Tennis & Golf Elbows: Epicondylitis
There are two fairly common afflictions of the elbow that cause a great deal of discomfort and, if not taken care of, early chronic pain. The most interesting aspect of these lay names, Tennis and Golf Elbows, is that you don’t have to play either sport to acquire, aggravate, or develop either one. However, you can get them from playing either sport, especially if you have bad form. (This column does not address your strokes in tennis and golf, there are other professionals who do that.) As we get older these are increasingly common problems with prevalence greatest over age 40 and about equal in men and women.
Tennis elbow is lateral epicondylitis. It is so named because it describes the pathophysiology, as we call it, of the problem. It is an acute or chronic problem with the tendons that join the forearm muscles to the elbow (humerus bone extension). This union occurs on the lateral or outside of the elbow. Unfortunately, it is not simply an inflammation of the tendons because that can be easily treated, more often and certainly in chronic conditions the tendons suffer injury, and micro-rupture, and are replaced by collagen. It is thought that a specific forearm muscle is the main culprit in causing the problem. When the muscle is weakened from overuse it causes microscopic tears in the tendon. This causes inflammation and chronic collagen deposit.
Overuse or repeated use of a particular arm movement is the major cause of tennis elbow. This can occur with tennis strokes, particularly improper or unnatural ones. Also, repeated actions that carpenters and others (e.g. plumbers, ditch diggers, painters, and butchers) repeat can cause this. Trauma, meaning a blow to the elbow, can also cause the injury. Sudden, forceful extension or pull of the arm can cause tennis elbow. However, I developed it from shoveling too much dirt for too long a time. The point is you don’t have to be a bad or awkward tennis player to develop tennis elbow.
Symptoms & Diagnosis
It is relatively easy to diagnose tennis elbow, and most lay people who have it can tell their doctor what they have. There is pain on the outer part of the elbow with certain motions. The pain may run from the outside of the elbow to the forearm and wrist. There is generally tenderness when pushing on the lateral tendons at the elbow. There can be weakness in grip that is noticeable with shaking hands and picking up items. Usually it is the dominant arm that is affected. Your doctor or orthopaedic surgeon can make the diagnosis usually without any expensive testing, but tests may be required to be certain or to rule out other problems.
As with everything in medicine, the earlier the treatment the better the long term outcome. Treatment involves resting the arm and refraining from tennis or any of the activities that caused the repetitive motion that causes the problem. So rest for the arm is the main treatment! Additionally aspirin, ibuprofen (Advil, Motrin IB), or naproxen (Aleve) can help with pain and swelling during the acute injury period (the day or early days of the injury). Some recommend ice several times a day in the acute period of injury. Physical therapy may be ordered for chronic cases. Also, certain braces can be placed over the back of your forearm to strengthen the muscles that pull on the tendons. There can be more elaborate treatments to help with chronic problems and unusually surgery may be indicated in chronic disease.
Tennis elbow tends to get better like many of the tendon disorders, but it is painful and it is very important to prevent recurrence. Prevention involves using proper equipment in the sport, using the equipment with “good strokes,” and wearing braces of the arm.
There is another elbow epicondylitis, but it is on the medial (inside of the elbow). Golfer’s elbow is much less common than tennis elbow though both occur more frequently as we age. The cause of both is overuse, but golfer’s comes from muscles pulling on the tendons on the inside and is associated with repetitive strong gripping with the hand and wrist turning. Symptoms are similar to tennis elbow except the pain and tenderness is on the inside of the elbow. The diagnosis and treatment are the same as for tennis elbow, as is the short- and long-term prognosis. Golfer's elbow can be painful. Rest, the analgesics mentioned above, and physical therapy, sometimes as simple as just squeezing a tennis ball gently, can be used to build up the offending muscles.
The bottom line is that it is possible to exercise too much or to mismanage one’s swings and grips resulting in epicondylitis. The sports in which these movements occur, as well as the occupations, are important to resume after treatment. With careful treatment (often at home) one can return to the activities that first caused the problem, but wearing a brace. See your physician if the symptoms do not resolve.