor carpi radialis||Palmar side of the middle hand bones, but more towards the wrist||Wrist flexion and abduction|
|Pronator teres||Mid-portion and side of the radius (the bigger forearm bone)||Pronation (turning your wrist so that your palm faces down)|
|Flexor digitorum superficialis||Palmar side of your fingers, excluding the thumb||Finger and wrist flexion|
Golfer’s Elbow SymptomsThe symptoms of golfer’s elbow and tennis elbow are very similar, with the key difference being that they occur in different locations. Pain is the #1 symptom with severity ranging from a mild ache to an excruciating throbbing ache. Elbow movements tend to cause a flare-up of pain, which can lead to a downward spiral of inactivity due to pain. Stiffness is also a common complaint, particularly for those who get to the point where they need to rest their elbow to feel better, avoid elbow movements, and gradually stiffen up. The main movements that can cause some of the pain to come on are active wrist flexion (using your muscles to flex your wrist), passive wrist extension (stretching the muscles on the front of your forearm), and this is usually in combination with movements at the elbow, particularly straightening the elbow. These types of movements at the wrist and elbow joint are common in golf, hence the name golfer’s elbow, but they can also be present in lots of occupations. It is not uncommon for carpenters or other laborers to experience symptoms of golfer’s elbow.
Golfer’s Elbow TreatmentTreatment for golfer’s elbow will depend on severity and frequency of symptoms, as well as your typical activity level. That said, there are a few go-to treatments that tend to be effective for much of the affected population. First, it has recently been discovered that isometric muscle contractions can be very effective in treating conditions that involve longterm pain of tendons, which fits the bill for medial epicondylitis. This is a great idea for those who have chronic golfer’s elbow, or have had it for a long time, and are experiencing flare-ups in pain. “Isometric” may sound complicated, but all it means is that you use/contract a muscle without actually doing any movement. In this case, simply making a fist and trying to flex your wrist using your other hand as resistance (so not actually moving your wrist) can be effective for this. For more long term management, exercises tend to focus on eccentric exercises, which is a little more complicated than isometric exercises. Eccentric exercises involve lengthening the muscle while still contracting it. This may sound weird at first, but we actually do this a lot without even realizing it. For example, when you walk down stairs, you are actually using your quad (thigh) muscles while stretch intermittently. For golfer’s elbow, it is common to use elastic tubing or a Thera-band. In this case, you would hold the tubing with your wrist starting in a flexed position and resistance being felt in the tubing. Then, slowly allow the tubing to bring your wrist back into a neutral position in a slow and controlled manner. This should stretch those muscle on the common flexor origin while you are using them to control the motion at the same time. Lastly, golfer’s elbow braces are quite popular, as they can help to alleviate pain while using the muscles/tendons that are injured. They work by compressing the affected tendons, which will slightly alter the line of pull when you are using them, giving them a break from the usual stress while still keeping them active, potentially for rehabilitation. The following video, courtesy of physiotherapists Bob and Brad, provides some great discussion and examples of exercises for golfer’s elbow.
Lateral Epicondylitis – aka Tennis ElbowIf you have read the info about golfer’s elbow, aka medial epicondylitis, then you already have much of the information you need to understand lateral epicondylitis. Whenever you see the word “lateral” in relation to human anatomy, this tends to denote away from the midline of the body, assuming you are standing upright with arms straight down and palms facing forward. For example, your arms are each lateral to your spine. In the case of the lateral epicondyle of the elbow, it is located at approximately the same level as the medial epicondyle, but it’s on the outside of the elbow as opposed to the inside. Once again, lateral epicondylitis refers to inflammation or longterm breakdown of the tendons that attach to the lateral epicondyle of the elbow. The main movements that bring on symptoms of tennis elbow are active wrist extension (e.g. using your muscles to move your wrist into extension, such as a backhand swing in tennis), passive wrist flexion (stretching those same muscles), and these are usually worse in combination with an extended (straightened) elbow. Just like the medial epicondyle, the lateral epicondyle has numerous muscles that all originate here and travel down the forearm into the wrist hand hand to control movement of everything from the elbow and below. These muscles are summarized in the following table.
|Extensor carpi radialis brevis||Dorsal surface of some small wrist bones close to the thumb||Wrist extension and abduction|
|Extensor digitorum||Splits into 4 tendons that insert onto the back of the fingers (not thumb)||Wrist and finger extension|
|Extensor digiti minimi||Dorsal surface of the pinky finger||Pinky finger extension|
|Extensor carpi ulnaris||Dorsal surface of a wrist bone on the pinky side||Wrist extension and adduction|