Lateral Epicondylitis (Tennis Elbow) | Johns Hopkins Medicine

What is tennis elbow?

Lateral epicondylitis, commonly known as tennis elbow, is swelling of the tendons that bend your wrist backward away from your palm.

A tendon is a tough cord of tissue that connects muscles to bones. The tendon most likely involved in tennis elbow is called the extensor carpi radialis brevis. Tennis elbow is usually diagnosed in both men and women between the ages of 30 and 50 years.

What causes tennis elbow?

Tennis elbow, as the name implies, is often caused by the force of the tennis racket hitting balls in the backhand position. Your forearm muscles, which attach to the outside of your elbow, may become sore from excessive strain. When making a backhand stroke in tennis, the tendons that roll over the end of our elbow can become damaged. Tennis elbow may be caused by:

• Improper backhand stroke

• Weak shoulder and wrist muscles

• Using a tennis racket that is too tightly strung or too short

• Other racquet sports, like racquetball or squash

• Hitting the ball off center on the racket, or hitting heavy, wet balls

However, many people who suffer from tennis elbow do not play tennis. The problem can be caused by any repetitive movement. Other causes of tennis elbow include:

• Painting with a brush or roller

• Operating a chain saw

• Frequent use of other hand tools on a regular basis

• Using repeated hand motions in various professions, such as meat cutters, musicians, dentists, and carpenters

What are the symptoms of tennis elbow?

The following are the most common symptoms of tennis elbow. However, you may experience symptoms differently.

At first, you may have pain, burning, or an ache along the outside of your forearm and elbow. With time, the pain gets worse. If you continue the activity that caused your condition, the pain may spread down to your wrist, even at rest. Pain may also persist when you place your arm and hand palm-down on a table, and then try to raise your hand against resistance. You may also feel pain when you try to lift and grip small objects, such as a coffee cup. A weak grip is another symptom of tennis elbow.

The symptoms of tennis elbow may resemble other medical problems or conditions. Always see your healthcare provider for a diagnosis.

How is tennis elbow diagnosed?

Your healthcare provider can usually diagnosis your tennis elbow by a physical exam. In some cases, you may certain tests, such as:

• An X-ray to look at the bones of your elbow to see if you have arthritis in your elbow.

• Magnetic resonance imaging (MRI) can show your tendons and how severe the damage is. An MRI of your neck can show if arthritis in your neck, or disk problems in your spine are causing your arm pain.

•  Electromyography (EMG) of your elbow may show if you have any nerve problems that may be causing your pain.

How is tennis elbow treated?

It’s important to avoid the movement that caused your injury in the first place. Treatment may include:

• Rest and stopping the activity that produces the symptoms

• Ice packs (to reduce inflammation)

• Strengthening and stretching exercises

• Anti-inflammatory medicines (such as ibuprofen or naproxen)

If these treatments do not work, your healthcare provider may talk to you about:

• Bracing the area to keep it still for a few weeks or use of a special brace with activities

• Steroid injections to help reduce swelling and pain

• A special type of ultrasound that can help break up scar tissue, increase blood flow, and promote healing

• Surgery (rarely necessary)

What can I do to prevent tennis elbow?

• Keep your arms flexible and strong

• Avoid repetitive movements

• Warm up before exercising or using your arms for sports or other repetitive movements

• If you play a racquet sport, make sure your equipment is right for you

When should I call my healthcare provider?

• If  pain or trouble moving affects your regular daily activities

• If your pain doesn’t get better, or it gets worse with treatment

• You see a bulge or lump on your arm

Key points about lateral epicondylitis

• Lateral epicondylitis, or tennis elbow, is swelling or tearing of the tendons that bend your wrist backward away from your palm.

• It’s caused by repetitive motion of the forearm muscles, which attach to the outside of your elbow. The muscles and tendons become sore from excessive strain.

• Symptoms include pain, burning, or an ache along the outside of the forearm and elbow. It gets worse and may spread down to the wrist if the person continues the activity that causes the condition. The grip may become weak.

• Lateral epicondylitis is diagnosed by an exam of the elbow joint. The healthcare provider may need an X-ray or MRI to see what’s causing the problem. An EMG may be done to look for nerve problems.

• Lateral epicondylitis can be treated with rest and medicines to help with the inflammation. Exercises often help too. Rarely, surgery may be done to repair the tendon.

• You can help prevent lateral epicondylitis by doing things like warming up before exercise or sports, increasing activity slowly, using the right equipment for activities, and strengthening your arm muscles.

• Follow your healthcare provider’s recommendations to get rest and manage pain and swelling. Let your healthcare provider know if these strategies don’t help reduce pain, swelling, and loss of function.

What it is, Causes, Symptoms & Treatment

Overview

What is tennis elbow?

Tennis elbow is an overuse injury that occurs when tendons (tissues that attach muscles to bones) become overloaded, leading to inflammation, degeneration and potential tearing. It commonly affects tennis players who grip their racquets too tightly. But anyone can develop this painful condition, medically known as lateral epicondylitis.

How common is tennis elbow?

Between 1% to 3% of Americans get tennis elbow. It’s most common in people ages 30 to 50 and affects all genders.

Who might get tennis elbow?

Anyone who regularly performs repetitive activities that vigorously use the forearms, wrists or hands can get tennis elbow. Tennis elbow can affect recreational and professional:

• Baseball and softball players.
• Bowlers.
• Fencers.
• Golfers.
• Tennis, squash, pickleball and racquetball players.

People who work in certain professions are also more prone to tennis elbow:

• Assembly line workers and auto mechanics.
• Butchers and chefs.
• Carpenters, cleaners, painters and plumbers.
• Dentists.
• Gardeners and landscapers.
• Manicurists.
• Musicians.

