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Inflammation of the inside or outside extensor or flexor tendons of the elbow, often called tennis elbow, is very common. The inflammation can arise from overuse such as playing multiple sets of tennis in one day or from a direct injury such as hitting a ball hard and feeling sudden pain at the elbow. Activities causing epicondylitis are not tennis alone; it can stem from golf or repetitive activities, such as washing windows, which can cause inflammation on the inside or outside of the elbow. A diagnosis can often be made through a patient’s history and physical examination. Sometimes, an MRI is used to isolate the area of inflamed tendon.
Immediate physical therapy, soft-tissue massage, and mobilization of tissues often diminish the course of the inflammation. Additionally, recent therapies using growth factors and platelet-rich plasma (PRP) have been helpful in speeding the healing response. Rarely is surgical intervention required but when it is required, the recovery is reasonably rapid and success rates are quite high.
Lateral elbow injury
Otherwise known as "tennis elbow," this condition is characterized by pain and weakness along the muscles and tendons on the outside of the elbow (extensor mechanism) right by the bony protrusion (lateral epicondyle). This injury is seen in many sports such as tennis or golf, as well as any activity or work which requires repetitive grasping or gripping. Chronic stress to the extensor carpi radialis brevis and extensor carpi radialis longus results in swelling and micro-tearing of the tissue, which in extreme cases causes a creaking of the tendon as it is being flexed and extended. Very chronic cases can have capsular restrictions as well.
Medial elbow injury
The extreme forceful contraction of the wrist flexors as in a golf swing or baseball pitch can cause an overuse injury to the inside of the elbow. Sometimes referred to as "golfer's elbow" or "little leaguer's elbow" in adolescents, this injury involves the pronator teres, flexor carpi radialis, and sometimes the flexor carpi ulnaris (the tendons on the inside of the forearm leading to the elbow). Unlike lateral epicondylitis, which most often happens as the result of repetitive mechanical and postural flaws, medial epicondylitis is usually a true overuse syndrome or as the result of one forceful contraction, such as a baseball pitch, which set off the symptoms.
Diagnosis of tennis elbow
Lateral injury diagnosis
First, a careful history of the injury is obtained--paying close attention to subtle clues such as morning pain, an increase in keyboard use at work, or changes in golf grip. Demonstration of tennis, golf, or hammer gripping technique or stance position (i.e. open vs. closed in tennis) can help spot clues on mechanical predisposition. Palpation will reveal pain along the anterior inferior aspect of the lateral epicondyle, made worse with active grasping. It is also important to rule out any other conditions such as a cervical problem, thoracic outlet condition, or nerve entrapment. Special tests, such as pain with manual-resistance wrist extensions with the hand in a fist, helps to confirm the diagnosis. An MRI is helpful to clarify the pathology and to rule out associated lesions.
Medial injury diagnosis
A detailed history of the injury is important to discover the most likely cause or mechanism of injury. Again, it is important to rule out more insidious conditions which may be manifesting themselves in the elbow. Point tenderness is found at the medial aspect of the elbow right at the attachment of the flexor mechanism of the wrist and hand. Pain with resisted wrist flexion also aids in confirming the diagnosis. An MRI is helpful to identify the pathology.
Treatment of lateral tennis elbow
Initial care consists of ice and ice massage to the area 3 - 5 times a day for 10 - 15 minutes to control the pain and swelling of the tissue. The use of anti-inflammatories for the first couple of weeks as prescribed your physician is also effective in controlling the inflammation. Depending on the extent of the symptoms, we have found the use of a wrist splint to be very effective. Treatment should consist of soft-tissue treatments to reduce the adhesions, passive stretching of the extensors, eccentric training of the flexors, a postural program, and modification of aggravating factors. It is also important to treat any shoulder conditions such as instability or significant rotator cuff weakness. An appointment with the local club pro can improve mechanical contributing factors, as well as equipment-related problems such as grip size or string tension.
Treatment of medial tennis elbow
Icing or ice massage 3 - 5 times a day for 10 - 15 minutes along with anti-inflammatories will aid in controlling the swelling and inflammation. Passive stretching of the flexors coupled with soft-tissue mobilization is effective in improving elbow mechanics. A shoulder and postural program, wrist splint, and modification of aggravating factors are all effective initial treatment plans. Once the initial symptoms are reduced, a progressive strengthening program of the flexor mechanism, beginning with resisted isometrics in neutral position and advancing to eccentrics as comfortable, is introduced.
Additional treatment options for tennis elbow
Additionally, recent therapies using growth factors and PRP have been helpful in speeding the healing response. Rarely is surgical intervention required; when it is required, the recovery is reasonably rapid and success rates are quite high.
Tennis elbow rehabilitation
Immediate physical therapy, soft-tissue massage, and mobilization of tissues often diminish the course of the inflammation.