What Causes Medial Epicondylitis?

The 3 Core Causes of Golfer's Elbow

Golfer's elbow is less common than tennis elbow but still accounts for 10 to 20 percent of all epicondylitis cases. Golfer's Elbow can affect anyone who uses their hands, wrists and fingers to wrap around instruments, type on keyboards, or grip objects (golfers, pitchers, racquet players, small parts manufacturers, office workers, lab technicians, hygienists, carpenters, wood choppers). It is most often a result of forceful contractions and overuse.

"[Golfer's Elbow] is highest among subjects ages 45 to 64 and more common in women compared to men. In certain occupations, the prevalence may be as high as 3.8% to 8.2%. Three out of four cases are in the dominant arm."

Most cases of medial epicondylitis are managed nonsurgically, although it is less common than lateral epicondylitis and more difficult to treat. [9] Initial management should include cessation of offending activities including decreasing their volume, frequency, or intensity. The provider should recognize that this may not always be possible depending on the patient's occupation. For example, a professional athlete or laborer may not be able to afford to take time off.

Kiel, John, and Kimberly Kaiser. 2018. "Golfers Elbow". Statpearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK519000/.

Tennis elbow and golfer's elbow are a result of vigorous use and movements or overstraining of the forearm muscles that move your fingers, hand, wrist and forearm. Overuse of your muscles really depends on how long you do something and how much effort you exert doing it. The constant tugging at the point of attachment on the outside of your elbow (lateral epicondyle) or the inside of your elbow (medial epicondyle) can cause these tendons to become inflamed and strained. Your muscles and tendons can then become irritated which can result in weaker tendons, tiny tendon tears and development of scar tissue and/or calcium deposits. The development of scar tissue will put pressure on your soft tissue and nerves, and interrupt the blood flow to this area; this can be very painful.

golfer elbow anatomical image

If golfer's elbow pain is due to a deterioration of the tendon (tendinopathy), it can take from two to six months to fully recover. Many cases of medial epicondylitis become chronic problems (just like lateral epicondylitis) that progressively get worse if the sufferer continues performing the causal activity that started the condition in the first place. When you do this, your body definitely indicates there is a problem as the area will continue to generate a lot of pain.

  • Acute Trauma: this can occur from an accident or high intensity movement. An example of this would be straightening your arm while hitting a golf iron into the ground.
  • Repetitive Stress: this happens through overuse of the elbow joint without proper treatment or recovery. A couple examples of this would be (1) spending hours per day typing at a computer without taking a break, or (2) using a hammer day in and day out without adequate rest.
  • Re-Injury (Chronic Trauma): this injury is from continually injuring your medial epicondyle tendon. Small tears in the tendon form and worsen over time, allowing the growth of scar tissue. An example of this would be painting high walls or ceilings with an already damaged elbow day in and day out.

Over time with overuse, your muscles and tendons can become irritated which will result in weaker tendons, tiny tendon tears and development of scar tissue and/or calcium deposits. The development of scar tissue will put pressure on your soft tissue and nerves, and interrupt the blood flow to this area. Scar tissue is tough to get rid of and can cause significant pain over a long period of time. The application of heat when combined with PT and a conservative treatment plan will aid most patients in a reduction of scar tissue, while simultaneously increasing growth of healthy tendon and muscle tissue. By following a conservative treatment regimen, most sufferers of golfer's elbow can rid themselves of this persistent injury and get back to a normal pain free lifestyle faster than they would expect.

Risk Factors for Golfer's Elbow

When we identify a "risk factor" what we are saying is that undergoing this activity (or profession) will elevate the risk that you might incur Golfer's Elbow. Generally, risk factors are identified that put you in a position where you either have a high likelihood of acute trauma or repetitive stress to the tendons and muscles attached to the medial epicondyle.

Traditional risk factors for golfer's elbow include actions like:

  • tightening a screw with your arm extended
  • gripping and swinging a large/heavy object such as an axe or sledgehammer
  • handling digging/weeding equipment as is common in gardening
  • handling tense rope over long periods - sailing
  • gripping very high loads, frequently - weightlifting

Office/Computer Specific Risk Factors for Golfer's Elbow

Modern day life in many ways has changed drastically over the last decade or two. The odds of your workday involving long periods at a computer station are higher than ever and the medical community is definitely seeing a rise in injuries due to frequent computer and mobile phone usage.

Long Keyboards

Users should know that using a keyboard and mouse causes their arms to be held in a tense posture - especially the forearms and wrist. Golfer's Elbow - when caused by keyboard and mouse usage - will arise most commonly in right handed people, as they typically are forced to keep their right elbow away from their side when using a mouse. This is usually due to the extended size of keyboards that have a number pad (and/or function pad) on the right side. This means that to use the mouse to the right of the keyboard, it has to be positioned too far right for the right elbow to be comfortable, and in such cases increases your risk of contracting golfer's elbow. A solution to this would be to use a keyboard without the extra keys on the right.