Does tennis elbow affect one arm or both arms?

Tennis elbow typically affects your dominant side. But depending on the type of repetitive activities, you may get tennis elbow in both arms.

What’s the difference between tennis elbow and golfer’s elbow?

Tennis elbow is a condition of the lateral (outside) epicondyle tendon, or outer part of the elbow. Golfer’s elbow is a condition of the medial (inside) epicondyle tendon, or inner part of the elbow. The medical term for golfer’s elbow is medial epicondylitis.

People with golfer’s elbow have inner elbow pain that radiates down the arm. They can also have finger numbness and tingling. Golfers can get tennis elbow, just as tennis players may get golfer’s elbow.

Symptoms and Causes

What causes tennis elbow?

Repetitive arm movements can cause your forearm muscles to get fatigued. A single tendon attaches this muscle to the bony bump on the outside of your elbow (lateral epicondyle). As your muscle gets tired, the tendon takes more of the load. This overloading can cause inflammation and pain, known as tendinitis. Over time, this overloading can cause a degenerative condition known as tendinosis. Together tendinitis and tendinosis can then lead to tendon tearing.

Sometimes, a sudden arm or elbow injury causes tennis elbow. Rarely, people develop the condition for no known reason (idiopathic tennis elbow).

What are the symptoms of tennis elbow?

Tennis elbow is usually the result of overuse. Symptoms tend to come on slowly. Pain may get worse over weeks and months. Signs of tennis elbow include:

• Burning or pain on your outer elbow that may travel to your wrist (these sensations may get worse at night).
• Pain when twisting or bending your arm (for instance, to turn a doorknob or open a jar).
• Stiffness or pain when extending your arm.
• Swollen elbow joint that’s tender to touch.
• Weakened grip when you try to hold items like a racquet, wrench, pen or someone’s hand.

Diagnosis and Tests

How is tennis elbow diagnosed?

Your healthcare provider will perform a physical exam to check for elbow joint pain, swelling and stiffness. Your provider may also ask about activities that can cause pain. To make a diagnosis, you may have one or more of these tests:

Management and Treatment

What are the complications of tennis elbow?

Pain from tennis elbow can make it hard to work or do physical activities. The condition can also affect your grip, which can make it difficult to grasp items. In general, tennis elbow doesn’t cause serious, long-term problems.

How is tennis elbow managed or treated?

Tennis elbow may get better on its own with little, if any, treatment. However, that recovery may take up to 18 months. Proven nonsurgical techniques exist that can accelerate your recovery. Nonsurgical and minimally invasive treatments for tennis elbow include:

• Rest: You may need to stop or decrease activities for several weeks to give tendons time to heal.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs, including ibuprofen (Advil®) and naproxen (Aleve®), may ease pain and inflammation.
• Braces: Your provider may recommend wearing a removable support brace called a counterforce brace. This tool takes tension off of tendons and muscles.
• Physical therapy: Physical therapy exercises can strengthen forearm muscles and your grip. Massage, ultrasound or other muscle-stimulating techniques may help to reduce pain and improve function.
• Steroid injections: Injectable corticosteroids temporarily relieve joint pain and inflammation. These injections must be placed in the correct area, which is why many providers will perform these injections under ultrasound guidance.
• Platelet-rich plasma (PRP) therapy: Platelets are tiny cell fragments in your blood that aid healing. During a (PRP) therapy injection, your provider removes a small amount of blood and separates platelets from other blood cells. Then they inject the concentrated platelets into the injured area under ultrasound guidance.
• Extracorporeal shock wave therapy: Sound waves can break up scar tissue. Afterward, blood flow to the damaged area improves.
• Minimally invasive tenotomy: Your provider may perform a minimally invasive procedure to remove degenerative tendon tissue from inside your tendon. This procedure (called TenJet) uses a needle device with high pressured saline to create suction and hydro-resect the degenerative tendon tissue. This may be an alternative to a larger surgical procedure.

If symptoms don’t improve after six to 12 months of nonsurgical therapies, your provider may recommend surgery, like an arthroscopic or open debridement of the tendon or a tendon repair. Surgery typically involves removing the injured tendon and muscle. Your provider replaces the damaged tissue with healthy tendon and muscle from a different part of your body. Recovery can take four to six months. Once you’ve had tennis elbow, you may need to wear a brace to keep symptoms from returning.

Prevention

How can I prevent tennis elbow?

These steps can help you avoid tennis elbow:

• Don’t push through pain. Pain is your body’s way of talking to you, and you need to listen. Pushing through pain can lead to damage to your tendon and potential tearing.
• Check equipment for proper fit. For example, stiff or loose-strung racquets may reduce stress on your forearm.
• Lift weights to strengthen forearms and wrist muscles.
• Stretch wrists and arms before starting work or an activity.
• Wear an elbow brace to keep symptoms from worsening.

Outlook / Prognosis

What is the prognosis (outlook) for people who have tennis elbow?

Approximately 95% of people with tennis elbow get better with nonsurgical treatments. Afterward, they can resume activities. It may take six to 18 months for symptoms to go away.

A small number of people need surgery. Between 80% to 90% of people who get tennis elbow surgery see their symptoms improve within one year.

Living With

When should I call the doctor?

You should call your healthcare provider if you experience:

• Difficulty moving your arm, extending it or holding items.
• Red, swollen joints, or a bump or bulge on your elbow.
• Severe pain that interferes with sleep or daily activities.

What questions should I ask my doctor?

You may want to ask your healthcare provider:

• Why did I get tennis elbow?
• What is the best treatment for tennis elbow?
• What changes should I make to manage symptoms?
• What changes should I make to prevent the problem from happening again?
• Should I watch for signs of complications?

