Tennis Elbow, Anyone?

Feature photo: Medial or lateral epicondylitis is commonly known as “Golfer’s Elbow” and “Tennis Elbow” (COURTESY GRAPHIC)

The United States Golf Association crowned its U.S. Open champion in June, and the United States Tennis Association will crown its U.S. Open champion just after Labor Day. Did you know many adults suffer from similar elbow afflictions related to those two sports, although not always caused by them?

“Golfer’s Elbow” and “Tennis Elbow” are two ailments more alike than different. These two conditions of the elbow – medically known as medial or lateral epicondylitis – mirror each other in terms of cause and treatment.

What is an epicondyle?

Epicondyles are the two bony knobs located at the bottom of your humerus, the upper arm bone, at the elbow.

The medial epicondyle is on the inner surface, near the funny bone nerve. The muscle group that provides power grip and turns the wrist in a palm downward motion is attached to the medial epicondyle by a common tendon.

Meanwhile, the lateral epicondyle is on the outer surface, and a common tendon attaches to the muscle group that straightens your hand and turns the wrist in a palm upward motion.

Whether one suffers from medial (Golfer’s) or lateral (Tennis) epicondylitis depends on which side of the elbow the injured muscle group is found.

Is this inflammation?

No, but it’s understandable why that might be confusing. Usually, when the suffix “itis” appears in a medical term, as in tendonitis, it means that body part is inflamed. Signs of inflammation include warmth, redness, and swelling.

In this case, however, epicondylitis is a wear down of the tendon at its attachment to the elbow knobs from muscle overuse or overload. Inflammation is not a major component. Typically, there is injury, microtears, and scarring.

That’s why another medical name for this condition is tendinosis orthe degeneration of the tendon’s collagen. An unhealthy tendon will cause pain and weakness when using the attached muscles.

Why it’s called “Golfer’s Elbow” and “Tennis Elbow”

Golfers often use the muscles attached to the medial epicondyle for power during the downstroke and ball strike of the swing. These muscles and tendons are particularly vulnerable to injury when hitting through a divot because the impact transmits up through the club, into the muscles, and to that inner knob.

In contrast, tennis players utilize the muscles attached to the lateral epicondyle (outer knob) for accuracy during the stroke. This often occurs on the backhand side and when positioning the racket at the proper angle to initiate a forehand.

Athletes routinely perform these motions hundreds if not thousands of times. After a while, this can lead to the overuse injury of epicondylitis.

However, not just club and racket athletes develop it. Any occupation that repeatedly uses power grip, twisting and turning, or repetitive heavy striking with the arms can cause epicondylitis. We see it in mechanics, carpenters, electricians, butchers, and many other manual laborers.

What if I have epicondylitis?

The treatment of medial or lateral epicondylitis falls into three categories:

Modification of physical activity
Conservative therapies
Surgery

Modification

First, one should decrease the amount of physical activity that caused the pain. Fewer repetitions, lighter loads, shorter hours, light duty, or cross-training are all modifications. In severe cases, one may need to stop the activity briefly.

Other modifications include changing racket size/weight or altering hand placement on the club or racket. Warm-up and specific stretches for the involved muscles also help.

One can also wear a forearm strap to redistribute and lighten the load on the involved muscles while continuing to work or play the sport.

Conservative therapies

Physical therapists can stretch the muscles and apply modalities to the elbow to reduce pain and help the healing process. Plus, after healing, therapists can teach how to build back the muscle properly to prevent a recurrence.

Again, wearing the strap or applying kinesiotape – that black tape we now see many athletes wear while engaged in their sport – supports the muscles and reduces pain while the arm is in use.

Previously, doctors may have injected a corticosteroid at the tendon. But we have learned this treatment does not significantly help recovery. Cortisone is an anti-inflammatory, and there isn’t much inflammation with this condition. Oral anti-inflammatory medications don’t work very well either.

Ice massage and topical creams can help temporarily, but they do not improve the healing rate.

In recent years, newer nonsurgical procedures have attempted to treat epicondylitis. These include dry needling, shock waves, high-pressure saline injections, and platelet-rich plasma (PRP) injections. Unfortunately, medical insurance does not cover many of these.

Surgery

Only the worst cases of epicondylitis – tears that have advanced from the tendon into the muscle or detached from the bone – need surgery. The surgeon will remove the scar tissue and repair the tendon close to its original configuration. Surgery can be traditional or arthroscopic, depending on severity. Some surgeons may add a PRP injection to aid recovery, which can take three to six months.

Conclusion

Golfer’s elbow and Tennis elbow do not occur only in golfers or tennis players. Any overuse of muscle tendons around the elbow causes the conditions of medial or lateral epicondylitis.

Since this mainly occurs to those in their 40s or 50s, some may consider the condition a rite of passage into middle age. But epicondylitis is treatable, and only the worse cases require surgery.

Dr. Jerome Enad is an accomplished, board-certified orthopedic surgeon specializing in sports medicine. He grew up in Stockton and graduated from Lincoln High School before obtaining his bachelor’s degree at UCLA and receiving his medical degree in Bethesda, Md. He has been practicing medicine for over 30 years and lives in Florida with his wife and three dogs. Dr. Enad will be a regularm health and fitness contributor to Stocktonia.org.