Prolotherapy For Golfing Injuries And Pain (P3)

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Elbow Injuries

Medial elbow pain, known as medial epicondylitis, has historically been referred to as “golfers elbow.” However, lateral elbow pain was found to be more common in the amateur golfer by a 5:1 ratio by one investigator. Other investigators found the occurrence to be equal. Both medial and lateral elbow pain is thought to occur as a result of poor swing mechanics, and are much more common in amateurs, with one study showing 25% of amateurs and 4% of professionals complaining of this problem. Medial injuries are thought to occur as a result of hitting shots “fat” (hitting the ground first), or sudden impact loading such as can occur by taking repetitive strokes that leave large divots. Lateral injury occurs with over-swinging with the right hand (in right handed golfers), and repetitive forceful extension of the forearm accompanied by a twisting motion, especially if associated with excessive gripping of the golf club. Both of these problems increase with age and frequency of play.There are ligamentous and tendinous complexes on both the medial and lateral aspects of the elbow. The medial aspect of the elbow is stabilized by the ulnar collateral ligament, while the lateral side is stabilized by the radial collateral and annual ligaments (see Figure 4). The extensor tendons attach at the lateral epicondyle while the flexor tendons attach medially. Prolotherapy is an effective treatment for these ligamentous and tendonous injuries, as long as there is not a complete rupture present. In the case of a complete rupture, surgery may be needed, however this is much less common than tendonitis, tendonosis, or ligamentous sprain.

Elbow Injuries
FIGURE 4. Ligaments and tendons of the elbow. Force exerted on the elbow can injure ligamentous or tendonous structures.

Shoulder Injuries

The shoulder is another common area of injury for the golfer, with the lead shoulder (left shoulder in the right handed golfer) particularly vulnerable to injury. Understanding the biomechanics of the golf swing is especially helpful in diagnosis of shoulder injuries and sometimes modifications to the swing can be helpful in preventing further injury.66 Symptoms of shoulder pain or instability usually occur at the extreme of range of motion (top of backswing or end of followthrough). Those with rotator cuff disease may display weakness during initial takeaway, leading to poor swing mechanics. Rotator cuff disease and subacromial impingement involving the lead shoulder are among the most common problems in golfers. Acromioclavicular joint disease is another common problem affecting this population. With acromiclavicular problems, symptoms will usually be experienced at the top of the backswing.

Shoulder Injuries
FIGURE 5. Glenohumeral ligament instability leading to impingement syndrome.

Glenohumeral Instability. The glenohumeral ligament is a stabilizing ligament of the anterior portion of the shoulder and is important in the overhead portion of the golf swing. Injury to this ligament— specifically the superior band—predisposes the shoulder to instability. In order to generate power during the swing, golfers attempt to maximize their shoulder turn relative to their hip turn. Unfortunately this degree of shoulder rotation done repetitively can create microtrauma on capsular and labral structures, affecting the glenohumeral joint ligaments, and creating laxity and instability. The patient will complain of pain and instability at the top of the backswing.

Glenohumeral Instability
FIGURE 6. Hauser Thumbs-Down Test: A person with early impingement of the rotator cuff will not be able to hold this position without experiencing shoulder pain and weakness.

Instability of the glenohumeral ligament then leads to rotator cuff injury and subsequent impingement syndrome (see Figure 5). A simple test for early impingement syndrome is the “Hauser Thumbs Down”test. The person holds their arms at 90 degrees to the body with the thumbs pointed down to the ground for 2 minutes. A sensation of a definite weakening or pain in the shoulder is a positive sign (see Figure 6). A positive test means that prolotherapy should be considered to correct existing weakness and prevent further damage to the glenoid labrum.

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