A note from Cleveland Clinic

Anyone who does activities or a job that requires repetitive arm motions (extending and bending) can get tennis elbow. See your healthcare provider if bending and straightening your arm causes pain or your outer elbow is tender to touch. Your provider can offer suggestions to reduce pain and inflammation. Rarely, people with tennis elbow need surgery. With proper treatment, you can safely return to the work or activities you enjoy pain-free.

What is Lateral Epicondylitis? (Also known as “Tennis Elbow”)

Lateral epicondylitis is commonly referred to as “tennis elbow” and affects 1-3% of the general population and 15% of workers in at risk industries. Tennis elbow, as the name implies, is often caused by the force of the tennis racket hitting balls in the backhand position. The forearm muscles, which attach to the outside of the elbow, may become sore from excessive strain. Tendons that connect these forearm muscles to the lateral bones of the elbow can roll over the end of the elbow and become damaged when making a backhand stroke in tennis. Specifically, tennis elbow can occur with improper backhand stroke, weak shoulder and wrist muscles, using an excessively tightly strung or short tennis racket, hitting the ball off center on the racket, or hitting heavy, wet balls. However, lateral epicondylitis is not limited to tennis players alone. It can be caused by a variety of sports and occupational activities such as painting with a brush or roller, operating a chain saw, or frequent use of other hand tools on a continuous basis.

The pain associated with tennis elbow is typically well localized and radiates into the upper arm or down to the forearm. The pain may increase down to the wrist, even at rest, if the person continues the activity that causes the condition. It is aggravated by lifting, repetitious use of the forearm and wrist, and shaking hands. Pain may cause weakness of the forearm. Symptoms of epicondylitis may occur suddenly or can develop gradually over time. Once they appear, symptoms are often persistent, although pain may spontaneously resolve. Symptoms occur most frequently in the dominant arm.

The diagnosis of tennis elbow usually can be made based upon a history of pain over the lateral epicondyle and on a physical examination. The physical examination findings may include local tenderness directly over the lateral epicondyle, pain aggravated by resisted wrist extension, pain aggravated by strong gripping or decreased grip strength. There is usually normal elbow range of motion and visual swelling is uncommon. Sometimes, an anesthetic-injection test is performed to confirm the diagnosis. In this test, an anesthetic is injected into the affected area. Epicondylitis is confirmed if the pain is temporarily relieved. In some cases, an x-ray of the elbow is necessary.

The goals of treatment are to allow the healing of forearm muscles and tendons, to reduce secondary inflammation, and to restore forearm muscle strength. Treatment of lateral epicondylitis in the acute period consists of activity restriction, pain relief, and immobilization. Movements involving the inflamed elbow such as lifting, hammering, repetitious wrist motion, and fine hand work should be eliminated to facilitate healing and avoid possible further injury. If tasks at work absolutely require such repetitive movements, then these actions should be avoided outside the workplace. Ice applied to the affected epicondyle for 15 to 20 minutes every four to six hours often results in pain relief. In patients who continue to have pain, a non-steroidal anti-inflammatory drug may be helpful. Many people find that immobilization for three to four weeks of the affected wrist and forearm reduces symptoms. Additionally, studies illustrate the effectiveness of corticosteroid injections within the first 6 weeks. Physical therapy has also been found to be effective after the acute period. Although rarely indicated, surgery, or lateral epicondylar debridement, may be considered in patients with refractory disease in whom symptoms have persisted for one year or longer.

Finally, preventive measures can be taken to prevent injury or recurrence of injury. A healthy elbow requires a healthy shoulder and wrist joint, and strong biceps and triceps to decrease the load on the smaller forearm muscles. Measures that avoid overuse and strain in the elbow and/or forearm include:

• Take frequent breaks from activities that require extensive hand/wrist motions.
• Reduce or avoid lifting objects with the arm extended.
• Reduce repetitive gripping and grasping with the hand and wrist. Decrease the overall tension of gripping.
• Avoid the extremes of bending and full extension.
• Work or weight train with the elbow in a partially flexed position. Use wrist supports when weight training.
• When using tools, increase the gripping surface by wearing gloves or adding padding. Use a hammer with extra padding to reduce tension and impact. Hold heavy tools with two hands.
• Use a two handed backhand in tennis.
• Apply grip tape or an oversized grip on golf clubs.

Disclaimer

This web site contains general medical information and does not replace the medical advice of your physician. If you have questions about your medical condition or exercises, ask your doctor or health care provider.

What causes tennis elbow and how you can alleviate some of your symptoms

Posted on: January 8th, 2015 by stephaniekrueger

Tennis Elbow? But I don’t play tennis….

Have you reached out to lift the coffee pot, or gripped your briefcase at your side and had pain in the outer part of your elbow? How many times have you done these activities before today without pain?

Tennis elbow, or lateral epicondylitis, is the overuse of the muscles and tendons that extend the wrist. These muscles attach at the bony area on the outside of the elbow (the lateral epicondyle) causing elbow pain.

5 Signs You Might Have Tennis Elbow:

1. Pain in the outer part of the elbow
2. Pain increased with gripping or wrist extension against resistance
3. Stiffness and pain with elbow motion, especially extension
4. Pain radiating into the forearm
5. Weakness of the wrist and hand

But I don’t play tennis, how did I get “tennis elbow?” There are many everyday activities that can contribute to lateral elbow pain.

• Lifting items repetitively including a gallon of milk or coffee pot
• Carrying heavy grocery bags or other items
• Typing for increased periods of time
• Using a screwdriver
• Gardening
• Raking leaves
• Shoveling snow

These are just a few activities requiring repetitive motions causing stress to the tissue that may result, overtime, in tiny tears in the tendons that attach the forearm muscles to the bony prominence at the outside of your elbow. Symptoms typically occur gradually following repetitive use of the wrist muscles, but onset can also be sudden.

