What is Tennis and Golfer’s Elbow?
Tennis Elbow, or Lateral 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 Epicondylitis is 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.
Because pain in either of these areas may indicate damage and tearing of these tendon fibers which connect a group of wrist muscles to bone, 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 in the tendinitis family, studies have shown that they are more likely tendinosis or tendinopathies because the tendon has tears and has degenerated or frayed.
In a roundtable discussion of the American Academy of Orthopaedic Surgeons, Dr. James Andrews reports: Tendinitis, tendinosis, and tendinopathy are often used interchangeably by patients and physicians alike, but they do indeed have different pathologies. Tendinitis is an inflammatory acute process, whereas tendinosis or tendinopathy is more of a chronic injury to the tendon. The treatment of tendinosis initially should be multimodal. Physical therapy, anti-inflammatory medications, PRP, rest, ice, and even a short period of immobilization can be used together to help relieve symptoms. The poor vascularity of tendons makes this a difficult and sometimes lengthy problem to treat. We trust our well-trained therapists with implementing the program.
What causes these conditions and who is at risk?
Because tendon attaches muscle to bone, with repetitive stress and strain small tears can develop in the tendon attachment to the bony prominence on the inside or outside of the elbow. This can also occur with an injury due to excessive force or load on the tendon. The elbow joint can become compressed, restricted, or deviated, placing the elbow at higher risk for continued symptoms and further injury due to faulty elbow mechanics. It can remain in this inefficient state until it is corrected manually and the joint and muscles are re-educated to maintain better alignment.
Tennis elbow is common in people who play tennis or other racquet sports because of faulty mechanics most commonly found in the backhand swing. But any activity that involves repetitive twisting or turning of the wrist, like the motion of using a screwdriver, can lead to this condition.
Golfer’s elbow is caused by overusing the wrist flexor muscles in the forearm that rotate your arm and flex your wrist. The repetitive motion of flexing and gripping like the motion produced with swinging a golf club can cause similar symptoms in the medial elbow. Throwing athletes, especially Pitchers, repeatedly use the motions that commonly produce medial elbow symptoms.
Despite their names, these conditions don’t just affect golfers and tennis players. Any jobs or tasks that require repetitive hand, wrist, or forearm motions can lead to either of these conditions. Even daily computer use or a faulty workstation set-up that causes poor posture can increase the risk of these conditions.
Signs and Symptoms usually include elbow pain that gradually gets worse and does not go away. Also pain can be reproduced with motions of the wrist and forearm, like turning a door knob or gripping the cap of a container to turn and open it. Even grip strength can be weak or painful from these conditions.
Because this is a soft tissue condition, x-rays are usually normal and a diagnosis is typically made based on the signs and symptoms of pain or tenderness when the tendon is pressed near it’s attachment to medial or lateral elbow. Pain will also be produced with resisted wrist flexion or extension.
How is it treated?
After getting a proper diagnosis for the symptoms, rest and avoiding the activities and motions that reproduce symptoms is needed. Using cold packs or ice massage to the area will help reduce pain and any existing inflammation. If your symptoms were caused by sports or job related activity, you will need to make changes in your posture and technique before resuming those activities. A tennis elbow strap that wraps around the forearm can help alleviate some of the pressure from the insertion of the tendon, especially with activity. If your symptoms are related to working on the computer, you will need to have someone like a Physical Therapist assess and make changes to your home or office workstation immediately or the dysfunction will persist and undermine your recovery.
Most people improve with nonsurgical treatment and cortisone injections are no longer the treatment of choice for this condition. There are many treatments options available to promote tendon healing including PRP injection, acupuncture, and massage. If the pain continues after rest, physical therapy treatment and the appropriate changes to your routine, you may require an MRI to determine the extent of the damage to the tendon and surgery may be recommended. Surgery is not usually needed unless symptoms have not improved.
A manual physical therapist can supervise even the early stages of your recovery and restore efficient elbow joint function through manual therapy. Proper instruction in eccentric wrist flexion and extension exercises is advised for both treatment and prevention. Also a healthy elbow requires efficient posture and function of the shoulder and wrist joints and properly operating muscles around the scapula to decrease the load on the elbow joint.
Always remember that your healthcare provider is the best source of information for questions and concerns related to your medical problem.
Michael Racca, MSPT is a Licensed Physical Therapist in New York and Connecticut with over 10 years of diverse clinical and management experience in both hospital and outpatient settings. He has extensive experience working with clinic and in-home patients of a wide variety of diagnoses to help them restore their full potential level of function. He has given community lectures on a variety of topics including back education, total joint replacements, injury prevention, and sports performance. Mike has most recently specialized in treating the post-surgical orthopedic outpatient population and has helped many local students and nationally recognized athletes return to their prior level of competition following injury and surgery. Elite Health Services, located in Old Greenwich, (and now Westport!) CT is a world-class provider of certified functional manual physical therapy, personal fitness, golf & triathlon performance training, massage therapy and wellness related services. Our team of highly skilled and dedicated professionals take a no-excuses approach to providing exceptional care and delivering exceptional results. To learn more visit www.EliteHealthServices.