Golfer's elbow, is a tendinopathy of the medial epicondyle of the elbow. It is in some ways similar to tennis elbow. In former time the condition was usually named medial epicondiylitis. However, the pathology is no longer thought to be inflammatory. Nowadays the accurate description would be "partially reversible but degenerative overuse-underuse tendinopathy". Because of the complexity of this description, the term " Golfer's elbow " is usually used.
The anterior forearm contains several muscles that are involved with flexing the digits of the hand, and flexing and pronating the wrist. The tendons of these muscles come together in a common tendinous sheath, which originates from the medial epicondyle of the humerus at the elbow joint. In response to minor injury, or sometimes for no obvious reason at all, this point of insertion becomes inflamed.
The initial treatment should be conservative including rest, physiotherapy, and nonsteroidal anti-inflammatory drugs. As in the case of chronic Achilles tendinopathy and chronic plantar fasciopathy, eccentric (lengthening only) exercises have become the mainstay of rehabilitation programs for tennis elbow. An attractive alternative is radial shock wave therapy (RSWT). In most circumstances, cortisone injections should not be used.
This is due to the fact that cortisone leads to very good results in the short term (six weeks) but has been demonstrated to be harmful in the longer term (more than three months). Surgery should be considered when conservative treatment fails.
Locate the area of pain through palpation and biofeedback.
Mark the area of pain.
3. APPLY GEL
Apply coupling gel to transmit shock waves to the tissue.
4. APPLY SHOCK WAVES
Deliver Radial or Focused Shock Waves to the area of pain while keeping the applicator firmly in place on the skin.
|Number of treatment sessions||3 to 5||3 to 5|
|Interval between two sessions||1 week||1 week|
|Air pressure Evo Blue®||1.5 to 3 bar||3 to 4 bar|
|Air pressure Power+||Not recommended||Not recommended|
|Impulses||2000 on the painful spot||2000|
|Frequency||8Hz to 12Hz||12Hz to 20Hz|
|Skin pressure||Light||Light to moderate|
Spacca G, Necozione S, Cacchio A.
Radial shock Wave therapy for lateral epicondylitis. A prospective randomised controlled single-blind study. Eura Medicorphys 2005; 41:17-25
Die radiale Stosswellentherapie bei der Epikondylitis humeri radialis – kurz- und mittelfristige Ergebniss. In: Maier M, Gillesberger F: Abstracts 2003 zur Muskuloskelettalen Stosswellentherapie. Norderstedt 2003; 121-122
Krischnek O, Hopf C, Nate b, et al.
Shock Wave therapy for tennis and golfers’s elbow – 1 year follow up. Arch Orthop Trauma Surg 1999; 62-66
Side effects of Radial Shock Wave Therapy (RSWT®) using the Swiss DolorClast®
When performed properly, RSWT® with the Swiss DolorClast® has only minimal risks.
Typical device-related nonserious adverse events are:
- Pain and discomfort during and after treatment (anesthesia is not necessary)
- Reddening of the skin
- Swelling and numbness of the skin over the treatment area
These device-related nonserious adverse events usually disappear within 36h after the treatment.
Accordingly the following contraindications of RSWT using the Swiss DolorClast® must be considered:
- Treatment over air-filled tissue (lung, gut)
- Treatment of pre-ruptured tendons
- Treatment of pregnant women
- Treatment of patients under the age of 18 years (except for Osgood-Schlatter disease and muscular dysfunction in children with spastic movement disorders)
- Treatment of patients with blood-clotting disorders (including local thrombosis)
- Treatment of patients treated with oral anticoagulants
- Treatment of tissue with local tumors or local bacterial and/or viral infections
- Treatment of patients treated with cortisone.