If you are having symptoms, what can you do?

1. Rest: Limit forceful gripping and lifting with your injured arm
2. Ice: Apply ice to the affected area (the outer portion of the elbow)
3. Stretch:  Stretches should be performed with elbow as straight as possible and only to a point of mild tension. Hold 30 seconds each, 3x/day

4. Wrist support brace: A wrist support brace allows the overused muscles to rest and may be used during the daytime as needed, as well as during nighttime.

It is not uncommon for pain to continue to a few months or even up to a year. If pain is not managed by performing the above suggestions, it is important to follow up with a physician. Other treatments including Occupational or Physical Therapy may be beneficial to decrease your symptoms and improve the functional use of your arm.

Tennis elbow | healthdirect

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What is tennis elbow?

If you have pain on the outside of your elbow, you may have tennis elbow.

Tennis elbow is when there is a tear or swelling in the tendons that attach the muscle of the forearm to the bone in the upper arm. It is caused by repeated use of the muscles around the elbow.

If you stop doing whatever has caused the injury, tennis elbow usually gets better without treatment, but recovery can be slow, taking anything from a few months to 2 years.

What are the symptoms of tennis elbow?

Tennis elbow can cause the outside of the elbow and the upper forearm to feel sore and tender to touch. The pain may build up over several weeks until it becomes a severe, burning pain.

Other symptoms can include swelling of the area, and weakness or stiffness in the forearm. It may hurt to do certain movements, like shake hands or turn a doorknob. Pressing on the outside of the elbow may make the pain worse.

What causes tennis elbow?

You can get tennis elbow pain from playing tennis or from using your wrist and forearm a lot in other activities such as gardening, painting and other racquet sports.

You may also get tennis elbow if your work involves repeated movements of the wrist and forearm such as butchery, carpentry and plumbing.

Repetitive use of a computer keyboard or mouse is another possible cause.

Tennis elbow occurs when there is damage to the tendon that connects the muscles of your forearm to the bone in your upper arm.

How can tennis elbow be treated and prevented?

If you have tennis elbow, it may go away on its own without treatment. You do not need to immobilise the elbow with a sling. The Royal Australian College of General Practitioners (RACGP) suggests that you remain active, but avoid actions that cause significant pain and don’t lift heavy objects with your hands facing down.

Using an ice pack regularly and taking pain relievers can help. You may choose to use non-steroidal anti-inflammatories (NSAIDs), but research has not been able to clearly show that they definitely help recovery.

If your pain persists, and certainly if it has not improved after 6 to 12 weeks, it is advisable to see a physiotherapist. A physiotherapist can suggest exercises to stretch and strengthen the muscles in the arm, and may recommend that you wear a brace or strap on your forearm to reduce stress on the painful area.

If your pain is severe and does not improve, your doctor may suggest corticosteroid injections, although these are only used for short-term relief. Another type of therapy, called platelet-rich plasma injections, may also be an option.

Surgery for tennis elbow is rarely needed, but might be used if other treatments do not work over several months.

Your doctor or physiotherapist may also suggest ways you can change how you do certain tasks, to reduce the strain on your arm.

Sports Injuries to the Hand, Wrist, Elbow

The benefits of regular exercise are well known. But sports activity is one of the leading causes of injury to the hand, wrist and elbow. They range from overuse injuries like tennis elbow and golfer’s elbow to damage resulting from falls, such as skier’s thumb and wrist sprains. Learn about some of the most common sports injuries that affect the upper extremities.

Understanding the upper extremity

Together the hand, wrist, and elbow make up the “upper extremity.” Learning about the anatomy of each joint can help you better understand how it works and how you can best preserve its function and comfort for years to come.

Your hands are busy from the time you wake up and make your first cup of coffee in the morning to the time you go to bed and pull up the covers. The same may be said about the wrist, arguably the most complex joint in the body. And don’t forget the elbow, which enables you to feed yourself, brush your teeth, and get dressed each day.

Hand anatomy

Your hand contains 19 bones. There are 14 phalanges, the bones that make up each finger: three in each of the index, middle, ring, and pinky fingers and two in the thumb. There are also five metacarpal bones that make up the middle part of the hand. Numerous ligaments connect the bones to each other. Tendons connect muscles in the arm or hand to the bone to enable you to move your fingers. Sheaths are tubular structures that surround part of the fingers.

Your hands are essential for interacting with your environment. There are thousands of nerve endings in your fingertips. Arteries, veins, and nerves provide essential blood flow and sensation in the hand and fingers. This complex network can be challenging to navigate during surgery, requiring the expertise of an experienced surgeon.

Wrist anatomy

The wrist – the joint between your hand and arm – contains eight bones called carpal bones that are arranged in two rows. The scaphoid, lunate, triquetral, and pisiform bones move with the arm bones, and the trapezium, trapezoid, capitate, and hamate bones are connected to the bones of the palm. The carpal bones are connected by ligaments.

Many tendons connecting the forearm muscles to the fingers and thumb run through the wrist. Extensor tendons on the back of the wrist straighten your fingers, while flexor tendons on the front of the wrist bend them. Nerves and blood vessels also pass through the wrist. Together all of these structures work in a coordinated way to provide your wrist with exceptional range of motion.

Elbow anatomy

The elbow is the joint comprised of the end of the upper arm bone, called the humerus, and the two forearm bones: the radius and ulna. Your “funny bone” is the protrusion at the end of the ulna known as the olecranon. The joint is stabilized by ligaments at the front, back, and sides of the elbow. Muscles and tendons in the joint enable you to bend and straighten your arm and to rotate the forearm without moving the upper arm. The ulnar nerve runs through the elbow and into the forearm, along with a network of vital blood vessels.

