Tennis and Golfer’s Elbow

Lateral epicondylitis or ‘tennis elbow’ is prevalent in workers who perform repetitive gripping or twisting actions with their wrist and hands. Males and females are equally affected, and usually it occurs between the ages of 30 and 50. Some say up to half of all tennis players get it to some degree, specifically related to playing a backhand. It begins as microtears at the origin of the main muscle implicated – extensor carpi radialis brevis (ECRB), which then heal by disorganized scarring. Patients mainly complain of pain with resisted wrist extension, and can often localize the exact spot where it is most tender. Some have an associated decreased grip strength.

Medial epicondylitis or ‘golfer’s elbow’ is also an overuse syndrome, but of the inside of the elbow. It involves repetitive strain of the flexor pronator mass, occurring in a similar population group, but is much less common. It can be very disabling and the mainstay of treatment is rest, pain and anti-inflammatory medication and stretching exercises. A counterforce brace is also helpful here, but steroid injections are less commonly used. Ultrasound has been shown to be helpful. In some cases it may be severe and affect the ulnar nerve, causing tingling down the arm to the hand and some grip weakness. If this is the case and non-operative management fails to improve it, surgery is indicated to release the nerve.



  • Management
Management

Non-operative

Non-operative management is the mainstay of management with avoidance of activities causing pain, non-steroidal anti-inflammatory drugs and paracetamol. A steroid injection into the painful area helps both relieve the pain and inflammation, and some patients have said that it has cured them. It is however not advisable to have more than 3, as repeated injections can cause further tissue degeneration.

A dedicated physical therapy rehabilitation regimen is advisable if symptoms are severe or not resolving. Some patients get great relief from a counterforce brace that is a strap worn just below the elbow, over the extensor muscle origin. Ultrasound/iontophoresis/shock wave therapy have some benefit in refractory cases. The main issue with this pathology is that it takes a long time to recover, and can be niggling and annoying.

Operative

Surgery is only really indicated after 6-12 months of non-operative management, and involves a small incision to release the fibrosed scar tissue.

Conditions Managed



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