What is a golfer's elbow?
Synonyms in a broader sense
- Golfer arm
- Golf arm
- Epicondylitis humeri ulnaris
- Medialis humeric epicondylitis
- Golf elbow
- Tennis elbow
definition
The so-called golfer's elbow is referred to medically as epicondylitis humeri ulnaris (epicondylitis humeri medialis). Patients who suffer from a golfer's elbow have pain on the inside of the elbow, in the area of the protruding bone where the tendons attach. Accordingly, a golfer's elbow is a so-called tendinitis (= attachment tendinosis) of the forearm flexor muscles. The cause of the chronic inflammation of the epicondyle medialis humeri is unclear, but it is assumed that overuse at work or sports (e.g. golf) have a mechanical trigger. This also explains the origin of the term "golfer's elbow".
Other tendons can also be affected if there is pain in the elbow.
Read more general information here: Tendinitis in the elbow.
Appointment with a specialist for a golfer's elbow?
I would be happy to advise you!
Who am I?
My name is dr. Nicolas Gumpert. I am a specialist in orthopedics and the founder of .
Various television programs and print media report regularly about my work. On HR television you can see me every 6 weeks live on "Hallo Hessen".
Even if golf is not your hobby and you still suffer from a golfer's elbow, I can help you get your arm going again.
In the past few years I have successfully treated several thousand golf elbows in my main area of activity.
You can find me in:
- Lumedis - your orthopedic surgeon
Kaiserstrasse 14
60311 Frankfurt am Main
Directly to the online appointment arrangement
Unfortunately, it is currently only possible to make an appointment with private health insurers. I hope for your understanding!
Further information about myself can be found at Dr. Nicolas Gumpert.
Quite often, patients complain that the pain is radiating into the forearm and / or upper arm, so that under certain circumstances the entire arm can hurt. Usually there is a local stabbing tenderness at the bone attachment of the affected muscles, as well as inflammatory pain on the inside of the elbow (Inflammation of the elbow), through fist closure and diffraction, especially against resistance.
Symptoms
If the patient has a golfer's arm, he will feel one Tenderness on the inside of the elbow, where swelling may occur.
They are pain-aggravating Close fist or bending the hand and forearm, especially against resistance, so that the patient is increasingly restricted in everyday life.
The pain often radiates both in the upper arm as well as in the forearm and the hand out, so that the patient describes a pain in the whole arm and the hand and finger muscles are reduced in strength, which is why the patient can no longer grasp properly.
Pain
The symptoms of golfers' elbows are triggered by pain-inducing substances, for example the so-called substance P or prostaglandin E2, which are released as part of the changes in the muscle attachments as a result of incorrect or overstrain and stimulate nerves, which then pass this signal on to the brain as a pain stimulus.
The typical complaints of a golfer's elbow can be described as stabbing pain on the inside of the elbow, which often radiates to the flexor side of the forearm. The symptoms often occur with increasing intensity when the muscles are strained, for example when forming a fist or when grasping an object when the arm is stretched. The flexion of the wrist and fingers is also affected, especially if the movement is against resistance.
The stress-dependent complaints often lead to massive restrictions in everyday life, as even simple tasks, such as writing or lifting objects, can become pain-related problems. Many patients also report pain on the inside of the elbow. This also extends along the flexor muscles on the forearm. Increasingly, it is not only active movement that causes discomfort, but also maximum passive stretching. In the event of further improper stress or if there is no therapy, the pain can also occur at rest.
Elbow pain can also be a symptom of periosteum inflammation. Read our article about this: Inflammation of the periosteum of the elbow.
Duration
After the diagnosis of a golfer's elbow, the painful arm is often immobilized, for example using a splint for up to two weeks. The immobilization should then be reversed, otherwise the muscles may shorten and the joint may stiffen as a result.
Treatment can be lengthy, but is necessary to prevent a chronic course. If the golfer's elbow has been treated with an operation, the arm is immobilized with a splint for 10 to 14 days, depending on the healing process. Then the movement is optimized again through various physiotherapeutic exercises. The duration varies from person to person and depends, among other things, on the patient's cooperation, but also on how the patient's body can cope with the strain. Incapacity for work depends on the occupation and is usually between two to eight weeks.