What is skier’s thumb?

Skier’s thumb got its name because it’s often seen in skiers who fall on the hand with the ski pole still in the hand, but it can occur among any athlete who falls on an outstretched hand – such as lacrosse or basketball players or baseball players sliding into a base. The ligament at the base of the thumb stretches or tears, leading to instability in the joint along with swelling, tenderness, and bruising.

If the ligament is only stretched or partially torn, you can get by with a splint for several weeks. If the ligament is completely torn and folds back on itself, it will need to be surgically re-attached, followed by wearing of a splint for six weeks to recover. Repairing this ligament is crucial to prevent lifelong instability of the thumb joint. Since the thumb is responsible for about 50% of hand function, permanent instability would make it difficult to perform simple tasks such as opening a jar or turning a key. Timely treatment is essential. At three months following the injury, an orthopedic surgeon may not be able to reattach the ligament and more complex surgery may be necessary.

You can protect your thumb when you ski by slipping your hand up through the strap and then lowering your grip around the pole, with the strap between your hand and the pole. If you fall, the pole will release but dangle from your arm so you won’t lose it, and your hand will be protected. You can check to see how this works: open your hand and the ski pole should fall out. Baseball players can wear special gloves containing thumb protection for sliding into a base.

What is a wrist sprain?

In sports, a wrist sprain occurs when you fall on an outstretched wrist or stop yourself when running toward a wall. A sprain is a partial or complete tear of a ligament – in the case of wrist sprains, most often the ligament on the backside of your hand called the scapholunate ligament. Ligaments hold bones to bones, so when they are not intact, you’ll experience instability in the joint accompanied by pain and swelling. If not treated correctly early in their course, sprains can lead to arthritis. Ligaments are also less resilient than other tissues so when they tear, they can take longer to heal.

If you injure your wrist, see a doctor or visit an urgent care center to have it checked out. The provider will examine your wrist, ask how you injured it, assess your range of motion, and order an imaging test such as an X-ray to see if there is a fracture. You’ll likely need to wear a splint or cast to immobilize your wrist. If you don’t feel better 7 to 10 days later, consult a hand surgeon for a more thorough evaluation. Treating a wrist sprain effectively within six weeks of the injury will give you the best chance of a successful outcome.

Surgery may be needed if you have a complete tear to repair the damaged ligament. Your recovery can be as little as two to three weeks or as much as three months for more serious sprains. Hand therapy is an important part of rehabilitation – whether your wrist has been immobilized or if you have surgery. The exercises are vital for regaining strength and range of motion.

What is tennis elbow and golfer’s elbow?

These are tendonitis conditions that affect the two tendons of the elbow, and they result from overuse or playing with inadequate equipment. In the case of tennis elbow (lateral epicondylitis), the tendons that join the forearm muscles to the outside of the bony prominence of the elbow become inflamed. Golfer’s elbow (medial epicondylitis) affects the tendons attaching the forearm muscles to the inside of the elbow.

In both cases, strain gradually causes microtears in the tendon, and the inflammation that results causes pain that can make routine activities such as dressing or cooking difficult, or even interfere with your sleep. In addition, as a tendon breaks down and repairs itself over time, scar tissue may form, which may make it harder to treat. Tennis elbow may result from putting top spin on the ball on your dominant side or “late hits,” or from using a two-handed backhand on your nondominant side. Golfer’s may also get tennis elbow on their nondominant side.

Treatment for tennis elbow and golfer’s elbow

Most people get better with time and nonsurgical approaches such as rest, stretching exercises, a wrist splint or counter-force brace, and anti-inflammatory medications. Some patients achieve relief from symptoms through therapeutic ultrasound. Don’t expect a quick fix, however: The tendons do not contain a lot of blood vessels, so when there are microtears, they can take six to nine months to heal. Cortisone shots are often prescribed, but these may not be the right choice for all patients. They may bring relief for one to two months, but there is no evidence they speed healing. A hand therapist or physical therapist may be able to guide you on how to move better to avoid these conditions and to prevent you from adopting compensating movements that may result in injury to other tissues.

If your symptoms persist after six to nine months, you may need surgery. For both conditions, the surgeon removes the section of damaged tendon tissue and reconnects the healthy tendon to itself and to the bone.

Tennis and golfer’s elbow surgery recovery

It can take three to four months to recover from the surgery, with splinting, physical therapy, and abstinence from the sport all playing a role in your rehabilitation regimen. If the irritated tendon compresses the ulnar nerve, the surgeon may repair that during the procedure as well. Your hand surgeon and hand therapist will discuss the goals of treatment with you.

Do you need to give up tennis or golf? The answer is probably not. There are things you can do to reduce your risk of tennis or golfer’s elbow, such as:

• Playing with new tennis balls. You have to apply more force to hit old, worn-out balls.
• Don’t string your tennis racquet too tightly.
• Avoid hitting the tennis ball late.
• Make sure you are gripping your tennis racquet or golf club properly; consult with an instructor or pro for guidance.
• If possible, play on a soft tennis court such as clay or grass.
• Shallow your golf swing so there is less shock in the arm when you take a divot.
• Avoid lengthy sessions hitting a golf ball off of a fake turf mat (such as at a driving range) or from a sand trap.
• Do exercises to strengthen your forearm muscles to take the load off your elbow. A therapist can guide you.

Preventing hand, wrist and elbow injuries

While many sports injuries will get better on their own, others are more serious. See an orthopedic specialist for a consultation sooner than later, when treatment brings the greatest chance of a good recovery.

