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Tennis and Golfers Elbow
Both medial epicondylitis (golfers elbow) and lateral epicondylitis
(tennis elbow) are inflammatory conditions at the elbow, just in
different locations. Usually these conditions are caused by
‘overuse’ of the arm in a repetitive and excessive manner such as
playing a lot of golf or tennis. Check out the pictures to see
exactly where the lateral and medial epicondlyes are located.
Forearm muscles/tendons that flex and extend the wrist are attached
to these boney areas. Injuries to the lateral and medial are not
limited to individuals that play tennis or golf. Anyone who uses
their hands repetitively at acute angles or to grip at work or with
hobby activities may get golfers or tennis elbow. For example, other
causes of epicondylitis are repetitive keyboarding, knitting,
hammering etc. Mostly, golfers and tennis elbow occur individually,
but they may occur together.
SYMPTOMS
Symptoms include pain at the elbow with use of the hand, wrist
and/or fingers, pain with gripping, weakness with dropping of
objects, occasionally numbness and tingling into the hand and almost
always tenderness to touch the medial/lateral epicondyle. Sometimes
the area is stiff in the morning also.
Technically speaking, epicondylitis is a degeneration of the tendon
just above the elbow that controls the movements of the wrist,
fingers and hand. The inflamed tendon is continuously trying to heal
itself and never is able to completely heal because the overuse of
the elbow tendons continues to cause repetitive microtrauma.
Treatments such as rest, nonsteroidal anti-inflammatory drugs,
bracing, physical therapy, and injections of corticosteroids
(cortisone shots) are often used but recent studies have called into
question their efficacy. Recovering from golfer/tennis elbow can be
quite tricky, involving all of the above therapies in combination.
Typically the longer you have had the condition, the longer it will
take to recover.
TREATMENT
1) REST In my experience with this condition it is essential to
eliminate or reduce the aggravating activity or ‘rest it’. This may
sound simple but can be very difficult to perform. For example try
asking a carpenter to swing his hammer with his nondominant hand for
a couple weeks, or a secretary to not type with her painful arm.
“Rest’ in this situation, is relative to the activity. “rest’ may
simply mean doing the activity at a different position of the arm,
not at all or with the other arm. “Rest’ should ultimately mean
avoiding painful activities or positions.
2) MEDICATIONS/INJECTIONS Oral (nonsteroidal anti-inflammatories)
and/or injectable medications (cortisone shots) may initially be
used to temporarily reduce the pain and inflammation associated with
epicondylitis. Most often this is not a long term cure and the
condition will return if one continues to abuse the elbow with the
same repetitive activity as prior to the medication. Repetitive
injections (more than 3 per year) can be detrimental to the elbow,
causing further degeneration. However, medications are very
important in getting past the acute inflammatory pain.
3) BRACING There are a number of braces on the market for sale that
are applied to the thickest part of the forearm musculature that
sometimes help the pain of epicondylitis. These braces work by
reducing the power of the contraction that the forearm musculature
are able to produce, thereby reducing the force on the tendons of
the lateral/medical epicondyles. The problem with the braces is that
they should not be used over a long period of time because by
reducing the amount of force that your forearm musculature can
produce, they weaken the muscle causing another set of problems –
one of them being epicondylitis.
4) PHYSICAL THERAPY As a physical therapist, I see a lot of this
condition. I manage to relieve pain from epicondylitis about 75% of
the time, some much quicker than others. Success in treating the
condition relates to several factors including how long you have had
the condition, your occupation and your compliance/self-discipline
as it relates to ‘resting’ your arm from aggravating activities. A
physical therapist will also give you very specific stretching and
strengthening exercises (stretches shown below). The progression of
the exercises is very important to your recovery as progressing too
quickly will exacerbate the condition. The exercises should cause
minimal to zero pain and be gradually progressed as your symptoms
subside. Recent evidence has shown that eccentric strengthening (at
the appropriate time in recovery) is the best type of exercise. Ice
and ultrasound to the elbow are also used in physical therapy to
help reduce inflammation. Your therapist should also look at
ergonomic adjustments that may help your pain. For example, is the
carpenter using a ‘non-shock’ hammer with an appropriate grip size
and weight? Is the secretary’s keyboard at an appropriate height?
These seemingly simple adjustments can make a big difference over
the course of a couple months of 40-50 hour work weeks.
5) SURGERY Surgery, as almost always, should be reserved as a last
option due to the inherent risks associated with it. Recovery from
this surgery involves not working for a while and gradual physical
therapy to restore the flexibility and strength of the forearm
musculature. The strength and flexibility of the elbow after surgery
and therapy (with time) obviously should be better than prior to
surgery so as to avoid a return of the epicondylitis upon returning
to the so called ‘aggravating activity’. The actual surgery involves
a small incision at or near the epicondyle to ‘release’ the tendon
and debriding of frayed tendon material.
PREVENTION
As in most instances, if your body is hurting during a particular
activity – it is telling you to stop or change the way your doing
it. Listen to your body and you can avoid a lot of injury including
epicondylitis. Often just slightly changing the position in which
you are doing something or taking a few breaks to stretch out every
so often will go a long way in preventing progression of
epicondylitis.
If you have an area of interest, please email it to
support@airphysicaltherapy.com
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