Some aspects of “Golfer’s elbow” with homoepathic mode of treatment

Also referred to as medial tennis elbow, Golfer’s elbow is a tendinopathy of the insertion of the flexors of the fingers of the hand & the pronators.
Epitrochleitis or Golfer’s elbow is very similar to lateral epicondylitis or tennis elbow but occurs on the medial side of the elbow, where the pronator teres & the flexors of the wrist & fingers originate. Tensing of these muscles by resisted wrist & finger flexion in pronation will provoke the pain.

Sex- Golfer elbow is most common in men.

Age- 20 – 50 years of age but the condition can affect anyone who repetitively stresses the wrist or the fingers.

Risk factors-
(1) Repeated or forceful movements of the fingers, wrist & forearm which causes repetitive strain on forearm flexors.
(2) Acute trauma may also play a role.

Pathophysiology- The flexor muscles of hand, wrist & forearm on excessive strain or over-use, may become irritated, inflamed & swollen. This causes pain & tenderness at the medial epicondyle of humerus. If not arrested at this point & allowed to progress, the tendon develops small tears in it at its attachment to the humerus.

Clinical Features-
(1) The most common symptom is pain & tenderness on inner side of elbow. The pain may occasionally extend along inner side of forearm. Onset of pain is usually gradual & aggravated by using the affected muscles while grasping objects or shaking hands. Tenderness is often less well localized than in tennis elbow.
(2) There may be a feeling of stiffness of elbow.
(3) Weakness of hands & wrists may also be there.
(4) Numbness or tingling sensation radiating into usaully ring & little fingers may be present.
(5) There will be pain on resisted forearm pronation with elbow extended or pain on resisted wrist flexion & these are the tests for clinical diagnosis.

Investigations- Golfer’s elbow is usually diagnosed clinically. X-ray of elbow is often done to rule out arthritis. MRI may be advocated if clinical diagnosis is difficult to be confirmed.

Differential Diagnosis- Golfer’s elbow is usually to be differentiated from Olecranon bursitis, Elbow arthritis, Carpal tunnel syndrome.

Treatment- It is the same as for tennis elbow but the treatment is even less satisfactory.
[A] General measures to be taken are-
(1) Rest.
(2) Restriction or total stoppage of activities causing pain.
(3) Elbow braces.
(4) Stretching exercises for flexor muscles which should be started after the disappearance of the symptoms of Golfer elbow. If there is any pain during or after the exercises, it should be stopped immediately.
(5) Physiotherapy.

[B] Homeopathic medicines to be used – Homeopathy may be used effectively in the treatment of Golfer elbow. If it is supposed to be due to overuse, Bryonia should be tried. Ruta Graveolens (Ruta) & Rhus toxicodendron (Rhus tox) are the medicines most commonly used. The potency & frequency of dosage as well as duration of treatment varies with the severity of the condition & the individual. Besides these, if it is supposed to be due to any previous injury, Arnica can be very effectively used. On the other hand, if it is supposed to be due to overuse, Bryonia may be tried.

Prevention-
(1) Modification of activities or particular techniques that lead to the development of this overuse injury.
(2) Guidance of a coach for sporting activities may often be helpful.

Prognosis- Golfer elbow is usually a self-limited problem which is quite unlikely to cause any long-term health hazard. With athletes a change in technique often resolves the problem. Life style modification is to be considered if Golfer elbow does not resolve or if it recurs.

In short, Golfer’s elbow is manifested by pain & tenderness on the medial side of the elbow & is to be treated by Rhus tox, Ruta, Arnica etc.

But in every case, a doctor should be consulted.

Some aspects of “Tennis Elbow” with homoepathic mode of treatment

Also referred to as ‘Lateral epicondylitis’, Tennis elbow is an eponym given to many painful conditions about the elbow & is the pain & tenderness on the lateral side of the elbow, some well defined & some vague that results from repetitive stress. Because people who play tennis or other racquet sports sometimes develop this condition due to faulty playing technique, it is known as “tennis elbow”. Tennis elbow usually affects the dominant arm but it can also occur in the nondominant arm or both.

