Tennis Elbow and Golfer's Elbow

Tennis Elbow

Tennis elbow is really an inflammation of the outside of the elbow. This area of the elbow is the bone called the lateral epicondyle, which is why tennis elbow is also known as lateral epicondylitis. The outer part of the elbow becomes painful and tender as a result of damage or tearing of the tendons and muscles of this area.

Golfer's Elbow

Golfer's elbow is quite similar to tennis elbow except the inflammation occurs on the inside of the elbow, around the bone called the medial epicondyle. Golfer's elbow is also referred to as medial epicondylitis. The inner part of the elbow becomes painful and tender as a result of damage or tearing of the tendons and muscles of this area.

Causes of Tennis Elbow and Golfer's Elbow

The terms Tennis Elbow and Golfer's Elbow are misleading because most people don't develop them from playing tennis or golf. The conditions are often brought on by overused or strained muscles, which in turn leads to the inflammation. Activities such as painting, raking, pitching and hammering involve repetitive arm movements that overuse and strain the muscles of the elbow.

Sometimes the conditions can be the result of a single injury or, they can be brought on from other conditions such as arthritis. The problem may be due to problems in the neck, or there may be no explanation for the inflammation at all. Usually, however, any activity that involves excessive force or repetition when gripping, twisting or reaching can trigger tennis or golfer's elbow.

Symptoms of Tennis Elbow and Golfer's Elbow

• Difficulty with movements such as gripping, lifting and carrying·
• Pain and tenderness either on the outside of the elbow (tennis elbow) or on the inside of the elbow (golfer's elbow).
• Pain that radiates down the arm toward the wrist
• Difficulty extending the forearm

Tennis elbow is a result of overuse of the common extensor muscle group. The common extensor muscle group is not only excessively used by tennis players, but also computer users, typists, cash register operators, carpenters, and hair stylists.Tennis elbow is far more common than Golfer's elbow. General treatment procedures are similar for both but the following is specifically written for tennis elbow sufferers.

Evaluation Procedures:

Resistance Test (Cozen's test): We will test to see whether the pain gets worse when you bend your wrist back (extend it) against resistance.Small tissue damage around the elbow tendon attachment of the Extensor Carpi Radialis Brevis (the muscle that runs from the lateral epicondyle to the middle finger) can be found in many tennis elbow cases.In those cases, the patient will feel sharp shooting pain in the elbow by extending his/her middle finger against resistance

Tenderness: We will also test for tenderness over or near the bony bump on the outside of the elbow. In the event of both these signs being present, it is likely that you have tennis elbow.

Grip Strength: Patients are asked to grip the dynamometer and stop as soon as pain is felt in the elbow (pain-free grip power) then grip with maximum power despite any pain (maximum grip power). Tennis elbow sufferers usually show a decreased maximum grip power and a large difference between pain free and maximum grip.

We may also examine your neck and upper chest regions as factors in these areas may be fully or partly causing your pain.

• The conventional approach often involves physiotherapy treatments, use of anti inflammatory drugs, and may include an injection of a small dose of steroid to the affected area.

Is there any natural alternative treatment?

• Acupuncture and moxibution treatment is used in order to decrease the hyper-tonicity of common extensor muscles.
• In some acute cases, we apply cryo (ice) massage around the lateral epicondyle.
• After acute inflammation has subsided, the massage technique called transverse friction is often incorporated to break down the existing scar tissues around the tendons and restore normal tissue health.

Is there anything I can do besides the treatment or shouldn't do?

Rest: The best way to relieve tennis elbow is to stop doing anything that irritates your arm - a simple step for the weekend tennis player, but not as easy for the manual laborer, office worker, or professional athlete.

Wearing a Brace: For those who are unable to commit to complete rest, wearing a brace (especially designed for tennis elbow which helps decrease the stress on the lateral epicondyle) is recommended.   In order to avoid muscle atrophy, the brace should be worn only at certain times of the day during activities and should be considered a temporary solution.

Ice: Application of ice helps decrease the inflammation.   During the acute phase of tennis elbow, it is recommended that you apply ice at home or office at least a couple times a day (10-15 minutes duration). Ice should also be applied immediately after any activity that has caused pain and in some cases after the treatment.

Exercise: When the acute inflammation has subsided, I'll show you an exercise that is helpful for your condition. The exercise consists of strengthening the common flexor muscle group (which will help relax the extensor muscles through the mechanism of antagonist inhibition reflex) and stretching the common extensor muscles.   You should avoid doing any weight exercise that puts stress on the common extensor muscles.

How about vitamins or herbs?

Certain nutritional supplements are helpful in decreasing the inflammation around the tendons and in repairing of soft tissues.   I will provide my recommendation at the appropriate time in the course of your recovery.