Is "golfers elbow" not a correct diagnosis?

There are 4 or 5 muscles that originate from the medial epicondyl, each with their own independent tendon. The pronator teres controls twisting your palm down or like turning a door knob. Swinging a golf club uses this a lot, but does climbing? 

Meanwhile climbing uses these muscles, all of which attach to the medial epicondyl:

• Flexor Carpi Radialis (FCR): Flexes the wrist and deviates it radially (thumb side).

• Flexor Carpi Ulnaris (FCU): Flexes the wrist and deviates it ulnarly (pinky side).

• Flexor Digitorum Superficialis (FDS): Flexes the fingers and contributes to wrist flexion.

Doesn't it seem like we should be differentiating between these various attachment tendons in order to target our epicondylitis PT effectively?

I can imagine people with FDS medial epicondylitis after landing a hard dyno in 3 finger drag. 

People with FCR and FCU medial epicondylitis might have climbed a slappy boulder problem on lots of slopers.

Meanwhile some golfer out there can't hold a frying pan because he's got pronators teres medial epicondylitis.

Aren't these all different?

For those who need a more visual explanation of the different muscles and motions:
Pronator Teres
Flexor Carpi Radialis
Flexor Carpi Ulnaris
Flexor Digitorum Superficialis

You do see 2 totally different exercises recommended, but you're right that it's basically never spelled out which does what.

https://theclimbingdoctor.com/portfolio-items/medial-epicondylosis-golfers-elbow/ (twisting exercises for pronator teres)
https://www.ncbi.nlm.nih.gov/books/NBK507006/ ("square" wrist/finger curl type exercises for the other 3)

I think the Pronator Teres is used every time you lock off. I almost collapsed when a PT tested it on me. I had actually thought it was fine since the normal "frying pan" type exercises were no problem, but in reality I was completely compensating around it.

Following this with interest as I currently have light symptoms of “golfer’s elbow”, and at age 66 don’t want it to get worse. I’m trying some exercises and stretching at the moment… will be checking out your link, Austin. Thanks. 

These muscles do not have their own independent tendons attaching to the medial epicondyle. Their myotendinous junctions all combine proximally to attach at the humerus, as the common flexor tendon. 

A person’s injury will be specific to their overuse mechanism (repetitive pronation vs repetitive flexion and wrist deviation), meaning that reproduction of symptoms and rehab will be somewhat unique to each patient. However, unless the injury occurred further away in the contractile muscle bellies (which is a separate injury type), you would not be accurate in diagnosing an epicondylitis of any specific muscle of the medial epicondyle. 

Thanks for the correction. Seems I was mistaken.

sometimes climbers think of golfer's elbow, when they are actually suffering from cubital tunnel syndrome

Austin Donisan wrote:

I think the Pronator Teres is used every time you lock off. I almost collapsed when a PT tested it on me. I had actually thought it was fine since the normal "frying pan" type exercises were no problem, but in reality I was completely compensating around it.

To the OP's point-  I have been dealing with medial epicondylitis for a few months now and it's been a frustratingly slow progression of healing, partly because I don't feel like my PT exercises are specifically targeted to my particular injury.  Austin, I am curious how your PT tested your pronator teres?

My treatment exercises so far consist of light weight/high rep wrist curls and extensions, as well as slightly heaver weight eccentric wrist curls. I've also mixed in some eccentric wrist pronation/supination with a hammer, and some shoulder stability stuff for good measure (IYT, external rotations). Plus stretching and massaging (Armaid).  Avoiding hard climbing.  I feel like it's a shotgun approach, I do wish I had more clear direction on what exactly I should be focusing on!

Clayton, I’m not sure exactly what I had—originally thought it was golfer’s elbow based on symptoms, but then I read what others have posted above. Anyway, I basically have been doing what you outlined in your second paragraph for the past 6-8 weeks (with no climbing, but some mountain biking) and I feel SO much better, maybe even cured?