Read more on the topic: This is how long periosteum inflammation lasts
causes
The term "golfer's elbow" does not mean that only golfers or athletes suffer from this condition. In fact, the “golfer's elbow” occurs only relatively rarely in athletes, usually as a result of one wrongly learned technique.
Because the golfer's elbow through chronic mechanical overuse This particularly affects craftsmen, mechanics, road and construction workers or secretaries.
In the course of the disease, painful wear and tear develop in the area of the attachment of the flexor muscles of the wrist. The golfer's elbow is also common in older patients. Investigations here may be very pronounced degenerative (arthritic) changes in the elbow joint on.
The forearm flexors are suspended on the inside at the end of the humerus. With it, humans can use the elbow as well as that wrist and bend your fingers.
The Muscle attachment tendons this muscle group is therefore stressed with many movements.
The causes for a golfer arm are mostly in one Overloading or improper loading of the affected arm.
The reasons for this can be varied, a golfer's arm not only occurs after playing golf, but can also be triggered by other activities.
Typical triggers are heavy loads on just one arm, for example when climbing, especially when the movements are technically not performed properly.
In everyday life there can also be a golfer's arm, which often lasts for hours Operating a computer mouse the trigger.
Why these burdens to one Inflammatory process in the muscle attachments is not fully understood, but the mechanical irritation of the tissue plays a major role.
Diagnosis of a golfer's elbow
The diagnosis can usually already be based on a anamnese and a simple one physical exam be asked.
The doctor becomes typical Pain points trigger by pressure.
It is important to ensure that there is no injury to the bones or elbow joint causing similar symptoms.
Furthermore, additional tests are carried out like the Provocation test:
When stretched Elbow joint will that wrist stretched out and the arm supported with the ball of the hand on a table. The pain on the inner elbow increases with golfers' elbows.
In this test, the flexor muscles on the forearm are used to the maximum. The tendons attached to the inner elbow are subjected to increased tension. The diseased tendons react to this with increased pain.
To rule out other diseases, a X-ray image on which you can see whether the pain is caused by old fractures, for example.
Occupational groups at risk include those who have to use the forearm flexors intensively. These are especially craftsmen, mechanics or construction workers.
Due to the strengthen Golfer's elbow pain, which occur more and more frequently when performing everyday activities and are sometimes so strong that even lifting light objects becomes torture, the patient seeks a doctor. Patients often complain that the pain is radiating to the forearm muscles.
During the clinical examination of the Golfer's elbow a strong pressure and touch pain is triggered on the tendon attachments concerned. Due to the pain, there is a restriction of movement in the Elbow jointwhich, however, comparatively rarely degenerative / wear-related changes is triggered.
As part of the medical examination, the doctor carries out so-called resistance tests on golfers' elbows. The patient has to make a fist and push up or down against force. If you have a tennis elbow or golfer's elbow, this test increases pain in the elbow joint. The entire forearm muscles are often very tense and, under certain circumstances, slight sensory disturbances can occur, such as tingling sensations. They are usually not caused by cervical syndrome (cervical spine syndrome) or local nerve damage.
When pressure is applied to the zones of origin of the finger and hand reflexors, a strong, stabbing pain occurs. Due to the pain of the patient, there is always a restriction of movement of the elbow joint. However, this is only in very rare cases due to degenerative changes and is more pain-related.
During an ultrasound examination, the doctor can detect swelling in the area of the tendon insertions, while x-ray examinations of the elbow joint reveal pathological changes only very rarely and usually in more advanced stages. In cases in which the golfer's elbow has already reached a chronic stage, calcification foci in the area of the tendon attachment or small periosteal irregularities (= periosteum irregularities) as well as bone extensions may be visible on the x-ray.
The doctor must be of the Epicondylitis humeri ulnaris (= Golfer's elbow) for example epicondylitis humeri radialis (= Tennis elbow) distinguish.
In order to be able to differentiate these from one another, the following tests will help the doctor.
