The Biomechanics of Golfer’s and Tennis Elbow Golfer’s elbow and tennis elbow are both musculoskeletal pathologies that are hallmarked by elbow pain, hence their names. However, even though these conditions cause elbow pain, they are not conditions of the actual elbow joint; rather, they are overuse syndromes of musculature of the hand and/or the fingers. Pain is experienced at the elbow because these muscles have their proximal tendinous attachments there. 56 massage & bodywork january/february 2020 By Joseph E. Muscolino, DC Take 5 and try ABMP Five-Minute Muscles at www.abmp.com/five-minute-muscles. 57 Anterior view of the right upper extremity. Golfer’s elbow causes pain at the medial 1 elbow. The muscles of golfer’s elbow common fl exor belly/tendon group are noted in red. Permission Joseph E. Muscolino, The Muscular System Manual, 4th edition, Elsevier, 2015. BIOMECHANICS Biceps brachii The biomechanics of golfer’s and tennis elbow can be nicely compared and contrasted because they are extremely Brachialis similar, although they are somewhat mirror opposites of each other. The Triceps brachii muscles of golfer’s elbow have their proximal attachments on the medial Medial epicondyle epicondyle of the humerus, so golfer’s of humerus elbow causes medial elbow pain; the muscles of tennis elbow attach onto the Pronator teres lateral epicondyle of the humerus, so Brachioradialis tennis elbow causes lateral elbow pain. Golfer’s elbow is an overuse condition Flexor carpi radialis of excessive fl exion of the hand at the Wrist flexor wrist joint and fl exion of the fi ngers at Palmaris longus group the metacarpophalangeal (MCP) and Flexor carpi ulnaris interphalangeal (IP) joints, resulting in overuse of the anterior fl exor compartment of the forearm musculature. In contrast, tennis elbow is primarily an overuse Flexor digitorum superficialis syndrome of excessive extension of the hand at the wrist joint and extension of the Extensor carpi fi ngers at the MCP and IP joints, resulting radialis longus in overuse of the posterior extensor compartment of the forearm musculature. Flexor pollicis longus GOLFER’S ELBOW Abductor Flexor digitorum profundus Golfer’s elbow involves fi ve muscles that pollicis longus all attach to the medial epicondyle of the humerus and along the medial supracondylar Pronator ridge of the humerus. These fi ve muscles are quadratus the pronator teres, the three muscles of the Palmar carpal ligament wrist fl exor group (the fl exor carpi radialis, Radial palmaris longus, and fl exor carpi ulnaris), styloid Transverse carpal ligament (flexor retinaculum) and the fl exor digitorum superfi cialis (Image 1). These muscles attach to the medial epicondyle via what is known as the common Flexor digitorum superficialis fl exor tendon because the proximal tendons of these muscles blend into each other. Flexor digitorum profundus Perhaps a better name might be the common fl exor belly/tendon because their bellies blend Flexor pollicis together before their tendons merge. longus As the name common fl exor implies, these muscles are involved with fl exion. The three muscles of the wrist fl exor group all cross the wrist joint anteriorly, so they fl ex the hand at the wrist joint. The fl exor digitorum superfi cialis crosses the 58 massage & bodywork january/february 2020 Posterior view of the right upper extremity. Tennis elbow causes pain at the lateral elbow. 2 The muscles of tennis elbow common extensor belly/tendon group are noted in red. Permission Joseph E. Muscolino, The Muscular System Manual, 4th edition, Elsevier, 2015. Triceps brachii Brachioradialis Elbow Pains by Different Names Medial epicondyle of humerus Lateral epicondyle of humerus Golfer’s and tennis elbow have classically been described as medial epicondylitis and Olecranon process lateral epicondylitis, respectively, because of the ulna Extensor carpi radialis pain experienced with these conditions longus (ECRL) is usually situated at, or near, the medial or lateral epicondyle of the humerus. Anconeus Extensor carpi radialis Pain from tennis elbow occurs primarily brevis (ECRB) at the lateral epicondyle because backhand strokes require wrist joint extension. This Flexor carpi Extensor digitorum ulnaris extension stresses the musculature of the Extensor digiti minimi common extensor belly/tendon that attaches at the lateral epicondyle of the elbow. Pain from golfer’s elbow occurs Extensor carpi ulnaris primarily at the medial epicondyle because gripping and swinging a golf club (and a forehand stroke in tennis) requires wrist and fi nger joint fl exion. This fl exion stresses the musculature of the common Abductor pollicis longus fl exor belly/tendon that attaches at the medial epicondyle of the humerus. Extensor pollicis brevis Because infl ammation often accompanies these conditions, the suffi x itis is part of Extensor pollicis longus the names. However, in recent years, it has become understood that the infl ammation Extensor indicis is often only present when the condition is ECRL tendon acute. When the condition becomes chronic, the infl ammation recedes or disappears; ECRB tendon therefore, the more general terms medial epicondylosis and lateral epicondylosis are applied instead. The suffi x osis simply means condition of and does not imply infl ammation. New terms have recently gained favor, including medial elbow tendinopathy for golfer’s elbow and lateral elbow tendinopathy for tennis elbow. These terms are likely better because they capture both the acute infl amed phase and the chronic noninfl amed phase. Take 5 and try ABMP Five-Minute Muscles at www.abmp.com/five-minute-muscles. 59 .