Golfer’s Elbow Test

Golfer’s Elbow Test (or Medial Epicondylitis Test) is used for Medial Epicondylitis of the elbow joint or Golfer’s Elbow.

How Golfers Elbow Test is Performed?

• The patient can be seated or standing for this test.
• The patient flexes the elbow and hand.
• The examiner grasps the patient’s hand and immobilizes the patient’s upper arm with the other hand.
• The patient is then requested to extend the elbow against the resistance of the examiner’s hand.

See Also: Medial Epicondylitis (Golfer's Elbow)

What does a positive Golfer’s Elbow Test mean?

If sudden pain or discomfort is reproduced along the medial aspect of the elbow in the region of the medial epicondyle, then the Golfers Elbow Test is considered positive.

See Also: Maudsley Test

Medial Epicondylitis (Golfer’s Elbow):

Medial epicondylitis is only one-third as common as lateral epicondylitis. It primarily involves a tendinopathy of the common flexor origin, specifically the flexor carpi radialis (FCR) and the humeral head of the pronator teres. To a lesser extent, the palmaris longus, flexor carpi ulnaris (FCU), and flexor digitorum superficialis (FDS) may also be involved.

The mechanism for medial epicondylitis is not usually related to direct trauma, but rather to overuse. This commonly occurs for three reasons:

1. Fatigue of the flexor–pronator tissues in response to repeated stress.
2. A predisposition for medial ligamentous injury due to a sudden change in the levels of stress.
3. The MCL fails to sufficiently stabilize against the valgus forces.

Medial epicondylitis usually begins as a microtear at the interface between the pronator teres and FCR origins with subsequent development of fibrotic and inflammatory granulation tissue. An inflammation develops in an attempt to speed up tissue production to compensate for the increased rate of microdamage caused by increased use and decreased recovery time.

Chronic symptoms result from a loss of extensibility of the tissues, leaving the tendon unable to cope effectively against tensile loads.

Clinical Presentation:

The typical clinical presentation for medial epicondylitis is pain and tenderness over the flexor pronator origin, slightly distal and anterior to the medial epicondyle. The symptoms are typically reported to be exacerbated with either resisted wrist flexion and pronation or passive wrist extension and supination.

Differential diagnosis for medial elbow symptoms includes:

1. MCL injury or insufficiency.
2. Ulnar nerve entrapment.
3. Medial elbow intra-articular pathology.

Intervention:

Conservative intervention for medial epicondylitis has been shown to have success rates as high as 90%.

The conservative intervention for this condition initially involves rest, activity modification, and local modalities.
Complete immobilization is usually not recommended as it eliminates the stresses necessary for maturation of new collagen tissue.

Once the acute phase has passed, the focus switches to restoring range of motion and correcting any imbalances of flexibility and strength. The strengthening program initially includes multi-angle isometrics, and then concentric and eccentric exercises of the flexor–pronator muscles. Splinting or the use of a counterforce brace may be a useful adjunct.

Reference

1. Kiel J, Kaiser K. Golfers Elbow. [Updated 2021 Jul 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519000/
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