高尔夫球肘特殊检查

Title: A Comprehensive Guide to Golfers Elbow Examination

Introduction:

Golfer's elbow, or medial epicondylitis, is a common condition among golfers and individuals who perform repetitive gripping activities. Proper examination is crucial for accurate diagnosis and effective management. In this guide, we will delve into the detailed examination of golfer's elbow, covering relevant tests and assessments.

1. Patient History:

Begin by obtaining a thorough patient history, including:

Onset of symptoms: When did the pain start? Was it sudden or gradual?

Nature of pain: Is it sharp, dull, or aching? Does it radiate to other areas?

Aggravating factors: What activities worsen the pain? Is it exacerbated by gripping or lifting?

Previous treatments: Have they tried any treatments before? If so, what was the response?

Occupation and hobbies: Apart from golfing, are there any other activities that involve repetitive wrist or elbow movements?

2. Physical Examination:

Perform a systematic examination focusing on the affected elbow and surrounding structures:

Inspection: Look for any signs of swelling, redness, or deformity around the medial epicondyle.

Palpation: Palpate the medial epicondyle and surrounding muscles for tenderness and swelling.

Range of motion (ROM): Assess active and passive ROM of the elbow, wrist, and forearm.

Strength testing: Evaluate grip strength and resistance to wrist flexion, pronation, and forearm supination.

Special tests:

Golfer's elbow test: Have the patient flex the wrist against resistance while stabilizing the elbow in extension.

Cozen's test: Resistive wrist extension with the elbow extended and forearm pronated.

Mill's test: Passive wrist flexion with the elbow extended and forearm pronated.

Tinel's sign: Tapping over the medial epicondyle to elicit tingling or pain along the ulnar nerve distribution.

3. Neurological Examination:

Assess the integrity of the ulnar nerve, which may be affected in cases of golfer's elbow:

Sensory examination: Test sensation over the ulnar nerve distribution, including the medial forearm and fourth and fifth digits.

Motor examination: Evaluate muscle strength of intrinsic hand muscles innervated by the ulnar nerve.

Reflex testing: Check for any abnormalities in the ulnar nerve reflex, though this is less commonly affected in golfer's elbow.

4. Imaging Studies:

While not always necessary for diagnosis, imaging studies can help confirm the diagnosis and rule out other pathologies:

Xray: To assess for bony abnormalities, such as osteophytes or calcification around the medial epicondyle.

Ultrasound: Useful for visualizing soft tissue changes, such as tendon thickening or tears.

MRI: Provides detailed imaging of soft tissue structures and can identify tendon degeneration or inflammation.

5. Differential Diagnosis:

Consider other conditions that may present with similar symptoms, such as:

Medial epicondyle fracture

Ulnar collateral ligament injury

Cubital tunnel syndrome

Radial tunnel syndrome

Pronator teres syndrome

Conclusion:

A comprehensive examination is essential for diagnosing golfer's elbow and guiding appropriate treatment. By combining patient history, physical examination, neurological assessment, and imaging studies, healthcare providers can accurately diagnose golfer's elbow and develop an effective management plan tailored to the individual patient.

References:

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Boyer, M. I., Hastings, H., & Lateral Epicondylitis Study Group. (1999). Lateral tennis elbow: "Is there any science out there?". The Journal of hand surgery, 24(5), 799807.

Nirschl, R. P., & Ashman, E. S. (2003). Elbow tendinopathy: tennis elbow. Clinics in sports medicine, 22(4), 813836.

Zeisig, E., Ohberg, L., Alfredson, H., & Painful conditions in the Achilles tendon and around the heel. (2006). Painful conditions in the Achilles tendon and around the heel. British journal of sports medicine, 40(3), 226230.