The Problem With The Conventional Computer Mouse

If you are sitting at a desk, put both of your hands on the desk with palms facing downward - we will call this "Position A". Take note of the position and the light awkward feeling that this position produces. Now, rotate your hands outward so that your thumbs are pointing upward and the outside flat of the hand is resting on the desk - we will call this "Position B". Take note of the difference in the feeling and tension in the wrist and forearm when changing to the new position.

If the results of your small experiment went the same as mine, you will overwhelmingly agree that Position B is a much more natural position. The reasons for this are fairly straightforward, as the two bones connecting your wrist to your forearm are twisted when in Position A. When your hands/arms are in Position B, the bones are straight, and are in what is termed a "neutral" stance. This is why specialists in the ergonomic field recommend using a vertical mouse instead of a standard mouse, as the vertical mouse allows you to maintain a "neutral" stance in your arm.

There is a posture checklist that should be adhered for long term workstation users. We have highlighted areas in the list that is specifically related to epicondylitis:

  • Computer screen should be arms length away from you.
  • The best position for wrists are to be inline with your forearm and not at an angle. Ergonomic keyboards and mice are advised for this reason.
  • Upper arm and elbows should be by your side and not extended outward from the body. A vertical mouse and compact ergonomic keyboard are advised for this reason.
  • Seat height should be adjustable so that your feet are on the floor. If not possible use a footrest.
  • Get up from chair and stretch often - many advise every half hour.
  • Ensure your chair has lumbar support for the lower back
  • Knees should generally maintain a 90 degree angle.
  • Don't slouch (keep upper back straight, chin up)

Golfer's Elbow Re-injury

There can be different factors leading to a re-injury of your medial epicondyle, but in most cases, the strongest reasons are:

tennis elbow injury can be work related
  • Strenuous Activity
  • Age (a person with a greater age has a greater chance of contracting tennis elbow)
  • Technique of Movement and Tools Used (ie. proper versus improper form on the court, use of an ergonomic keyboard when typing may help prevent tendonitis, etc.
  • General Health and Wellness (armchair & weekend athletes are at greater risk of a tendon injury compared to an athlete that does such activities on a daily basis.

Activities - If your household, workplace, or recreational activities involve significant repetitive movement of your wrist, forearm, upper arm, and/or shoulder you are at risk for developing Golfer's Elbow. Some common activities that can cause Golfer's Elbow include (but are not limited to): painting, house cleaning, playing an instrument, racquet sports, throwing sports (ie. baseball pitchers), weightlifting, heavy lifting, frequent use of a computer (or typing), and/or shaking hands frequently.

As you can see, its not just professional athletes or people with physically demanding jobs who suffer from Golfer's Elbow.

Actively moving your arm for long periods of time can cause a lot of stress to be exerted on your elbow. Repeated movements gradually increases the stress placed on muscles.If you don't give your body a chance to rest and regain strength, stronger muscles (like the ones in your shoulder) have no choice but to transfer energy to less capable structures (such as the muscles in your hand or wrist). Weaker muscles cannot handle the impact stronger muscles can. As a result, they begin to strain and even tear.

It is important that you allow your body to rest between periods of exertion or repetitive movement. Fatigue in your muscles can lead to bad form, or overuse. You body is an amazing thing! It is constantly trying to heal itself and perform at its fullest capabilities. When you don't allow your body to rest and push yourself beyond your physical limitations, chances of becoming injured are quite high.

So What Happens To Elbow Tendons When Forced To Deal With Overuse And Repetitive Movement?

Your tendons attach your forearm muscles to the bone of your elbow. When high levels of stress are exerted on your forearm, tendon fibres stretch beyond their limits. If this action is repeated over and over again, tendon fibers lose their strength and elasticity. They can become disorganized and tangled. If repeated long enough or with too much stress exerted, your tendon fibres may even begin to tear.

These small tears cause inflammation in the area of your elbow called the epicondyle ( the bony bumps on the inside (medial) and outside (lateral) of your elbow where the tendon attaches the forearm muscles to your elbow bone ). You elbow may become swollen, bruised, or disfigured. Your elbow joint is a very small complex structure and doesn't handle swelling well. Swelling will limit blood flow and possibly put pressure on the ulnar nerve - this can cause tingling and/or numbness in the wrist and hand. Micro tears and swelling can cause mild discomfort to intense pain. The limited blood flow can restrict your body's ability to heal. If not treated, your tendon will begin to deteriorate. It can take months for you to fully recover.