Seen in-
(1)All levels of tennis players in whom ‘Backhand Stroke’ appears to be the prime cause in most of the players but ‘SERVE’ also plays a role.
(2) Seen in other sports also.
(3) May be occupational etc.

Causes in tennis players-A majority of tennis players all over the world are affected with this problem over 35 years of age.
(1)Novice.
(2)Excessive playing of games per week.
(3) Age over 35 years.
(4) Equal sex incidence.
(5)Backhand stroke appears to be the cause in most of the players followed by ‘SERVE’.
But ‘Forehand stroke’, ‘Backhand volley’, ‘Overhead smash’, or ‘Forehand volley’ may play a role.

Contributing factors in tennis players-
(1) Little playing experience.
(2) Consistent missing of ‘sweet spot’ while hitting.
(3) Poor stroke techniques: use of arm instead of body.
(4)Poor power or flexibility.
(5)Heavy stiff racket, large handle size, too tight racket stringing.
(6)Heavy duty wet balls.
(7)Playing surface-balls bounce quicker off the cement court (quicker bouncing like Playing surface).

Sex-It affects men more than women.

Age-It affects people between ages of 30 & 50, although people of any age can get it.

Site of lesion-Lateral tennis elbow involves the common tendon to the extensor muscles of the wrist & hand. The tendon of the extensor carpi radialis brevis has been identified as the most common site of the lesion.

Clinical Features-
Symptoms-At the very beginning due to acute inflammation, the patient complains of pain during activity. The pain is very soon felt both during activity & at rest due to chronic inflammation. Ultimately the patient complains pain at rest, & pain during daily activities & even night pains.

Signs-
(1) Local tenderness over the lateral humeral epicondyle at the common extensor origin with aching pain in the back of the forearm.
(2) Extension of the wrist against resistance with elbow in full extension elicits pain at the outside of the elbow.
(3) Passive wrist flexion & pronation with elbow in extension produces pain.

Investigations- Tennis elbow cannot be diagnosed from blood tests. Radiographs only rarely reveal soft tissue calcification near the lateral humeral epicondyle, & MRI is of questionable aid in making the diagnosis. It is rather usually diagnosed by description of pain & certain findings from physical exam. However, MRI has been shown to be helpful in diagnosing cases of early Tennis elbow.

Differential Diagnosis- Other causes for lateral elbow pain should be considered, including radiocapitellar arthritis & posterior interosseous nerve compression,elbow arthritis, radial tunnel syndrome etc.

Treatment-
[A] General measures to be taken are-
(1) Rest.
(2) Restriction or total stoppage of activities causing pain.
(3) Avoidance of lifting of heavy items especially with palm facing downwards.
(4) Wrapping of a band around forearm near the elbow.
(5) Wearing of a wrist splint.
(6) Exercises to stretch & strength the wrist extensor muscles. But exercise should be started when healing has occurred to the level that the exercises do not increase pain.
(7) Physiotherapy.
(8)In tennis players exercises, light racket, smaller grip, elbow strap etc are helpful.

[B] Homeopathic medicines to be used – Homeopathy plays a vital role in treatment of Tennis elbow. Constitutional treatment is essential specific remedies include Ruta Graveolens (Ruta) & Rhus toxicodendron (Rhus tox). If it is due to any previous injury, Arnica can be very effectively used. If it is supposed to be due to overuse, Bryonia should be tried.

Prevention-
(1) Correct technique of play to be adopted, backhand stroke to be played with whole body & not just with the wrist.
(2) Use of a forearm brace wrist or elbow is weak.
(3) Wet, heavy balls should always be avoided.
(4) Use of a light racket in case of an occasional player.
(5) Strings should not be too tight.
(6) Activities requiring repetitive wrist & forearm motion should be avoided.
(7) Change in size or type of tennis racquet or tool may be helpful.
(8) Change of occupation to prevent further injury may also help in some cases.

In short, Tennis elbow is manifested pain & tenderness on the lateral side of the elbow & is to be treated by Rhus tox, Ruta, Arnica etc.

But in every case, a doctor should be consulted.