Epitrochleitis (golfer's elbow)

Synonyms

• Medial elbow tendinitis
• Epitrochleopathy

What is the difference between epitrochleitis and epitrochleopathy?

The two are almost identical. Science has recently discovered that there is not always inflammation present in tendon pain.

"So, when there is tendon pain without inflammation, it is called tendinopathy (epitrochleopathy here). When there is tendon pain with tendon inflammation, it is called tendinitis (epitrochleitis here)."

In both cases, whether it is tendinitis or tendinopathy, the management is similar. Therefore, we will include tendinopathies and tendinitis as being the same injury.

What is elbow epitrochleitis?

It is an irritation or inflammation of the tendons on the inner side of the elbow.

What is a tendon?

A tendon is the structure that attaches a muscle to a bone. When a muscle contracts, the force is transmitted to the tendon, and the tendon stiffens to move the bones. The 'epitrochlear' tendons are the tendons of the muscles that allow you to close your hand and make a fist.

Why is it called "golfer's elbow"?

Because it is a common injury among golfers due to repetitive movements and the significant load on the elbow tendons.

What are the causes of elbow epitrochleitis?

This can be caused by:

• Repetitive movements of the wrist or elbow
• Overload of the elbow muscles (after a new sport or activity, for example)
• Inflammatory arthritis (see inflammatory arthritis section)

"Often, epitrochleitis is caused by overuse of certain arm muscles compared to others. Poor muscle recruitment can therefore contribute to this injury."

Here are some classic examples of the development of this pathology:

• Doing renovations all day without being used to it, doing a lot of painting, hammering, or using a screwdriver
• Cooking all day by kneading dough or mixing a lot with your hands (repetitive movements with the hand closing).
• Starting our golf season without pacing the progression.

« Did you also know that a problem with the ulnar nerve can cause the same symptoms as epitrochleitis? » See the arm neuralgia section to learn more.

What are the symptoms of elbow epitrochleitis?

The most common symptoms are:

• Specific pain on the inside of the elbow that has appeared gradually.
• The pain may radiate into the forearm and even to the wrist and fingers
• Weakness and pain when picking up objects (picking up a pot, a coffee cup, a grocery bag)

If you also have pain that radiates towards the shoulder or numbness in your hand or fingers, it is likely that you also have arm neuralgia. (see arm neuralgia section).

How to diagnose elbow epitrochleitis?

Diagnosis is possible with a review of your symptoms and a clinical examination. Imaging tests are not necessary for diagnosis.

When to consult a physiotherapist for elbow epitrochleitis?

You should consult a physiotherapist if you have symptoms as described above or if your doctor has already ruled out any other cause that may be responsible for your pain.

You do not need to see a doctor before consulting a physiotherapist. If your condition requires you to see a doctor, your physiotherapist will be able to tell you.

What physiotherapy treatments are available for medial epicondylitis (golfer's elbow)?

Your physiotherapist will perform an assessment to determine the cause of your medial epicondylitis by evaluating the following elements:

• Your joint mobility
• The gliding of your nerves
• The quality of your movements
• Your strength and stability

Based on the assessment results, your physiotherapist will:

• Will mobilize your elbow to reduce pain and improve your movement.
• Will provide you with specific exercises to retrain the movement control of your elbow and wrist.
• Give you exercises to regain mobility, reduce pain and regain your muscle strength.
• Teach you how to properly manage your daily activities and hobbies to optimize healing
• Give you advice for your posture and movements.

What can I do at home for medial epicondylitis (golfer's elbow)?

Temporarily stop doing movements that cause too much pain, and then gradually start doing them again.

If you have pain at night or morning stiffness, make sure your neck is well supported while sleeping with a pillow that fills the hollow of your neck. Avoid sleeping with your arm behind your head or under the pillow. Keep your arm along your body or supported with a pillow.

Here are some other tips that may help relieve the pain:

• Wear a medial epicondylitis compression band/brace a few centimeters below the elbow.
• Slightly raise your shoulder upwards before straining or lifting a load (this helps reduce pain).

If you don't see any improvement after 10 days, you should consult a physiotherapist.

Sources

• Donaldson O, Vannet N, Gosens T, Kulkarni R. Tendinopathies around the elbow part 2: medial elbow, distal biceps and triceps tendinopathies. Shoulder & Elbow. 2014 Jan;6(1):47-56.
• Vaquero-Picado A, Barco R, Antuña SA. Lateral epicondylitis of the elbow. EFORT open reviews. 2016 Nov;1(11):391-7.