If you repeatedly injure your tendon without proper treatment and recovery, scar tissue will form. Scar tissue is weak and inflexible tissue that hardens around the tendon without giving it any support or strength. Scar tissue will never heal into healthy, mature, strong tissue. Scar tissue will put pressure on your soft tissues and nerves. It interrupts the blood flow to the areas of your elbow causing pain and delaying recovery. It is important to prevent the growth of scar tissue with conservative treatments.

This is why it is very important to seek medical advice when you've had an accident or injury. Your doctor will be able to recommend the best course of action for treating your tendon injury using cooling and heating treatments. If there is little swelling, as is often the case with Golfer's Elbow, we recommend the application of an Elbow as this will become a significant aid in boosting circulation in the area as well as helping reduce risk of tissue reinjury. To view more about how to treat Golfer's Elbow, go here.

tennis elbow injury can become chronic if too much scar tissue is present in the damaged tendon

How Your Age Affects Risk of Golfer's Elbow

Age is always a factor when it comes to injury. As we become older, our tendons begin to weaken and eventually break down. By not training our bodies or allowing repetitive injuries, we speed up this process.

If you have read a few pages on this website, you probably know that Golfer's Elbow is all about tendons - damaged tendons that attached to the medial epicondyle to be exact. So when we talk about aging and its effects on Golfer's Elbow, we are really talking about the effect that age has on tendons in the forearm.

Degeneration, or the break down of tendon tissue, is especially noticeable in individuals who have a repeated history of overuse.

Over time, repeated damage to your tendon can cause you to develop a condition called 'Tendinosis'. This means that your tendon becomes unable to ever heal fully. Age and repeated injury without proper treatment can cause the breakdown of your tendon.

Getting Rid of Golfer's Elbow for Good

Your body is an amazing organism and has all of the tools to heal itself. However, healing your tendon can take a very long time. It is unrealistic to expect anyone to put their life on hold for weeks or months. Without the proper treatments, your tendons will thicken with weak, inflexible scar tissue.

If you are experiencing a deterioration of the tendon (tendinopathy), it can take from two to six months to fully recover. Many cases of medial epicondylitis become chronic problems that progressively get worse if the sufferer continues performing the causal activity that started the condition in the first place. When you do this, your body definitely indicates there is a problem as the area will continue to generate a lot of pain.

Only you can prevent injury. Take steps before you injure your body to avoid spending valuable time in recovery instead of at work, with your family, or your favorite activities.

It is important that you speak to your doctor about the recovery and prevention options available to you.

golfers elbow injury and tendinosis

The more committed you are to your recovery, the faster you can return to your active lifestyle free from pain and immobility.

  • Have you recently re-injured your elbow by returning to your normal daily activities too quickly?
  • How many times in the past have you aggravated your elbow just trying to perform basic tasks around your house?
  • Is your tennis elbow preventing you from work or activities you love to do?

Most people we deal with tell us these scenarios have happened to them many times in the past. The real challenge is how to achieve a full recovery, quickly, without causing further damage (re-injury). This goal is even more complicated by the fact that you have to use your arm / elbow for almost everything in everyday life.

What Can You Do To Actually Start Healing Your Golfer's Elbow?

To go to our Golfer's Elbow Treatment page, go here

The best option we came across in our research to accomplish true healing of elbow soft tissue injuries is the Elbow T•Shellz Wrap®. Use of this device results in a dramatic increase in blood flow to the injured tissues located deeper within the body - all in a non-invasive manner.

Using the T•Shellz Wrap® is truly a unique experience. Within moments of applying a treatment to your injured elbow, you can feel the healing sensation due to the increase in blood flow deep within the area. During a treatment, and for quite some time after you finish, the treated area will feel relaxed and less painful. It's a very soothing sensation and extremely effective.

A Recap of the Benefits of the Elbow T•Shellz Wrap®..

  • Can be used on the forearm, bicep, elbow (outside, inside, or the side) on either arm.
  • It can be used before activity or exercise to warm up tissue in the elbow to reduce the risk of further injury
  • FDA Registered medical device for use in home or clinics - very high quality
  • Temporarily increases flexibility and length of soft tissue (reducing the re-injury factor)
  • It soothes pain and whisks away toxins
  • Carbon fiber Energy Pad is strong, lightweight, and flexible - contours very easily
  • A boost in blood flow helps maximize the body's ability to recover from soft tissue damage. This can be beneficial in saving time and money when associated with doctor or physio visits
  • A boost in blood flow will maximize the body's ability to recover quickly. This can be beneficial in post-surgery rehabilitation, getting you back to work faster. Do not use until at least 6 weeks after surgery, and only after approval from your doctor.

When Should I Use My TShellz Wrap During the Day?