Tests golf elbow and tennis elbow
Epicondylitis humeri radialis (tennis elbow)
Pain in the outer elbow area from:
- Rotation of the forearm
- Wrist extension against resistance
- Extension of the middle finger against resistance
- Extension of the elbow and passive flexion of the hand
You can find more information on our website: Diagnosis of tennis elbow
Epicondylitis humeri ulnaris (golfer's elbow)
Pain in the inner elbow area from:
- Flexion of the wrist
- Rotation of the forearm against resistance
- Lifting heavy things
therapy
If you have complaints in the form of a golfer's arm, it is advisable to take care of the affected arm. This will prevent the inflammatory process from progressing and make symptoms worse.
Therapy for the golfer's arm is usually conservative, and surgery is only carried out in rare cases.
There are numerous options and variants of conservative therapy, some of which are presented below:
- Physical measures
As with other inflammations in the body, it is helpful to have the golfer's arm cooled. This stops inflammatory processes and relieves pain. It is advantageous that the painful areas can also be cooled by the patient himself. In addition, many physical therapists use electrical stimulation when treating the golferam.
The technique used is called TENS, which means "transcutaneous electrical nerve stimulation is available". Electrodes are used to deliver electrical impulses to the skin. The aim of this process is to reach the nerve fibers that transmit the pain. The aim here is that less pain information is transmitted to the brain. The therapy is not painful, so the patient at most feels a tingling sensation on the skin.
One advantage of this procedure is that patients can use a rented or purchased device to carry out applications independently at home. Another widely used therapy is shock wave therapy. Here the attempt is made to stimulate the tissue with the help of shocks and thereby achieve increased blood circulation and regeneration of the tissue, which should ultimately bring about healing.
More information on this under our topic
- Golfer Elbow Therapy
- Forearm bandage
Shock wave therapy for a golfer's elbow
Shock wave therapy is used for golfers 'elbows when the usual conservative treatment options for golfers' elbow have failed, but one does not want to go so far as to perform an operation.
This form of therapy is now mentioned in the therapy guidelines. However, there are still many who are skeptical of this type of treatment. The statutory health insurance companies unfortunately steadfastly refuse to take over this effective therapy.
How exactly shock wave therapy helps with golfer's elbow is not yet understood down to the smallest detail. It is assumed, however, that the pathologically altered tissue structures on the affected muscle or tendon attachments are crushed into tiny particles by the ultrasonic pulses used, which trigger regenerative processes on the tendon.
In addition, the “impact” caused by the shock wave initiates repair mechanisms and stimulates blood flow, which also helps accelerate the healing of the tissue.
As a rule, extracorporeal shock wave therapy (ESWT) should be performed on a golfer's elbow patient on an outpatient basis and without anesthesia or local anesthesia.
It works in such a way that the affected area on the elbow is first covered with a contact gel. The shockwave head of the device, which resembles that of a kidney stone smashers, is then directed at the painful area and so shockwaves (ultrasonic waves / pressure waves) are directed into the affected area.
In golfers' elbows, low-energy shock waves can normally be used for this, as the tendon attachments are relatively directly under the skin.
Many patients perceive the shock wave therapy as a small blow, which makes the therapy uncomfortable. If carried out correctly, however, the treatment is otherwise not fraught with complications.
Various smaller nerves and blood vessels run along the inner elbow that are sometimes irritated by the shock waves.
So there may be bruises or pain in the treated area. If the treatment is not carried out correctly, it can, in the worst case, damage the elbow nerve (Ulnar nerve), which can impair the spreading and closing of the fingers.
If the treatment worsens the pain that is already there and it does not go away after the second or third session, you should stop the shock wave therapy and switch to one of the other therapy options.
The success rate of around 80% can be regarded as quite high. However, one must also bear in mind that the success depends on a number of external factors, especially the time at which the therapy is started.
Shock wave therapy helps more reliably in the early stages than in the chronic stage. Nevertheless, it is a very effective procedure, especially for the chronified golfer's elbow, which is becoming more and more popular due to its low side effects and the good prospects for complete healing.
In some cases it can make sense to use other methods in parallel to extracorporeal shock wave therapy in order to optimize the therapy, for example physiotherapy or pain-relieving, anti-rheumatic drugs.
surgery
If after six months of treatment no improvement in complaints occurs or it even worsens, surgical therapy should be considered together with the attending physician.
