Tennis and Golfers Elbow
Tennis and golfers elbow are both conditions affecting tendons in the elbow. Pathology can occur in tendons where they become thickened, inflamed and weak. This is called a tendinopathy and can occur in various areas in the body. Common areas for tendon problems to occur are the elbow, the rotator cuff of the shoulder and the Achilles tendon in the ankle. Two forms of tendinopathy occur in the elbow; tennis elbow, which results in pain on the outside of the elbow, and golfers elbow, which causes pain on the inside. The correct medical terms are lateral epicondylitis and medial epicondylitis respectively.
Tennis elbow effects the tendons of the extensor muscles of the wrist. These muscles function to lift the wrist back and turn the hand palm up. Golfers elbow effects the flexor muscles of the wrist that function to bend the wrist forwards and turn the hand palm down
Cause of Tennis and Golfers Elbow
Tendons are bands of fibrous tissue that connect muscle to bone. During everyday arm movements strain, or load, is placed on these tendons. This is normal and keeps the tendons healthy and strong. If too much load (tendon overload) is placed on the tendons a tendinopathy can develop. Tendon overload can occur as the result of an injury, such as a fall or direct blow to the elbow. In this case, pain may begin quite suddenly. It is, however, more commonly the result of repetitive strain with symptoms beginning gradually and worsening over time.
Playing tennis or golf can cause these conditions but they are not exclusively triggered by these sports. Tendon overload, or repetitive strain, can occur as the result of any repeated activities that involves bending or twisting of the wrist and gripping. For example DIY or typing. These activities are more likely to trigger a tendinopathy if this is unaccustomed activity. Symptoms may develop during the activity or over the following days
It is also important to note that certain risk factors have been identified that mean you are more likely to develop tendon problems. These include smoking, alcohol consumption and a poor diet.
Symptoms of Tennis Elbow and Golfers Elbow
Pain is normally localised to the bony lump on the outer elbow in tennis elbow and to a bony lump on the inner elbow in golfers elbow. In both conditions pain can extend down the forearm. This pain is produced when pressure is applied to the outside or inside of the elbow. Once a tendinopathy has developed activities that involve extension or flexion of the wrist, as well as gripping or twisting, can reproduce pain. Some examples include opening a jar or a door and gripping a screw driver or steering wheel. Additionally, lifting a heavy object such as a kettle can be painful. Weakness on lifting and gripping is also a feature of this condition.
Resting from aggravating activities is important, particularly in the early stages. This is not always an easy thing to do due work, home life commitments and hobbies. We will assess this and advise ways in which you can modify activities to try and prevent further aggravation.
The short term use of simple pain killers, such as paracetamol or anti inflammatories, can be useful in the management of this pain. Always take as recommended on the box and seek advice from your doctor or pharmacist first if you are taking other medication.
An elbow clasp can be worn below the elbow during painful activities to help reduce stress on the tendons.
Research has shown that physiotherapy is often successful in treating tennis and golfers elbow. This involves a specific exercise program to target the elbow tendons. The main aim is to restore strength of the tendon so it can cope with everyday strains and higher loads in sports. This treatment can take between 3 and 6 months to fully resolve symptoms. At Yorkshire Physiotherapy we have experience of guiding patients through this treatment. We will provide you with a program tailored this to your individual needs whilst identifying and correcting the possible causes to reduce the risk of reoccurrence. Manual therapy techniques, such as joint mobilisations, may also be useful for pain relief and for improving movement.
Steroid Injections: These have been used to treat both tennis and golfers elbow in the past when rest, pain relief and exercise has been unsuccessful. The latest clinical research, however, has shown that although these injections result in short term improvement in pain they may cause the condition to last longer and increase the risk of it reoccurring. Based on recent studies, experts in this field now conclude there is no role for steroid injections in the management of tennis elbow.
PRP Injections: Platlet Rich Plasma is another type of injection which some studies have shown to be more effective than steroid. If your symptoms are not improving as expected and you wish to consider this we can refer you to an orthopaedic consultant.
For some people, the symptoms of tennis or golfers elbow can persist despite rest, pain killers and physiotherapy. In these cases a surgical procedure may be appropriate, however, this is a last resort and in most cases surgeons would not offer this until the above management options have been tried. If your symptoms don’t improve as expected, and you wish to consider surgical options, we can refer you to a specialist orthopaedic surgeon.