with Michael Racca, PT, MSPT, CEAS
Tennis Elbow, orLateral Epicondylitis,is soreness or pain from inflammation or injury to the outside elbow. This is the point where the tendon attaches the wrist extensor muscles to the lateral bone of the elbow.
Golfer’s Elbow, or Medial Epicondylitisis soreness or pain from inflammation or injury to the inside elbow. This is the point where the tendon attaches the wrist flexor muscles to the medial bone of the elbow.
Pain may indicate damage of the tendon fibers which connect the wrist muscles to bone, but symptoms may not be limited to the elbow and can radiate down into the hand. Although these symptoms were originally thought to be the result of inflammation and considered to be tendinitis, studies have shown they are more likely tendinosis or tendinopathies because the tendon has tears and has degenerated or frayed.
Tendinitis is an inflammatory acute process, whereas tendinosis or tendinopathy is a more chronic injury to the tendon.
What causes these conditions and who is at risk?
Repetitive stress causes small tears in the tendon attachment to the elbow. Excessive force or load on the tendon can also cause injury. The elbow joint can become compressed, restricted, or deviated, placing the elbow at higher risk for symptoms and injury due to faulty elbow mechanics. It can remain in this dysfunctional state until corrected manually, followed by joint and muscle re-education to maintain efficient alignment.
Tennis elbow is common in people who play racquet sports because of faulty mechanics commonly found in the backhand swing. Any activity that involves repetitive twisting or wrist turning like using a screwdriver can lead to this condition.
Golfer’s elbow is caused by overusing the wrist flexor muscles in the forearm that rotate the arm and flex the wrist. Repetitive flexing and gripping like swinging a golf club can cause symptoms in the medial elbow. Throwing athletes, especially Pitchers, repeatedly use the motions that commonly produce medial elbow symptoms.
Jobs or tasks requiring repetitive upper extremity motions can also lead to either of these conditions. Even daily computer use with a faulty workstation set-up causes poor posture and increases the risk of these conditions. *Research has shown a higher prevalence of cervical and thoracic spine pain (C2-T7) in persons with lateral elbow pain. Therefore, the cervical and thoracic spine should also be assessed in patients with lateral elbow pain.
Signs and Symptoms include elbow pain that gradually gets worse, does not go away, and can be reproduced with wrist and forearm motions. Turning a door knob, gripping, and grip strength can also be weak or painful.
Because this is a soft tissue condition, x-rays are usually normal and a diagnosis is typically made based on pain or tenderness when the tendon is pressed near it’s elbow attachment. Pain will also be produced with resisted wrist flexion or extension.
How is it treated?
The poor vascularity of tendons makes this a difficult and sometimes lengthy problem to treat. Rest and avoiding activities and motions that reproduce symptoms is needed. Cold packs or ice massage to the area can help reduce pain and existing inflammation. If symptoms were caused by sports or job related activity, changes in posture and technique are necessary before resuming those activities. A properly placed “tennis elbow” strap that wraps around the forearm can help alleviate some of the pressure from the insertion of the tendon with activity. If symptoms are related to working on the computer, assess and make changes to home or office workstations immediately or the dysfunction will persist and undermine recovery.
Most people improve with nonsurgical treatment and cortisone injections are no longer the treatment of choice for this condition. Treatments options to promote tendon healing include PRP injection, acupuncture, and massage. If pain persists, an MRI may be indicated to determine the extent of tendon damage and surgery may be recommended. Surgery is not usually prescribed unless symptoms have not improved.
A Physical Therapist can supervise even the early stages of your recovery and restore efficient elbow joint function through manual therapy. Eccentric wrist flexion and extension exercises are utilized for both treatment and prevention. A healthy elbow also requires efficient posture and function of the shoulder and wrist joints, and stability around the scapula to decrease the load on the elbow joint. Treatment of the cervical and thoracic spine may also be needed.
Always remember that your healthcare provider is the best source of information for questions and concerns related to your medical problem.