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Medial epicondylitis or golfers elbow is most commonly caused by overuse of the muscles and tendons of the forearm and elbow. Repeating certain types of activities over and over again can put too much strain on the tendons around the medial epicondyle (bone that protrudes on the inside of the elbow). This strain can cause damage and inflammation of the tissues and cells around these tendons. Activities that bring about medial epicondylitis aren’t limited to golf and can also include swimming or gardening. The main symptom of golfers elbow is tenderness and pain at the medial epicondyle of the elbow and may spread down the forearm. Bending at the wrist, twisting the forearm or grasping objects may aggravate the symptoms. Medial epicondylitis may also result in significant weakness in the muscles around the elbow, forearm and wrist.
Golfers elbow can be treated conservatively with a comprehensive physiotherapy programme, medication as well as other modalities to relieve symptoms such as ice, electrical stimulation, strapping or rest from any aggravating activities. In severe cases of medial epicondylitis and when conservative treatment fails, medial epicondylitis release surgery is required to alleviate symptoms such as pain, tenderness and loss of function in the elbow joint.
During medial epicondylitis release surgery the surgeon begins by making an incision along the elbow over the medial epicondyle. Soft tissues are gently moved aside and then the flexor tendon is cut and cleaned up where it attaches to the medial epicondyle. The surgeon then divides the tendon and removes any damaged or scarred tissues. If there are any bone spurs (bone growths on the surface of bone) found, then they are also removed. In some cases, the loose end of the tendon is then attached to nearby tissues. Following the removal of all the damaged tissues and after the surgeon has cleaned up the flexor tendon, the wound can be closed up using sutures (stitches).
It is crucial to undergo medial epicondylitis release surgery to help relieve symptoms caused by severe cases of golfers elbow (medial epicondylitis). Physiotherapy after medial epicondylitis release is imperative to maximise the success of the surgery, prevent the likelihood of any problems occurring and to help guarantee the return of full or near to full strength and function in the elbow.
Above: Strengthening exercises for the muscles and connective tissue around the elbowPhysiotherapy before medial epicondylitis release
Physiotherapy prior to your medial epicondylitis release is recommended to better prepare your elbow for the surgery. Physiotherapy at this time will also give you a head start in your rehabilitation after the surgery helping to ensure a rapid and problem free recovery of your elbow and upper limb. Physio.co.uk offers a physiotherapy programme for before the medial epicondylitis release surgery that aims to strengthen the muscles around your elbow, wrist and shoulder whilst also including activities that improve your cardiovascular fitness and muscle endurance for maximum preparation before your operation.
Above: Soft tissue massage of the the connective tissues around the elbowSymptoms after medial epicondylitis release
After you have undergone medial epicondylitis release, you will experience pain, swelling and stiffness in your elbow joint along with a short term reduction in range of movement and function in your elbow, forearm and hand. The wound on your elbow will be covered with a dressing and you will be provided with a sling to use for a short period of time for essential support and protection. You will be given pain killers to aid discomfort and your elbow should remain elevated to lessen swelling in the initial period after the surgery. Physiotherapy will begin immediately after you have had medial epicondylitis release to regain mobility and function in your elbow as soon as possible. However, repetitive bending of the elbow or lifting anything heavy is ill advised in the initial period after your operation and in until you have undergone successful rehabilitation, you will have to avoid activities that aggravated medial epicondylitis originally. Furthermore, you will be unable to drive until you have full and painless range of movement in your elbow.
Above: Strengthening exercises for the muscles and connective tissue around the elbowPhysiotherapy after medial epicondylitis release
After undergoing medial epicondylitis surgery it is essential to take part in a comprehensive physiotherapy course to maximise the success of the surgery, to prevent the likelihood of further problems or symptoms and to give you back full or near to full function in your elbow as soon as possible. Physio.co.uk offers a personal physiotherapy programme that focuses on returning the full range of movement, strengthening the muscles around the elbow joint and improving function within your elbow joint.