The most common question we receive from individuals prior to purchasing is - how many times a day should I be using my elbow wraps and when should I be using them? While treatment plans will differ for each individual and their specific injury, there are general guidelines that should be adhered to.

  • Use a Cold Compress or Ice Pack when you are experiencing inflammation (usually after exertion or movement of the injury area).

The Elbow T•Shellz Wrap® would then be used:

  • Right after rising from bed in the morning (as this is when it is most stiff)
  • Prior to going to bed at night (to relax the arm, allowing for better sleep)
  • Before you know you will be using your injured joint (going to work, driving, typing, etc).

Your body can heal itself and it's the blood in your body that makes it all happen. Your blood is how everything that's good inside of you is transported directly to your injured elbow tissue. Your blood carries oxygen, nutrients and water right to the source of your injury and pain. Bringing proper blood flow to your injured elbow is essential for healing.

The only way to get Circulatory Boost through daily treatments at home is through the application of an Elbow T•Shellz Wrap®.

Regular treatment with the T•Shellz Wraps® will ensure:

  • Your pain will be reduced.
  • In most cases, your body's healing process will be accelerated (due to enhanced blood circulation) with reduced potential for re-injury*.
  • Soft tissue in the treatment area will have a enhanced range of motion and increased extensibility of collagen tissue. (Chapter 9 of "Therapeutic Heat and Cold", 4th edition. (amazon.com link - Ed. Justus F. Lehmann, M.D., Williams, and Wilkin)

Increased Blood Flow => More Oxygen, More Nutrients, Less Toxins => Faster Healing

Use A Circulatory Boost Elbow T•Shellz Wrap®:

  • After swelling and inflammation have been reduced with cold compression.
  • Before exercise or workouts to warm up your elbow to prevent re-injury.
  • Before and after tennis elbow surgery, during rehabilitation, to warm up your elbow before PT exercising or stretching.
  • Anytime you feel your elbow has stiffened up, is tight and your mobility is reduced causing you more pain.
  • Anytime you have sore or aching tissue in and around your elbow.
  • Any other situation where you need to relax soft tissue in the elbow, relieve pain, help reduce risk of re-injury and/or enhance flexibility of soft tissue in your elbow and forearm.

Techniques and Tools To Help Prevent Golfer's Elbow

Your environment plays a huge part in the health of your body. Using tools that are properly fitted and weighted to your body and abilities will help you perform with success and avoid injury.

Young athletes with improper training are at significant risk of suffering from Golfer's Elbow symptoms. When starting a new job, activity, or exercise routine, it is important to learn and understand the best techniques for you to achieve your tasks and goals.

It is important for athletes to have their techniques and equipment checked by professionals for the best fit and performance. Why use movements or tools that don't give you the best opportunities for success?

tennis elbow injury can be for over exercising

Just like athletes, workers with physical jobs or people performing repetitive tasks should refer to occupational therapists. These specialists understand how the body works and which movements should be avoided as they can lead to injury.

Over extending your arm while painting can cause an injury just as easily as an improper back hand swing. It is important to understand that your body is a complex network of connected structures. When using wrong muscles, improper form or positioning during work effort, you put your body at elevated risk for injury.

General Health and Fitness Help Prevent Injury

Maintaining your general health and fitness can help you prevent injury.

Training your body to perform the ways you need it to will decrease your risk of injury. An untrained body is more likely to make movements using awkward motions where force is improperly handled by your body mechanics. This will cause stress hotspots which will definitely be more likely to damage soft tissue in the body, leading to long term injury.

It is important to remain physically active as this will keep your soft tissue more healthy and flexible. The health of your whole body contributes to the health of the individual parts. Maintaining a healthy weight and overall level of fitness through regular activity and healthy eating will increase your body's ability to avoid injury.

Lack of activity can cause muscles to become weak and unsupported. Without strong muscles your body places the stress on weaker structures like joints. Strong muscles help maintain a strong body, evenly distributing weight and forces to the areas that can handle it properly.

Remember to drink fluids and rest. Resting your body will help reduce fatigue in your muscles. Energized muscles are strong and will help you complete tasks efficiently and effectively.

If you want to avoid re-injury, or manage pain and increase circulation for lifelong health benefits, an Elbow T•Shellz Wrap® will provide the results you are looking for. To prove this, we offer a 60 day trial period on every T•Shellz Wrap®.

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During your recovery, you will probably have to modify and/or eliminate any activities that cause pain or discomfort at the location of your soft tissue injury until the pain and inflammation settle. Always consult your doctor and/or Physical Therapist before using any of our outstanding products, to make sure they are right for you and your condition. The more diligent you are with your treatment and rehabilitation, the faster you will see successful results!


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