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. 2011 Dec;55(4):325-32.

Lateral epicondylosis and calcific tendonitis in a golfer: a case report and literature review

Erik A Yuill  1 , Grant Lum
Affiliations

Lateral epicondylosis and calcific tendonitis in a golfer: a case report and literature review

Erik A Yuill et al. J Can Chiropr Assoc. 2011 Dec.

Abstract
in English, French

Objective: To detail the progress of a young female amateur golfer who developed chronic left arm pain while playing golf 8 months prior to her first treatment visit.

Clinical features: Findings included pain slightly distal to the lateral epicondyle of the elbow, decreased grip strength, and positive orthopedic testing. Diagnostic ultrasound showed thickening of the common extensor tendon origin indicating lateral epicondylosis. Radiographs revealed an oval shaped calcified density in the soft tissue adjacent to the lateral humeral epicondyle, indicating calcific tendonitis of the common extensor tendon origin.

Intervention and outcome: Conventional care was aimed at decreasing the repetitive load on the common extensor tendon, specifically the extensor carpi radialis brevis. Soft tissue techniques, exercises and stretches, and an elbow brace helped to reduce repetitive strain. Outcome measures included subjective pain ratings, and follow up imaging 10 weeks after treatment began.

Conclusion: A young female amateur golfer with chronic arm pain diagnosed as lateral epicondylosis and calcific tendonitis was relieved of her pain after 7 treatments over 10 weeks of soft tissue and physical therapy focusing specifically on optimal healing and decreasing the repetitive load on the extensor carpi radialis brevis.

Objectif: exprimer en détail la progression d’une jeune golfeuse de calibre amateur qui a développé une douleur chronique au bras gauche en jouant au golf 8 mois avant son premier traitement.

Caractéristiques cliniques: douleur légèrement distale à l’épicondyle latérale du coude, prise plus faible et test orthopédique positif. L’ultrason diagnostic a démontré l’épaississement du tendon extenseur commun, ce qui indique une épicondylose latérale. Les radiographies ont révélé une densité calcifiée de forme ovale dans les parties molles adjacentes à l’épicondyle humérale latérale, ce qui indique une tendinite du tendon extenseur commun.

Intervention et résultat: les soins conventionnels visaient à diminuer la charge répétitive sur le tendon extenseur commun, particulièrement le muscle court extenseur radial du carpe. Les techniques des parties molles, les exercices et les étirements, ainsi qu’un support de coude ont contribué à réduire la tension répétitive. Les niveaux de douleur subjectifs ont été établis, et une imagerie a eu lieu 10 semaines après le début du traitement.

Conclusion: une jeune golfeuse de calibre amateur souffrant d’une douleur chronique au bras a reçu un diagnostic d’épicondylose latérale et de tendinite calcifiante et fut guérie de sa douleur après 7 traitements répartis sur une période de 10 semaines de thérapie physique et des parties molles axée sur la guérison optimale et la réduction de la charge répétitive sur le muscle court extenseur radial du carpe.

Keywords: calcific tendonitis; epicondylosis; golf.

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Figures

Figure 1
Figure 1
Imaging results for the patients left elbow. A) Diagnostic ultrasound showing thickening of the origin of the common extensor tendon, indicating lateral epicondylosis. B) Anterior to posterior radiograph showing an oval shaped calcified density in the soft tissue adjacent to the lateral humeral epicondyle, indicating calcific tendinosis.
Figure 2
Figure 2
The most common mechanism for lateral epicondylosis is caused by repetitive eccentric contraction of the extensor carpiradialisbrevis (ECRB) muscle. This causes microtears within the common extensor tendon origin. A) ECRB muscle at proximal lateral epicondyle attachment. B) ECRB muscle with overlying posterior interosseous nerve. (Image courtesy and copyright Primal Pictures www.anatomy.tv)
See this image and copyright information in PMC

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