WHAT IS IT? FLEXOR TENDINOPATHY
The medial forearm and elbow pain associated with flexor tendinopathy is more commonly referred to as ‘golfer’s elbow’.
The muscles affected are the flexor muscles of the forearm and the Pronator Teres muscle. When these muscles are overused, chronic degenerative changes can take place. This involves a pathological process called ‘Tendinosis’.
Tendinosis – see page (Achilles, patellar, forearm extensors and flexors, RC)
Signs & Symptoms
Medial elbow pain, from the medial epicondyle to the forearm flexor bulk.
Gradual onset or specific to an incident
Aggravated by lifting heavy items (golf club, tennis racquet) or gripping things
Aggravated with repeated activity (playing tennis, laboring)
Tenderness and thickening on palpation of the medial elbow and forearm muscles
Pain is reproduced with resisted wrist flexion and pronation
What Causes It?
Golfer’s elbow usually begins as an irritation and inflammation of the flexor tendons of the forearm where they attach to the humerus.
Overuse of wrist flexor and pronatory muscles (incorrect sporting technique)
If these activities continue, then the inflammatory nature of the initial pain turns into a chronic tendon problem that is characterised by pain, weakness and degeneration of the tendon. Once this elbow problem is chronic, it can be very persistent and much more difficult to treat.
How to Self Manage
Follow the R.I.C.E. protocol
Trial a short course of Non Steroidal Anti Inflammatory Drugs to combat the initial inflammation
Stretch the forearm flexors by .. .
On resumption of activities, a compression strap can be effective at reducing the stress on the painful area whilst allowing the user to continue with activities.
Tendinosis is a condition whch take s a long time to treat, especially if the pain is chronic prior to seeking initial management.
If conservative management is unsuccessful then an xray may be deemed necessary to exclude bony degeneration or calcification.
Ultrasound imaging may be useful for imaging the tendon integrity and to assess any bursa type irritation.
Your GP may suggest a corticosteroid injection to the area to reduce your pain
A surgical option is to ‘scrape’ the tendon to remove the degenerative tendon.
How Physio Helps
Determine if your medial elbow pain is flexor/pronator tendinopathy, whilst excluding other causes (cervical/thoracic referral, nerve entrapment, other elbow conditions)
Assess for contributing factors
Review recent training and activities to identify areas for modification (eg tennis racquet size, weight, grip, string tension).
Liaise with coach RE racquet and or technique (especially top spin forehand)
Provide advice about work activities and workstation set-up
Provide manual therapy which may include soft tissue release of the forearm muscles, dry needling and/or acupuncture, stretching of muscles and nerves, ultrasound, and possible brace prescription
Provide a progressive eccentric loading program which is absolutely key to successful rehabilitation