Preventing a sports-related hand injury may not always be possible, but there are steps you can take to reduce their impact if they do occur. Stretching and strengthening exercises that protect the hands and wrists are simple to perform and do not require special equipment. Dr. Carlson advises anyone who participates in athletic activities to:

• Practice strengthening exercises on a regular basis.
• Always stretch before playing
• Refrain from playing while experiencing pain.

For stretching, try extending the arm with elbows straight, and curling the hand to move the wrists up and down. Individuals can build strength by squeezing a ball in the hand, doing wrist curls while holding a soup can or a light weight, or extending the fingers against the resistance of rubber bands placed around them.

Posted: 12/21/2020

Authors

Michelle G. Carlson, MD

Attending Orthopedic Surgeon, Hospital for Special Surgery
Professor of Clinical Orthopedic Surgery, Weill Cornell Medical College

Daniel A. Osei, MD, MSc

Associate Attending Orthopedic Surgeon, Hospital for Special Surgery
Associate Professor of Orthopedic Surgery, Weill Cornell Medical College

Elbow pain | Causes, exercise, treatments

Some of the specific conditions that affect the elbow include the following:

Tennis elbow and golfer’s elbow

Tennis elbow and golfer’s elbow are two separate but similar conditions in which tendons become painful. Anybody can develop them, but they’re most common between the ages of 40 and 50. Tennis elbow is the more common of the two conditions.

Despite their names, playing tennis or golf aren’t the most common causes. They’re overuse injuries linked with activities involving repetitive actions of the wrist and hand.

People who are continually gripping and twisting – for example carpenters and plasterers, or people who use a computer mouse – may be at risk. Repetitive actions combined with weight, for example lifting heavy boxes, can also cause these problems.

Tennis elbow affects tendons on the outside of the elbow. Golfer’s elbow affects tendons on the inside of the elbow.

Symptoms

The main symptoms are pain and tenderness – on the outside of the elbow for tennis elbow, and on the inside for golfer’s elbow. People may also have pain when gripping.

The level of pain can vary from person to person, ranging from a mild discomfort to a severe ache that prevents you from sleeping.

Often all that’s needed is to stop or change any activities causing the problem or making it worse, alongside some self-care steps you can do at home.

Both conditions can last between six months and two years. Most people get better within a year. Unfortunately, they can both return.

Surgery for tennis and golfer’s elbow

Surgery is only needed for a small number of people with these conditions. These operations can be done using keyhole surgery or through a cut about 4 to 5 cm long. You should be able to start using the elbow gently straight after these operations, but it will take several weeks to fully recover, and you’ll usually need a short course of physiotherapy.

Olecranon bursitis

Olecranon bursitis occurs when the bursa at the back of the elbow becomes swollen and inflamed. Bursae, which is the plural for bursa, are sacs of fluid found where parts of the body move over one another, for example where tendons or ligaments pass over bones. They help cushion the area and reduce friction.

The olecranon is the bony tip you can feel on your elbow. It has a bursa between the bone and the skin.

Olecranon bursitis most commonly occurs when there is pressure or friction over the back of an elbow, for example if you often lean your elbows on a chair or table. For this reason, this condition is sometimes called student’s elbow.

Symptoms

The main symptoms of olecranon bursitis are:

• swelling, pain and warmth over the bony part at the back of the elbow
• restricted movement of the elbow.

Occasionally, bacteria can cause the bursa to become infected. Olecranon bursitis often clears up on its own, but if the condition is caused by an infection, your doctor will prescribe a course of antibiotics.

Resting your elbow and applying ice packs can help. If this doesn’t work, talk to your doctor about other treatment options. This may include a healthcare professional draining fluid with a syringe. This treatment is called aspiration.

Surgery for olecranon bursitis

A small number of cases may need surgery if this condition keeps coming back or affects everyday activities. The operation involves removing the bursa through a cut at the back of the elbow. Some surgeons have recently started to use keyhole surgery for this procedure.

Compression or entrapment syndromes

If the nerves that travel across your elbow into your forearm are squeezed or pressed on, it can cause symptoms in your forearms, wrist or hands including:

• pain
• tingling in the fingers and hands
• weakening of your muscles.

These are called compression or entrapment syndromes.

Cubital tunnel syndrome

Cubital tunnel syndrome is caused by the ulnar nerve being squeezed where it passes the inside of the elbow. This can be due to the space it passes through becoming tighter than usual.

In rare cases, it can be due to arthritis. Other causes can include a fracture around the nerve which has healed into a different position or new bone growing when the fracture heals.

Symptoms

The main symptoms of cubital tunnel syndrome are:

• tingling and numbness of your ring and little finger after your elbow has been bent for long periods or after you’ve been resting on the inner edge of your elbows
• weakness of the small muscles of your hand, causing your ring and little fingers to become claw-like – this only happens if it’s left untreated.

Radial tunnel syndrome

Radial tunnel syndrome is similar to cubital tunnel syndrome but is caused by the radial nerve being pressed on below the elbow. It’s a rare condition.

Radial tunnel syndrome normally gets better on its own.

Symptoms

The main symptom of radial tunnel syndrome is pain starting from the outside of the elbow that runs down to the forearm. Because this type of pain also occurs in tennis elbow the two can be confused, but with radial tunnel syndrome there’s no tenderness on the outside of the elbow – the problem is further down the arm.

Treatments for cubital and radial tunnel syndromes

A physiotherapist will be able to tell you about the best exercises for you.

Most cases can be treated at home by:

• stopping or changing movements that are aggravating your symptoms
• applying ice – such as a bag of frozen peas wrapped in a tea towel
• taking painkillers
• wearing a splint to support it – a GP, pharmacist or physiotherapist will be able to give you advice on the best ones to wear.