Above: Soft tissue massage and mobilisation of the connective tissues around the elbow joint.1-2 weeks
In the early stages of your recovery post medial epicondylitis surgery your physiotherapy programme with Physio.co.uk will concentrate on reducing any pain and swelling you are experiencing whilst also aiming to maintain mobility and range of movement. Your Physiotherapy will secondly focus on improving strength in your wrist, shoulder and unaffected arm for extra support for your elbow joint. Your physiotherapy will include:
- Cryotherapy (Ice)
- Pain modalities
- Elevation
- Compression
- Passive range of movement exercises - may be placed on continuous passive motion machine (CPM)
- Strengthening and stretching exercises for wrist, shoulder and unaffected arm for support
2-6 weeks
After successful rehabilitation during the early stages of your recovery, your physiotherapy will continue to control pain and swelling in and around your elbow joint whilst also gradually beginning to include more active stretching and strengthening exercises for the muscles around your elbow, wrist and shoulder. This stage of your physiotherapy may begin about 2-3 weeks after your surgery. It is important not to do too much too quickly after your medial epicondylitis surgery. These exercises work the muscles of the forearm without straining the healing tissues. Your physiotherapy will continue to include passive and active range of movement exercises to improve function within the elbow joint. Your physiotherapy at this stage will include:
- Modalities for pain control
- Cryotherapy (ice), elevation and compression
- Passive (assisted) range of movement exercises (bending, straightening, twisting)
- Gentle active (on your own) and active assisted (some assistance) range of movement exercises (bending, straightening, twisting)
- Stretches for muscles around elbow
- Gentle strengthening exercises for major muscle groups around elbow
- Strengthening and stretching exercises for wrist, shoulder and unaffected arm for support.
6-12 weeks
During the later stages of your rehabilitation with Physio.co.uk you will have seen marked improvements in range of movement, strength and function within your elbow joint. Your physiotherapy programme with Physio.co.uk will focus on maximising the mobility and range of movement in your elbow as well as increasing the strength and muscle control in the muscles around you affected elbow, wrist, shoulder and unaffected arm. Exercises will also aim to improve fine motor control and dexterity of the hand to further maximise function within your affected upper limb. Additionally, the goals of your physiotherapy with Physio.co.uk at this stage will be directed towards activities that improve your cardiovascular fitness and muscle endurance. There will also be emphasis on activities that are specific to everyday tasks and your job, hobby or sport. Your therapist will also provide you with exercises that you will be encouraged to do at home. Your physiotherapy will include:
- Continuation of modalities to control for pain and swelling (Ice, elevation, compression)
- Passive and active range of movement exercises for elbow and wrist (bending, straightening, twisting)
- Strengthening exercises for muscles around elbow joint (biceps, triceps etc)
- Hand squeezing exercises (putty/sponge)
- Upper limb mobility exercises
- Stretching exercises to increase flexibility
- Strengthening exercises for muscles in wrist, hand and shoulder
- Activities for opposite arm
- Static arm cycle
- Hydrotherapy
- Functional activities relative to job, hobby or sport
- Emphasis on independent home exercises
Summary
Medial epicondylitis release is a surgical procedure to treat problems caused by medial epicondylitis, a condition more commonly known as golfers elbow. Medial epicondylitis or golfers elbow is most commonly caused by overuse of the muscles and tendons of the forearm and elbow which causes tissue damage and inflammation within the elbow joint. Medial epicondylitis release surgery aims to remove any damaged tissues and consequently reduce inflammation. Medial epicondylitis release surgery alleviates symptoms such as pain, stiffness and reduced upper limb function that are a result of golfers elbow. Physiotherapy after medial epicondylitis release surgery is essential to maximise the success of the surgery and to achieve full or near to full function in the elbow joint. It is also necessary to undergo physiotherapy post medial epicondylitis release surgery to ensure a rapid recovery and to help prevent problems associated with golfers elbow in the future. Physio.co.uk offers a comprehensive physiotherapy course that will help you achieve all your rehabilitation goals and get you back to your everyday tasks, job, hobby or sport. Call Physio.co.uk now on 0330 088 7800 for more information or to book an appointment please contact us.