Unless there are circumstances that speak against it, such as a lack of care at home after the operation or complications related to a anesthesia For previous operations it is usually possible to have the golfer's elbow surgery outpatient perform.
The operation is also carried out frequently minimally invasive, this means that the surgeon inserts his devices through small incisions in the skin and a complete opening of the joint is not necessary. It should be noted, however, that the Ulnar nerve runs near the affected joint and special care should be taken during surgery.
Therefore, some surgeons still prefer one conventional surgery with opening of the joint. Which procedure is used in each individual case must be decided with the attending physician. The anesthetic can be used as either Regional anesthesia into a vein, as plexus anesthesia, i.e. anesthesia of all nerves in the armpit and thus of the entire arm, or in special cases as general anesthetic respectively.
When performing the operation can be between two standard procedures can be distinguished.
In the Surgical technique according to Hohmann become the origins of the Musclesthat start at the elbow and cause pain. To do this, a small cut is first made with the scalpel Elbow set and exposed the underlying muscles with their attachments. Since the skin is very elastic, the cut does not have to be large. The surgeon can simply slide the skin to one side to see all of the major muscles. This enables the surgeon to identify those muscle attachments that are under tension and are responsible for the pain in the elbow. Now these tense fiber strands are cut and in this way the Arm relieved. Those muscle attachments that are loose and relaxed remain untouched and preserved, because they have nothing to do with the origin of the pain. Once all the necessary attachments have been severed, the surgeon checks the arm's mobility in the operating room and under anesthesia. In addition, a test is carried out to determine whether a dent near the elbow is visible when a third person shakes hands firmly. This is usually the case. If the surgeon is satisfied with these two tests, the wound is closed again.
The second Standard technology according to Wilhelm become smallest annoy, which are responsible for the supply of the elbow and thus for the transmission of pain in the golfer's elbow, severed and obliterated. This process is also called Denervation. Most of the time there will be a Combination of both techniques applied. Following the golfer's elbow surgery, the arm is covered with a Upper arm plaster splint immobilized for about two weeks. After the plaster splint has been removed and the sutures pulled, movement exercises should be performed if there is no pain. In some cases there is also a physical therapy makes sense. The costs for such an operation are currently not covered by many statutory health insurance companies, so you should check with the respective health insurance company in good time.
homeopathy
In addition to medicinal, conservative and surgical treatments, there is another possibility to use homeopathic remedies on.
At the beginning of a homeopathic treatment there is usually a detailed one Anamnesis interview. The focus is not only on the actual complaints, the golfer's elbow, but on the whole person and his current state of health. In this way the homeopath tries to get an impression of the Overall situation and distinguish symptoms caused by the golfer's elbow from symptoms that have other origins.
On the basis of this conversation, the homeopath can then decide which remedy should be used in the case of the individual patient. A general information on useful substances is therefore difficult.
The following medications are used in homeopathic therapy for golfers' elbows, depending on how the patient's symptoms are presented, i.e. whether the pain improves or worsens, for example when heated:
- Bryonia, The bryony, is used in homeopathy when the patient has problems with the Movement execution and feel more stabbing pain that gets better with pressure and cold.
- Also find Arnica and Ruta Use in treatment after Overuse. Both substances can be used externally.
- Also to be mentioned are Rhus toxicodendron when the symptoms improve with movement and warmth and at the same time worsening when wet, rhododendronif touch stimuli are perceived as unpleasant, and Acidum hydrofluoricumwho have favourited hydrofluoric acid.
Other treatment options
- alternative healing methods / naturopathy
Many doctors and therapists from the field of traditional Chinese medicine use acupuncture to treat the golfer's arm.
A naturopathic approach is leech therapy.
The affected elbow is covered with leeches, which remain there for about 30-60 minutes until they fall off by themselves. Up to now it is unclear how the effect of the leech therapy is achieved. The prevailing theory is that the saliva of leeches contains substances that help alleviate inflammation. Leech therapy can not only be used to treat the golfer's arm, patients with rheumatic diseases or osteoarthritis can also be successfully treated with leeches.
- Bandages
Sports bandages are able to immobilize the joint for some time and promise relief. Special elbow bandages ensure a protective position, but at the same time allow partial use of the joint.