If your symptoms don’t get better after a few weeks, or if your pain is bad, see a doctor.

A small number of people will need surgery for these conditions. The operation involves making a cut to find the affected nerve, which is then freed from the tissues that are pressing on it. You can use your elbow for activities that don’t involve heavy lifting straightaway and continue with other tasks as your pain allows.

Distal biceps rupture

The bicep is the large muscle at the front of the upper arm. Its upper (proximal) end is attached at the shoulder and its lower (distal) end is attached to the upper part of the radius by a tendon close to the elbow joint. A distal biceps rupture is caused if this tendon close to the elbow tears, which can happen if you’ve lifted a heavy weight. You may hear the tendon snapping.

Symptoms

The symptoms of a distal biceps rupture are:

• a sudden and severe pain in the elbow, which gradually eases
• bruising around the elbow and forearm within a few hours or days after the injury first occurred
• the bicep changing shape and shifting up towards the shoulder – this is commonly called the Popeye sign
• difficulty in twisting the forearm to turn the palm upwards, for example when turning a door handle or using a screwdriver – your arm will feel weak compared to the unaffected arm when doing this.

A similar condition can occur in the triceps, the muscle at the back of the arm. This is called a distal triceps rupture and it can cause pain and swelling at the back of the elbow, and reduce movement. It’s very rare, but it can be caused by falling onto an outstretched hand.

Treatment for distal biceps rupture or triceps rupture

If you think you have a distal biceps rupture or a triceps rupture you should seek medical attention as soon as possible. These conditions may require urgent surgery to prevent permanent damage to your arm. You should either go to an accident and emergency department or book an urgent appointment with your GP.

Surgery may be recommended depending on your level of activity and whether your activities need you to twist your forearm. This operation involves making a cut over the front of the elbow and fixing the torn tendon back onto the radius.

90,000 Tennis Elbow and Golfer’s Elbow

These diseases are otherwise called external and internal epicondylitis – chronic diseases of the elbow joint, which is a degenerative-inflammatory process at the points of attachment of muscle tendons to the epicondyles of the humerus.

As a rule, epicondylitis occurs as a result of chronic microtraumatization of the tendons and their attachment points to the epicondyle of the humerus, but can also result from direct trauma.Histological examination reveals an excessive number of fibroblasts, insufficiency of microvessels in this area, replacement of normal tissue with scar tissue. Scar tissue is not capable of performing the function of normal tissue, and therefore, symptoms characteristic of epicondylitis appear.

Tennis elbow

External (lateral) epicondylitis is most common. With this pathology, as a result of microtraumatization, the tendons of the extensor muscles of the wrist (brachioradialis muscle, long and short radial extensors of the wrist) are affected.This disease affects people whose activities are associated with repeated flexion and extension of the forearm at the elbow with a load, for example, tennis players, whence the disease has its second name – tennis elbow.

Symptoms of the disease

Pain on the outside of the joint, sometimes radiating down the forearm or up the shoulder.
Pain occurs most often during the extension movement in the elbow joint, when lifting a load. As a rule, there is no pain at rest.

Golfer’s Elbow

Internal (medial) epicondylitis occurs as a result of microtraumatization of the tendons of the flexor muscles and muscles that provide rotation of the forearm. This disease is most susceptible to athletes playing golf (which gives the disease its second name – “golfer’s elbow”), table tennis or tennis and people who often have overloaded forearm muscles.

Symptoms of the disease

Pain on the inner surface of the elbow.The pain that occurs when the arm is bent at the elbow joint or when the arm rotates around its axis can also occur at rest, spreading to the entire joint.

Diagnostics

A traumatologist can diagnose internal and external epicondylitis during examination. There is rarely a need to prescribe instrumental methods – radiography, ultrasound, magnetic resonance imaging.

Treatment

Unfortunately, conservative treatment of epicondylitis is ineffective.As mentioned above, the disease is associated with chronic trauma to the tendon attachment sites and replacement of normal scar tissue. Therefore, the use of anti-inflammatory drugs is aimed only at the short-term elimination of pain. The use of hormonal drugs is dangerous in that it suppresses the already slowed down regenerative processes, thereby, over time, deteriorating the condition of the tendons and their attachment points.

In the 90s of the last century, a method of shock wave treatment of tennis elbow and golfer’s elbow was developed and successfully introduced in Europe.

The use of a shock wave in the treatment of this pathology made it possible to fight directly with the pathological process itself – with a shock wave effect, the scar tissue dissolves, new microvessels grow, which leads to the restoration of the normal architecture of the tendon tissue. Thus, the pain syndrome does not just stop, but the cause that caused it disappears. The tendon again becomes elastic, which makes it possible to re-accept the usual physical activity, return to sports

Tennis Elbow: Home Treatment

Causes and symptoms of the development of epicondylitis.At-risk groups. Treatment methods.

Tennis Elbow or Lateral Epicondylitis: Causes, Symptoms and Treatment

Does the pain on the outside of the elbow joint prevent you from playing sports, working at the computer and doing household chores? It is possible that you are suffering from a form of the disease such as “tennis elbow” . The medical name of the disease is lateral epicondylitis .

You will be surprised, but not only tennis players face this disease.More precisely, athletes make up just over 10% of patients with epicondylitis. Who is susceptible to this type of joint inflammation and what modern medicine offers to combat the disease – we will consider in this article.

Contents:

• Causes and symptoms of the development of epicondylitis.

• Who suffers from this form of joint inflammation.

• Modern methods of treatment:

1. Kinesio taping

2. Shockwave therapy

3. PRP therapy

• Prevention of epicondylitis: professional advice.

