tennis elbow

What Is Tennis Elbow And Golfers Elbow?

There is an increase in popularity of sports involving overhead arm movements. In general, involvement in activities that require frequent movement of the arms while overhead places an individual at an increased risk for injury to the elbow joint. Epicondylitis is one type of injury that occurs within the elbow and is related to overuse.

There are three bones that conjoin to create the elbow joint. The humerus is the bone of your upper arm. The radius and the ulna are the bones within your forearm. At the end of the humerus, where it meets with the radius and the ulna, there are two rounded bumps, known as epicondyle. More specifically, there is the lateral epicondyle and the medial epicondyle. These bony protrusions serve as a point of contact for the connective tissue of the elbow joint.

The elbow is a synovial joint, meaning that there is a thin coating of articular cartilage covering the ends of the three bones that meet at the elbow. Moreover, there is a protective capsule that surrounds the joint, which is formed by the synovial membrane. In order to provide extra protection to the structures, as well as to maintain lubrication of the joint, this joint capsule is filled with a fluid known as synovial fluid. All around the joint capsule is an extensive network of connective tissue. These ligaments help to maintain the stability of the elbow joint, as well as protect against stress caused by use of the joint.

In most cases, the symptoms of tennis elbow or golf elbow will develop over time, though a portion of patients will report that their symptoms developed suddenly following strain or injury to the elbow.

In terms of tennis elbow, symptoms of pain and discomfort are most commonly reported to occur along the outside of the elbow at the area of the lateral epicondyle. Conversely, patients suffering from golf elbow frequently complain of pain and discomfort at the inside of the elbow, within the area of the medial epicondyle. For both conditions, it is not uncommon for symptoms of pain and discomfort to radiate out from the areas of origin, either up or down the arm. Patients with epicondylitis will also experience joint stiffness, particularly in the morning; joint weakness; and numbness or tingling sensations that radiate down into the fingers.

Interestingly, though epicondylitis generally emerges as the result of injury, strain, or irritation to the structures that comprise the elbow, patients are most likely to experience pain that is exacerbated when doing things with their hands.

Individuals with tennis or golf elbow may report pain that worsens when:

  • Lifting
  • Making a fist or when gripping an object
  • Shaking hands
  • Opening a door
  • Straightening the wrist or raising their hand

Causes Of Tennis Elbow And Golfers Elbow

The most common cause of both lateral and medial epicondylitis is overuse, which leads to damage of the muscles within the forearm. Individuals who are involved in activities that require repetitive movements using the forearm muscles or who engage in activities requiring overhead arm use are regarded as being most at risk for developing complications related to tennis or golf elbow. While many athletes, such as tennis players, suffer from symptoms of epicondylitis, non-athletes who are involved in other activities that place strain on the forearm muscles are also at risk for developing tennis or golf elbow. For instance, carpenters, plumbers, and painters are regarded as particularly prone to experiencing pain and discomfort associated with epicondylitis.

An individual’s age is also considered to be a risk factor. More specifically, adults between the ages of 30 and 50 are among the most common to be diagnosed with epicondylitis.

Treatments For Tennis Elbow And Golfers Elbow

Tennis Elbow, Golfers ElbowPrior to determining the appropriate treatment for your symptoms, your doctor will conduct a thorough physical examination and interview to assess for the underlying cause for your pain and discomfort. Physical examination of the elbow will include palpation of the area, as well as physical manipulation of the joint in order to assess for the degree of joint stiffness, muscle weakness, flexibility, and pain.

Your doctor may wish to order additional tests in order to rule out other possible causes or to confirm a suspected diagnosis. These tests may include imaging techniques, such as an X-ray or magnetic resonance imaging (MRI). Electromyography (EMG) may also be used in order to assess for the possibility of nerve compression.

Most cases of epicondylitis can be effectively treated without the use of surgery. In fact, some studies have estimated that nearly 95% of patients suffering from either tennis or golf elbow are able to achieve relief using non-surgical techniques, which include:

  • Rest: Rest is commonly recommended to patients suffering from pain or discomfort within the elbow region that is the result of strain, overuse, or injury. Individuals are strongly encouraged to temporarily suspend their involvement in sports or work activities related to the injury, in order to avoid further damage.
  • Over-the-counter analgesics: It is not uncommon for physicians to recommend that patients with epicondylitis pain take an over-the-counter analgesic, such as non-steroidal anti-inflammatory drugs (NSAIDS).
  • Physical therapy: Physical therapy may also be recommended, which involves specified stretches and exercises that are targeted to strengthen the arm and joint.
  • Brace: In some cases, a protective brace may be worn that restricts movement of the joint. This provides the muscles with rest in order to promote healing, as well as protects against exacerbation of the injury.
  • Steroid injections: Some patients will experience symptoms of chronic, refractory pain associated with epicondylitis. Given that these patients have been unable to achieve relief despite trials of various interventions, a more targeted approach is warranted. Steroid injections provide effective relief from pain as they target the application of pain-relieving and inflammation-reducing medication directly to the affected area for maximum effectiveness.

Patients suffering from symptoms of epicondylitis that persist despite numerous non-surgical treatment trials may be appropriate candidates for surgery. There are several types of surgery available to treat epicondylitis, though most include removal of deteriorated muscle tissue and reattachment of healthy muscle.

There are a number of risks associated with surgical intervention to treat epicondylitis, including:

  • Bleeding or infection at the incision site
  • Accidental neural or vascular tissue damage
  • Loss of flexibility within the elbow joint
  • Loss of strength in the elbow joint
  • Need for additional surgeries

Conclusion

Tennis elbow and golf elbow are pain conditions that emerge as the result of overuse, strain, or injury to the elbow joint. Tennis elbow frequently leads to symptoms of pain along the outside of the elbow, as it is related to strain caused to the lateral epicondyle. Golf elbow most commonly leads to pain along the inside of the elbow, as it is associated with strain to the medial epicondyle. Treatments for these conditions can range from more minor interventions, such as rest or over-the-counter oral analgesics, to more interventional approaches, including steroid injections. Most cases of tennis and golf elbow are effectively treated using non-surgical techniques.

References

  1. Field LD, Savoie FH. Common elbow injuries in sport. Sports Med. 1998;26(3):193
  2. De Smedt T, de Jong A, Van Leemput W, et al. Lateral epicondylitis in tennis: Update on aetiology, biomechanics and treatment. Br J Sports Med 2007;41:816
  3. Sims SE, Miller K, Elfar JC, Hammert WC. Non-surgical treatment of lateral epicondylitis: A systematic review of randomized controlled trials. Hand 2014;9(4):419
  4. Amar E, Checkik O, Khashan M, Lador R, Rath E. Lateral epicondylitis treatment: International survey of surgeons’ preferences and literature review. Int J Clin Pract 2014;68(11):1383
  5. Hoogvliet P, Randsdorp MS, Dingemanse R, Koes BW, Huisstede BM. Does effectiveness of exercise therapy and mobilisation techniques offer guidance for the treatment of lateral and medial epicondylitis? A systematic review. Br J Sports Med 2013;47(17):1112
  6. Van Hofwegen C, Baker CL, Baker Jr CL. Epicondylitis in the athlete’s elbow. Clin Sports Med 2010;29(4):577

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