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Tennis Elbow and Golfer's Elbow

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Overview of Tennis Elbow

Tennis ElbowTendinitis, an irritation and inflammation of the tendon, is the most common condition affecting the elbow and is frequently referred to as "tennis elbow".

A tendon is a tough cord or band of dense white fibrous connective tissue that unites a muscle with the bone. The tendons involved in tennis elbow are on the outer side of the elbow and responsible for anchoring the muscles that extend (lift) the wrist and hand and attach to the bony prominence on the outside of the elbow (lateral epicondyle). Illustration courtesy of MerckSource.

Tennis elbow can be caused by a single-handed backhand, using poor technique, or any activity that involves heavy, repetitive use of the wrist and forearm muscles such as using a screw driver, painting, hammering, etc. Another name for tennis elbow is lateral epicondylitis.

Overview of Golfer's Elbow:
Tendinitis of the elbow is referred to as "golfer's elbow" or "little leaguer's elbow" when there is an injury to the inner tendon (medial side) of the elbow. Another name for this condition is medial epicondylitis and can caused by golf, throwing a baseball, a tennis forehand injury, or any activity that involves heavy, repetitive use of the wrist and forearm muscles.
Causes of Tendinitis:
Tendinitis can occur as a result of injury, overuse, or with aging as the tendon loses elasticity. Any action that places prolonged repetitive strain on the forearm muscles can cause tendinitis of the elbow.
Symptoms of Tendinitis:
  • Pain in the area of the involved tendon
  • Pain may radiate down the arm into the wrist
  • Tenderness with touching, palpating or bumping the affected tendon
  • Pain with movement or use of the forearm muscles.
  • Weak grip might occur, with difficulty or pain holding onto, pinching, or gripping objects.
Contact your health care provider immediately if:
  • your pain is extremely severe and accompanied by swelling. You may have a ruptured tendon, which requires immediate medical attention.
  • you have a prolonged case of tendinitis that doesn't improve with home care.
  • the pain is due to a direct elbow injury.
  • there is obvious deformity.
  • you are unable to use the elbow.
  • you have fever or swelling and redness of your elbow.
  • a child has elbow pain.
Prevention of Elbow Problems in Children:
  • Do not pull on a straightened arm.
  • Avoid lifting or holding the child up by the hands or forearm.
    • Note: Young children commonly develop "nursemaid's elbow," usually when someone is pulling on their straightened arm. The bones are stretched apart momentarily and a ligament slips in between, where it becomes trapped when the bones try to snap back into place. Children will usually quietly refuse to use the arm, but often cry out with any attempt to bend or straighten the elbow. This condition is also called an elbow subluxation or partial dislocation.
Diagnosis of Tennis Elbow:

Your doctor usually can diagnose tennis elbow by examining your elbow and asking you questions about your symptoms. An X-ray will only help in ruling out other possible causes of elbow pain, such as a fracture or arthritis.

Treatment: 1st relieve the pain and inflammation
  • Ice: Local application of ice for 20 minutes as often as every 2 hours. (If ice is very cold, apply only for 10 to 15 minutes) This is very helpful in controlling pain, inflammation, and facilitates healing. It's especially helpful to apply ice after any activity that uses the affected muscles or aggravates the condition. There are a variety of ways to apply ice: ice packs or bags purchased at the drugstore are convenient, an iced towel wrapped around the elbow is effective, or even a frozen bag of vegetables works well as a last resort.