I have definitely noticed that I feel much better with my body—it just feels “tighter”—if I maintain a regular program of low weight, high rep weight work with arms, shoulders, and core, as well as consistent stretching of arms, shoulders, hips, and legs. I really need to stay disciplined with this and try to get in 1-2 weight/stretching sessions a week. I think it really makes my climbing feel so much better. My “climber’s elbow”, or whatever it was, came about during a period when I was not doing any stretching or weight work, and I was hitting the rock gym 4-5 times a week and constantly trying hard (for me) stuff.

I think I need to keep my muscles “in balance”.

Another thing I read somewhere… that the quickest way for your average climber to move up a grade or two is to improve flexibility. 

I had a bad case of "climbers elbow" in 1970 that kept me off the rock for almost a year. I called it that at the time. 

(I finally ended up following Bonnie Prudden's advice and deep messaging the area below the attachment, and then gradually stretching that tissue by pressing on my hand at right angles. Never a problem after that as long as I did the stretching after workouts or climbs)

John, it's awesome hearing you weigh in on various topics here. I had a similar experience, massage and stretching with slow improvement over six months.

I'm curious if people get this more frequently with their dominant arm, or what other factors have led to the problem? I'm now having my second flare of tendonitis in the right elbow, both times caused by periods of high volumes of work with hand tools - route development, home projects, gym setting - combined with climbing/not stretching the forearms. Pain is most noticeable when I'm warming up and not bad once I get into a session.

Kevin - I've had a lot of issues with recurring medial epicondylitis - I believe you're in the early stages (pain warming up then it feels fine). You'll want to be sure to tackle the issue now before it becomes a more chronic problem.  Identifying a route cause can be difficult often times can come from issues at the wrist or shoulder.  

Any sudden increases in usage/strain can piss off your tendons., which it sounds like you're dealing with now.  Aside from making sure all your non-elbow connections are happy and firing as they should, I've had the most luck with isometric holds for calming things down.

When my elbow is particularly angry I'm doing :40-:50 second wrist curl holds with a weight that's challenging but not painful, 4-6 sets with 1-2 min rest in between, 2-3x per day.  Also doing static holds with a tension block (half crimp or 3 finger drag) with a weight I can comfortably hold for the same time period as the wrist curls. 

When things start to feel better I do slow pullup negatives or :30 second hangs from a pullup bar with elbows at 90 degrees.

Staying consistent with these things is the biggest challenge.  Biggest takeaway is that tendons hate rest, if you just rest, you can take months off and come right back to the same pain.  As long as you can do the light PT without causing pain need to be working to strengthen and remodeling the tendon to make progress.

I'm not sure it matters. A good rehab or prehab program will target the full range of muscles/tendons around the elbow for strengthening and support, regardless of which particular one is injured. I do full ROM wrist curls, Full ROM wrist extensions, Full ROM wrist rotations, banded "no-moneys", bicep curls, and tricep extensions. Workout takes about 40 mins. If that doesn't fix up your elbows when paired with a high animal protein diet, nothing will.

Pain around the medial side of the elbow could be related to the insertion of the common flexor tendon, or one or some of the muscles attaching to it - as the OP suggests - , or the medial collateral ligament, or irritation of the ulnar nerve, or referred pain from the neck area. There are probably other possibilities. 

The inference of the OP is that "golfer's elbow" could be due to several different pathologies and so have several different optimum management approaches. This is true but there is more to this than just different muscle-tendons. 

Eric Marx wrote:

I'm not sure it matters. A good rehab or prehab program will target the full range of muscles/tendons around the elbow for strengthening and support, regardless of which particular one is injured. I do full ROM wrist curls, Full ROM wrist extensions, Full ROM wrist rotations, banded "no-moneys", bicep curls, and tricep extensions. Workout takes about 40 mins. If that doesn't fix up your elbows when paired with a high animal protein diet, nothing will.

That much full ROM work can make an already tendinotic elbow much worse.

Has only helped mine whenever I moonboard 4x a week and it flares up. The exercises should be performed with an amount of weight that gives you a 2/10 on a pain scale, increasing as tolerated.