- TAPE treatment
Kinesio taping involves applying an elastic adhesive bandage directly to the skin. This has a regulating effect on the muscular balance in the elbow joint. Kinesio tapes are used both therapeutically and preventively. The effect of the kinesio tapes occurs indirectly via the irritation of skin receptors on the muscles. For this purpose, various investment techniques are available depending on the desired effect. The system technology is determined through consultation with a physiotherapist and a doctor. However, this effect has not been scientifically proven.
Before applying the tapes, the skin must be cleaned so that it is free of oils, creams and hair. This increases the durability of the strips on the skin. The tape should remain on for about 1 week, with the main effect expected in the first 3-5 days after application. Bathing, swimming and sports are also possible after the facility. If necessary, itching may be felt under the tape, if this occurs it should be removed.
- Medication
Creams or gels with anti-inflammatory active ingredients such as diclofenac are suitable for superficial application.
A stronger effect is achieved if painkillers and anti-inflammatory drugs are taken in the form of tablets for some time.
These are for example ibuprofen or diclofenac. These active ingredients can cause irritation of the gastric mucosa, which is why other medications may be used to protect the stomach, e.g. Pantoprazole, must be taken.
Interview with Mein-Allergie-Portal.com: Tennis elbow - mouse arm: What to do with painkiller intolerance?
On this topic, Dr. Nicolas Gumpert conducted an interview with mein-allergie-portal.com: "Tennis elbow - mouse arm: What to do with painkiller intolerance?"
- Injections
There is also the option of injecting pain killers on the affected elbow to relieve the pain. Cortisone is also suitable for injection and inhibits inflammation in the golfer's arm. However, caution is advised as the inflamed area on the golfer's arm is very close to the ulnar nerve. During the injection, the doctor injects the selected substance into the irritated tissue, he must not hit the nerve, as this leads to a sudden stabbing pain on the one hand, and cortisone may damage the nerve on the other.
- physical therapy
If the inflammation in the affected arm is acute and very painful, physiotherapeutic measures should initially be avoided.
It is advisable to first wait for the first pain relief and containment of the inflammation while taking care and other treatment concepts.
If only milder symptoms are present, physiotherapy can be started.
It has been shown that stretching the surrounding muscles in particular is very promising and often exceeds the benefits of other therapies. Suitable stretching exercises are presented under the heading Exercises.
- Operational approaches
The decision to have surgery on the golfer's arm should be considered carefully. It is recommended that conservative therapies are initially carried out for six to twelve months, as the operation cannot guarantee a cure. As a rule, the operation of the golfer's arm can be done on an outpatient basis, so no inpatient admission to hospital is necessary. The procedure is usually not carried out under general anesthesia, but with plexus anesthesia. The nerves of the arm are numbed with the help of local anesthetics so that the patient does not feel any pain.
Most surgeons operate on the golfer's arm by making a small incision over the affected tendon attachment, then severing it and removing any calcification so that the tissue is not further irritated. This technique, known as Hohmann's operation, can be combined with sclerosing small nerve endings in the elbow joint so that pain can no longer be transmitted. This procedure is called Wilhelm's operation.
Compared to tennis elbow, there is a higher risk of damage to the ulnar nerve during surgery on the golfer's arm, as it is in the immediate vicinity of the surgical field.
To minimize this risk, the surgeon needs to know exactly where the nerve runs, which is why he is visited after the skin incision before the actual operation begins.
stretch
Stretching exercises are a good way to prevent pain, such as those that occur with golfers' elbows, or to improve existing pain. These relieve the tendon attachments and thus prevent a state of tension in the muscle attachments, which leads to pain. However, one should note that the exercises should ideally be carried out in consultation with a doctor. Furthermore, a visit to a doctor is advisable if the pain does not improve or even gets worse.
The tendons of the wrist flexors, i.e. the tendons that attach to the inside of the elbow, are stretched, for example, by stretching the arm on which the golfer's elbow occurred horizontally forwards, with the palm facing up. Then the hand is bent downwards in the wrist, i.e. towards the floor. With the other hand you now grip your fingers and help with the downward movement until you feel a stretch on the inner elbow. The same effect can be achieved by placing the flat hand on a table top with the fingers pointing towards your body. In both exercises, it is particularly important that the affected arm remains straight at all times.
forecast
The prognosis can be described as good, as most patients with a golf elbow disease are conservative, i.e. can be cured without surgery. However, the disease may appear over a long period of time and, under certain circumstances, can only be healed with an operation. In rare cases, even surgery cannot provide permanent pain relief.
