Epicondylitis - Tennis/Golfer's Elbow

The elbow joint consists of the joining of three bones: one from the upper arm (humerus), and two from the forearm (ulna and radius). The collateral ligaments are strong bands of tissue that hold the bones together in proper alignment. The elbow is both a ball-and-socket joint as well as a hinge joint, allowing the elbow to bend (flexion) and straighten (extension) as well as enable the hand to rotate palm-up (supination) and palm-down (pronation).

Overview

A condyle is a rounded prominence at the end of a bone, usually where the bone connects to another bone. An epicondyle is the most prominent part of the condyle where tendons are attached. Epicondylitis is inflammation or damage to the area where the tendon attaches to the bone. The most common types of epicondylitis are “Tennis Elbow” and “Golfer’s Elbow.” “Tennis Elbow,” which is also known as lateral epicondylitis, is an overuse injury to the lateral (outside) area of the epicondyle of the elbow of the humerus, which is the upper arm bone. “Golfer’s Elbow,” which is known as medial epicondylitis, is similar to tennis elbow, but the damage occurs in the medial (inside) area of the epicondyle of the elbow of the humerus. Tennis elbow is an inflammation of the extensor tendon attachment, whereas golfer’s elbow is an inflammation of the flexor tendon attachment. Both of these conditions occur as a result of repetitive strain on the forearm extensor/flexor muscles such as tennis and other racquet and throwing sports, golf, gardening, carpentry, etc. These conditions can also occur due to traumatic events such as a motor vehicle accident in which the tendon attachment is violently stretched.

Symptoms

Common symptoms of tennis/golfer’s elbow are:

• Pain and tenderness over the lateral/medial epicondyle that is aggravated by the bending of the wrist.
• Gradual pain that is aggravated with use/overuse of the affected muscles
• Swelling or inflammation of the tissues near the joint
• Overall instability or a locking sensation of the elbow joint

Diagnosis

The physician will take many factors into consideration prior to making a diagnosis. After taking a full, detailed history of the symptoms and recreational or occupational risk factors, the physician will examine the arm and the elbow for symptoms by conducting a number of tests aimed at making a diagnosis.

Treatment

Most individuals who have either tennis elbow or golfer’s elbow are fully treated with non-operative methods.

Rest – It is advised to decrease or completely stop the activity that makes the pain worse. A great way to stay active while allowing the symptoms to subside is to switch to low-impact activities.

Medication – Over-the-counter medication such as ibuprofen and naproxen usually help reduce pain and swelling. If these are deemed insufficient by your physician, they might prescribe stronger medication to relive pain and reduce inflammation.

Physical Therapy – Physical Therapists will often prescribe specific strengthening and range of motion exercises that promote healing and help recover as much mobility in the elbow joint as possible. It is crucial that these exercises be done accurately and routinely to optimize recovery of the elbow joint.

Steroid Injections – Injecting the damaged tendon with cortisone, a powerful anti-inflammatory medicine, might aide in decreasing pain and improving symptoms.

Surgery – When non-operative treatments have been exhausted and are insufficient to control the symptoms for more than six to 12 months, the physician may recommend an operative approach. The exact procedure will vary based on the extent of the injury, the individual’s general health, and their need to return to sport or activity that requires extensive use of the involved muscles. Options must be discussed extensively with the physician to determine the appropriate operative treatment and procedure.

Recovery

Each patient is unique and their recover will depend on the treatment method prescribed by the physician. If surgery is deemed necessary for the tennis/golfer’s elbow, recovery will depend on the severity of the condition and the complexity of the procedure. The elbow will most likely be placed in a splint following surgery for a couple of weeks. Once the splint is removed, physical therapy to stretch and restore movement in the elbow will be recommended for a few months. The physician will provide instructions for when an individual can return to sport or the prior level of activity which usually takes up to six months after surgery.

Disclaimer

CALL 911 IMMEDIATELY IF YOU ARE HAVING A MEDICAL EMERGENCY!

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