  • Rest:
    • DO NOT return to the activity that caused the problem for at least 3 weeks and only when you experience minimal or no pain.
    • Avoid any activity that reproduces the pain.
    • Avoid lifting objects with the affected arm fully extended.
    • Minimize repetitive gripping of the affected hand and lighten up on the overall tension of gripping.
    • Hold heavy tools with two hands instead of one if possible.
    • Tennis players see below
    • Golfers see below
  • Medications to decrease pain and inflammation:

    • Over-the-Counter:
      • Ibuprofen (Advil) Useful for minor arthritic pain, fever, headaches, minor aches and pain. Always take with food and fluids as it can cause stomach irritation, ulceration or even GI bleeding. Contraindicated in people with aspirin allergy, 3rd trimester pregnancy. Precautions dehydration, pregnancy, nursing mothers. Increased risk of GI bleeding wtih alcohol. Do not take aspirin or other pain relievers with ibuprofen. For children: Use children's or junior form. Ibuprofen tends to be more effective than acetaminophen in treating high fevers (103 degrees Fahrenheit or higher). However, ibuprofen should only be given to children older than 6 months. Never give it to a child who is dehydrated or vomiting continuously. If your child has a kidney disease, asthma, an ulcer or other chronic illness, ask your pediatrician if it is safe for your child to take ibuprofen.
      • Naproxen Sodium (Aleve) for minor arthritic pain, headaches, minor aches and pain. Should be taken with food and fluids as it can cause stomach irritation, ulceration or even GI bleeding. Increased risk of GI bleeding wtih alcohol. Do not take aspirin or other pain relievers with naproxen. Not recommended for children. Contraindicated in people with aspirin allergy, 3rd trimester pregnancy. Precautions gastrointestinal disease, liver or kidney disease, dehydration, pregnancy, nursing mothers.
    • Prescription medications are similar to these over-the-counter medicines but are stronger.

  • Physical Therapy can be very helpful in achieving the quickest recovery possible. The longer an injury of this type goes untreated and lingers, the more likely it will become a chronic problem that never fully heals.
Treatment: 2nd Strengthen the Muscles and Prevent Reinjury
Begin an exercise program to build muscle strength and range of motion, ideally with a physical therapist, after the acute phase of pain and inflammation is over.
Tennis players:
  • Change to a two-handed backhand in tennis.
  • Add vibration dampeners to your racquet.
  • Try using a tennis elbow brace--some people get relief with this and some don't.
  • Lower the string tension on the racquet which transmits less impact upwards to the elbow. Stay at the lower end of the manufacturer's recommendation. Higher string tensions provide improved ball control but they also increase the torque and vibration experienced by the arm.
  • Use synthetic nylon string material and re-string every 6 months.(1)
  • Consider changing the grip size on the tennis racquet. A grip too large or too small lessens control and promotes excessive wrist movement.(1) To see how to measure your grip size, click here and then scroll down to the bottom .
  • Consider changing the type of tennis racket used. Graphite composites are considered the best in terms of torsion and vibration control. A midsize racquet (95-110 square inches) is optimal in preventing tennis elbow. The popular oversized racquets cause problems because they make the arm susceptible to injury due to the increased torque effect of shots hit off-center.(1)
  • Have a tennis professional review your technique to see if you're using the proper motion. Swinging the racket with just the wrist, instead of the whole arm, places stress on the tendons. Get your entire body involved in the stroke, not just your wrist.
Golfers:
  • Apply grip tape or an oversized grip to your golf clubs
  • Have a golf professional review your technique to see if you're using the proper motion.
Complications of Tennis Elbow:

Both tennis elbow and golfers elbow are common and often lingering problems. The longer left untreated, the more likely tendinitis of the elbow will lead to chronic pain that never fully resolves. You may find the pain restricts your movements, and results in pain when lifting objects, gripping handles, or when opening doors. This further aggravates the condition as avoiding using your arm in certain ways can lead to loss of some of the function of your arm. Furthermore, overusing the arm again before it has healed can result in a more severe injury. It is important to seek professional advice if this problem does not resolve with the above measures.

Video Tutorials
Tennis Elbow from Medline Plus. Scroll down to tennis elbow and follow the directions.  You will view a comprehensive tutorial complete with exercises.  Medline Plus is a service of the Nat'l Library of Medicine and Nat'l Institute of Health
References

(1) Physical Therapy Corner: Tennis Elbow from NISMAT.org
(2) Tennis Elbow from the American Academy of Orthopedic Surgeons
(3) Basic Wrist and Elbow Rehabilitation from the National Aeronautics and Space Administration



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