Golfer's elbow, an overview of epitrocleitis

By Cristiano Antonino On May 1, 2023

Epitrocleitis, golfer’s elbow: what is it? The tendon complex that connects the medial epicondyle of the humerus to the anterior muscles of the forearm becomes inflamed due to the frequent repetition of a certain movement

Those who suffer from it experience pain, joint stiffness and weakness.

Typical of those who practice golf (hence the name), but also sports such as tennis (not to be confused with epicondylitis or tennis elbow) and baseball, epitrocleitis is a state of suffering caused by overload.

0.4% of the world population suffers from it, according to the American Journal of Epidemiology, with a clear prevalence among those who perform sports/work with risky gestures, in subjects aged between 45 and 55, smokers and overweight.

Smoking, in fact, damages the microcirculation, while obesity reduces muscle efficiency.

What is epitrocleitis?

The patient suffering from epitrocleitis suffers from an inflammation of the tendons that connect the medial epicondyle of the humerus to the anterior muscles of the forearm.

The medial epicondyle is the “relief” that is perceived to the touch when the arm is extended along the side, with the palm of the hand facing forward.

Anatomically, it is the portion of the humerus to which the tendons connected to the proximal head of the anterior muscles of the forearm bind (or rather, 5 of the 8 total: flexor carpi ulnaris, palmaris longus, flexor carpi radialis, pronator teres and flexor superficial of the fingers).

Epitrocleitis therefore occurs on the side of the elbow opposite to that of epicondylitis, or tennis elbow, and falls into the group of tendonitis.

The disease is multiphasic:

The first stage is that of inflammation without angiofibroblastic degeneration, easily reversible and simple enough to treat with conservative therapy;
in the second stage there is a slight tendon degeneration, with healthy or inflamed tissue: treatable conservatively with some more difficulty, it tends to become chronic;
in the third stage there is a marked angiofibroblastic invasion, with interruption of the tendon fibers: surgery is often necessary.

The causes of epitrocleitis

Epitrocleitis is caused by a functional overload of the muscles that insert at the level of the medial epicondyle of the humerus (where overload means excessive strain).

These, due to the stress to which they are subjected, inflame the tendons used in the flexion movement of the hand towards the wrist.

And it is precisely this movement which, repeated very often at work or in sport, leads to the onset of the disease.

In particular, the cause of the epitrocleitis is the excessive solicitation of the muscles that allow the wrist and fingers to flex (to pick up objects) and which cause the adduction and abduction of the wrist.

For this reason, you are more likely to get golfer’s elbow:

golfers: the swing stimulates the anterior forearm muscles, but those who have the habit of hitting from above, lowering the club forcefully using the right arm and thus putting pressure on the flexor muscles of the forearm, are more likely to suffer from epitrocleitis elbow (instead of having your left arm and body help you);
those who practice tennis: the “criminal” movements are topspin and the backhand, but those who use a racket or balls that are too heavy, rackets with excessively taut strings or with too small handles increase the chances of suffering from epitrocleitis;
anyone who plays baseball, javelin throwing, softball, baseball, and any pitching sport;
those who lift weights, especially if they do not have perfect technique in flexing their fingers to grip dumbbells and barbells;
the masons;
the typists;
the carpenters;
the plumbers.

Specifically, the repetition of a risky gesture with an incorrect technique or for more than two hours, the use of inadequate sports equipment, obesity, cigarette smoking and being over 40 favor the onset of the pathology. years.

Symptoms

The first symptom of epitrocleitis is pain, which is felt on the inside of the elbow (usually in the predominant arm).

Sometimes, rather than pain, there may be a feeling of soreness, and it is possible that stiffness in the elbow, weakness in the hand and wrist, and numbness or tingling in the fingers may also appear.

The pain can appear suddenly and be immediately quite important, or gradually become more slowly.

Furthermore, since epitrocleitis is a form of tendonitis, it worsens when movements are made that solicit the muscles involved.

If you often feel pain in the inner region of the elbow and notice the connected symptoms (stiffness, weakness, pins and needles, etc.), it is advisable to consult your doctor to avoid the onset of complications.

Epitrocleitis can, in fact, evolve into a more serious form of tendinopathy, with degeneration or injury of the tendons and chronic pain.

If this were to happen, the patient could also suffer psychologically because he feels unable to perform simple movements.

Diagnosis and treatment of epitrocleitis

The diagnosis of epitrocleitis is rather immediate, as it is based on the observation of the symptoms and on the physical examination.

Through palpation of the elbow and specific maneuvers (the execution of movements that accentuate the pain), the doctor is able to identify the presence of inflammation.

The visit ends with the anamnesis, and therefore with the study of the symptoms observed and with a series of questions asked to the patient to confirm the diagnosis.

Sometimes, a diagnostic investigation with an X-ray, an ultrasound or an MRI may be necessary.

Treatment for epitrocleitis is in most cases conservative.

The patient must remain at rest, with the indication not to carry out the movements responsible for the inflammation for a period of time.

Ice can be applied to the sore area for 15 to 20 minutes four or five times a day, focusing on the inside of the elbow.

While, to facilitate the healing process, it is useful to wrap the elbow with a weakly compressive bandage or use a brace.

In 90% of patients, the epitrocleitis resolves with rest, bandages, wraps and drug therapy.

The most commonly used drugs are:

NSAIDs (non-steroidal anti-inflammatory drugs), oral or topical, used for their anti-inflammatory and analgesic action;
pain relievers such as acetaminophen, to relieve pain;
local injections of corticosteroids, under close medical supervision and for a short period of time.
Epitrocleitis generally resolves in 3-4 weeks, and requires a gradual resumption of one’s activities but it is not uncommon for it to become chronic and last several months.

In this case, after resting in the acute phase (10-15 days), it is useful to perform targeted re-education exercises, starting with stretching and strengthening the flexors.

A good physical therapist will be able to teach you the correct movements to perform.

Surgery, performed in a low percentage of cases, is necessary if after several months of conservative therapy the patient has not obtained any benefits.

To prevent inflammation from returning, it is good practice to adopt a series of virtuous behaviors: do not overdo risky sports activities (unless you are professional athletes), warm up properly before training, take several breaks when gestures potentially responsible for inflammation are performed, use standard and good quality sports equipment, learn the correct execution technique for each exercise.

This is useful to avoid the onset of the disease or relapses.

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