The golfer's elbow / golf arm also occurs frequently with a tennis elbow.
Figure elbow joint
- Upper arm head -
Capitulum humeri - Outer femoral knot -
Lateral epycondilus - Inner femoral knot -
Epycondilus medialis - Upper arm roll - Trochlea humeri
- Upper arm shaft -
Corpus humeri - Spoke head - Caput radii
- Spoke neck - Collum radii
- Roughness of the spoke -
Radial tuberosity - Roughness of cubit -
Ulna tuberosity - Spoke shaft -
Corpus radii - Ellschaft -
Corpus ulnae - Articular cartilage
- Joint capsule -
Articular capsule - Ellen's nerve -
Ulnar nerve - Arm extensor -
Triceps brachii muscle - Upper arm muscle -
Biceps brachii muscle
You can find an overview of all Dr-Gumpert images at: medical illustrations
Exercises
For the golfer's arm to heal, it is helpful if the patient exercises regularly.
It is important that not the patience is lost if the desired goal is not achieved immediately.
The effect only develops over time and can only occur if the exercises are in regularity and duration were consistently carried out.
stretching:
For one, it is important that Forearm muscles to stretch.
To do this, stretch the affected arm in the elbow, then hyperextend the wrist and pull it further into the overlap with the other hand.
The flexor muscles are stretched, and there is a slight pull on the underside of the forearm.
The extensor muscles can be stretched by flexing the wrist to the maximum and then pressing it lightly against it with the other hand.
For this exercise, too, the arm must be extended.
The stretching exercises should be performed for about 30 seconds and repeated three times per exercise unit. Ideally, the exercises are carried out at least once a day, or even better several times.
Once the inflammation and pain have subsided a little, it is time to strengthen the forearm muscles, as this is another one Overstimulation prevented.
The training should be done with a low weight load and high repetitions (20-30) be performed.
A simple form of exercise is to take a 0.5 l PET bottle in your hand and place your forearm on a table so that your hand is held in the air over the edge of the table.
Now the bottle should be raised and lowered by stretching and bending the wrist.
The exercise should be done in two ways, one time the arm should be held with the back of the hand facing up, another time with the palm facing up.
This is the only way to ensure that both muscle groups, both Straightener as well as Flexorto be trained.
This exercise should also be done three times per unit with a repetition number of 20-30.
Summary
At the Golfer's elbow it is a localized inflammation in the flexor muscles of the forearm and hand. From a medical point of view, it is a so-called Epicondylitis (humeri medialis).
On the one hand, it belongs to the Insertion tendopathies (= Disease of the tendons, tendon sheaths and ligaments), on the other hand also to the Myotendinoses (Disease of the unit Muscle = myo and Tendon = tendo). Accordingly, epicondylitis (humeri medialis) is a disease of the tendons and ligaments with involvement of the adjacent muscles.
Tendopathies (= tendinitis) can possibly cause painful changes to tendons in the area of a muscle origin, muscle, ligament or capsule attachments. Tendopathy can therefore occur almost anywhere in the body.
When golfer's elbow occurs as a result of a Overuse of the muscles characteristic pains, which under certain circumstances limit the usability of the affected arm enormously. The golfer's elbow, the epicondylitis humeri medialis, occurs Men and women alike on, most often in middle age.
The golfer's elbow can be treated both conservatively and surgically.
Usually one tries first of all, the clinical picture conservative to treat. This implies treatment methods such as: Immobilization, electromechanical stimulation, cortisone injections, ointment bandages and extracorporeal shock wave therapy.
If the conservative measures don't work, a surgery become necessary. This implies a relaxation of the muscles that are needed to stretch the arm (= "forearm extensor").
The golfer arm is one Overstimulation the forearm flexors and is associated with pain in the arm.
There are numerous treatment methods, whereby the patient's independent practice is an important part of the therapy. An operation should only be chosen in exceptional cases and in the case of severe, protracted processes.
