tennis elbow; golfers elbow; Pro-Am Sports Injury Clinic

Tennis Elbow

Tennis Elbow affects the lateral (outside) aspect of the joint.

The muscles found to be inflamed are the extensors of the wrist mainly the extensor carpi radialis brevis (ECRB) tendon. This muscle originates from the lateral epicondyle of the humerus and extends to insert at base of the third metacarpal.

Although as many as half of tennis players suffer from tennis elbow at some point, they only account for 5% of all tennis elbow injuries. Tennis elbow is also known as lateral epicondylitis and effects many manual workers where the extensors of the wrist are over used through repetitive movements.

Symptoms

Recurring pain on the outside of the upper forearm just below the bend of the elbow; occasionally, pain radiates down the arm toward the wrist.
Pain caused by lifting or bending the arm or grasping even light objects such as a coffee cup.
Difficulty flexing the forearm fully (because of inflamed muscles, tendons and ligaments).
Pain that typically lasts for 6 to 12 weeks; the discomfort can continue for as little as 3 weeks or as long as several years.

Golfers Elbow

Golfers Elbow affects the medial (inside) aspect of the joint.

The muscles found to be inflamed are the flexors and pronators of the fingers and wrist. The muscles are responsible for bending the fingers and thumb, clenching the fist, they come together in a common tendon which is inserted in (i.e. attached to) the medial epicondyle of the humerus at the elbow joint.

Golf players have a higher risk of developing this injury hence the name but it can also occur in other activities like using a computer, top spin in tennis.

Symptoms

Tenderness and pain at the medial epicondyle, made worse by flexing the wrist. The pain may spread down the forearm. Activities that use the flexor muscles like bending the wrist or grasping can make matters worse.

Weakness, stiffness sometimes tingling and numbness

Difficulty extending the forearm fully (because of inflamed muscles, tendons and ligaments).

Pain that typically lasts for 6 to 12 weeks; the discomfort can continue for as little as 3 weeks or as long as several years.

The damage that tennis elbow/golfers elbow incurs, consists of tiny tears in a part of the tendon and in muscle coverings. After the initial injury heals, these areas often tear again, which leads to haemorrhaging and the formation of rough, granulated tissue and calcium deposits within the surrounding tissues. Collagen, a protein, leaks out from around the injured areas, causing inflammation. The resulting pressure can cut off the blood flow and pinch the radial nerve, one of the major nerves controlling muscles in the arm and hand.

Tendons, which attach muscles to bones, do not receive the same amount of oxygen and blood that muscles do, so they heal more slowly. In fact, some cases of tennis elbow can last for years, though the inflammation usually subsides in 6 to 12 weeks.

90-95% of patients will respond to conservative treatments like ultrasound, massage, ice, stretching and strengthening. Those who are unresponsive after 6 months of treatment including cortisone injections may require surgery.

Causes

By far the most common cause of tennis/golfers elbow is overuse. Any action which places a repetitive and prolonged strain on the forearm muscles, coupled with inadequate rest, will tend to strain and overwork those muscles.

There are also many other causes, like a direct injury, such as a bump or fall onto the elbow. Poor technique will contribute to the condition, such as using ill-fitted equipment, like golf clubs, tennis racquets, work tools, etc. While poor levels of general fitness and conditioning will also contribute.

Treatment

The goal of initial treatment is cessation of the offending activity. Rest, use of a counterforce brace, and non steroidal anti-inflammatory drugs (NSAIDs) often provide relief of symptoms. Resting maybe easy for the recreational tennis player but for a manual worker it may not be possible as you still have to make a living. Using a brace has been shown to ease pain immediately making gripping stronger and pain free. Cortisone injections have proved to be effective but these last three methods are just for pain relief they do not treat the cause of the injury. Massage therapy to relax the over used muscles and break down thickened areas of scar tissue is a must, with this stretching and strengthening can be started when pain allows. Some therapists may also combine this with ultrasound therapy. If the patient is a tennis player then the size and weight of the racket needs to be looked at as well as technique when hitting and gripping the racket. For manual workers having lighter tools with a more comfortable handle can help, making sure nothing is too repetitive, taking breaks.