Causes and symptoms of epicondylitis

All the muscles of the forearm, which are responsible for the movement of the fingers and hand, are attached to the humerus at two points – along the outer and inner epicondyle. Constant and high physical exertion on these muscles causes microtrauma, including in the tendons. Microtrauma in the joints attachment points over time lead to chronic pain and inflammation.

Depending on the focus of inflammation, external and internal epicondylitis are isolated.The external type acts as a complication when stretching the outer part of the elbow joint. Internal – with loads on those muscles that are responsible for the flexion-extensor function of the arm. There is a third type of epicondylitis – damage to the back of the elbow that occurs after trauma and bruising.

In this case, the external form of the disease is more common than the internal one. As a rule, men are exposed to it. And not only athletes. Any professions that are associated with constant stress on the elbows and wrists: painters and other specialists in the field of construction and repair, musicians, massage therapists, IT specialists and others.

Make an appointment with a traumatologist-orthopedist Ondar Temir Evgenievich and you will receive an effective treatment program :

What are the symptoms of epicondylitis?

The main symptom of “tennis elbow” is aching pain in the elbow or shoulder joint, which is not accompanied by any external changes. In this case, the patient experiences painful sensations only at the moment of loading the joints (flexion-extension).This distinguishes epicondylitis from an elbow injury.

Over time, when the disease worsens, the patient is unable to move the arm, experiences night pains, numbness in the fingers and loss of muscle strength. In the acute phase of epicondylitis, a person suffers pain with a simple handshake and lifting even an empty cup.

Attention! If you experience temporary pain in the area of ​​the elbow joints, please see a doctor immediately! Painful sensations with the “tennis elbow” may recede, but the inflammation of the tendons continues to destroy the joint from the inside, becoming a chronic form.

Who suffers from this form of joint inflammation

At risk are :

• Patients aged 30 to 65 years old, on average 45–54 years old.

• Experienced smokers.

• Women and men who are engaged in monotonous manual work: seamstresses, cashiers, masseurs, office workers, etc.

• Athletes. If tennis players, then they are more amateurs than professionals who do not have the correct technique. Hard strikes with an inverted wrist racket load the tendons and cause the development of the tennis elbow.

• People who suffer from congenital connective tissue dysplasia.

Modern treatment methods

So, who is to blame for epicondylitis, we figured it out.On the agenda is the question – what to do? Treatment methods for tennis elbow are mostly conservative. First of all, they include procedures that allow you to relieve pain syndrome:

• local anesthesia with ointments;

• physiotherapy;

• exclusion (in the acute stage) or limitation of the load on the joint;

• in rare cases – blockade pain-relieving injections (steroids, hormones, anesthetics).They are not aimed at tissue regeneration, therefore they only act to reduce painful sensations.

If epicondylitis is suspected, cold procedures are contraindicated: do not cool the sore elbow. Yes, it will help relieve pain, but tendon inflammation will continue to progress.

Consider a few more innovative and effective methods for restoring damaged joints.

Kinesio taping

Treatment with tapes is a simple way to reduce pain and swelling in lateral epicondylitis in the subacute and late period of inflammation. The specialist applies the application for a period of 3 to 5 days. Moreover, the tapes do not impede movements, they are not felt on the body. They provide muscles with 24/7 support and relieve pain, including during physical exertion.

The main thing is to choose high-quality and proven tape tapes that do a good job with their functions.

Shockwave therapy

Tennis elbow has been successfully treated with physiotherapy. The most effective of them is shock wave therapy, which copes well with the disease both independently and in combination with other techniques.

Shock (acoustic) waves, which we cannot perceive by ear, penetrate deeply into tissues, quickly relieve pain and inflammation. The effect is noticeable after 1-2 sessions.However, during the course of SWT, it is extremely important to avoid physical exertion and adhere to the most sparing regimen for the diseased limb.

PRP-therapy

PRP therapy is a new method of injection therapy. It is based on the introduction of the patient’s own platelets into the joint cavity, which improve tissue regeneration. Of all injection procedures, this method is the most preferable, since it affects not only the symptoms of pain, but also deeply penetrates into the joints, relieving inflammation and providing a healing effect.

Using a concentrate of its own plasma restores joint mobility 2-3 times faster than with conventional drug therapy.

Prevention of epicondylitis: professional advice

• Office workers. Use ergonomic computer technology, and also observe the height of the furniture: the elbows should be completely on the table, reducing the tension on the muscles of the forearm. Take breaks.

• For sports fans. Observe correct tennis technique. Ideally, get a special briefing. Choose the optimal weight for your sports equipment.

• Construction workers. Use a cordless tool that does not restrict your movement. Lift weights with your palms up. Dose the load.

Fortunately, conservative treatment in 95% of cases is enough to overcome the disease and get rid of the disease for many years.However, it should be remembered that with heavy loads or injuries, the risk of getting a relapse is quite high. Doctors recommend adhering to the rules for the prevention of epicondylitis, as well as contacting a doctor at the first sign of pain.

Sports and Rehabilitation Center “New Step” offers modern and effective methods of treating “tennis elbow”. Reception is led by experienced specialists who develop an individual treatment program and accompany patients at every stage of the study.

You can sign up for a consultation by calling +7 (495) 477-55-40 or via the online feedback form.

Epicondylitis (tennis elbow, golfer’s elbow) – treatment, symptoms, causes, diagnosis

Lateral and medial epicondylitis are similar diseases, localized in the upper extremities. Epicondylitis causes pain and functional impairment and usually results from certain physical activity associated with professional and sports activities. Lateral , originally described by Morris as “tennis elbow” in 1882. Currently, “tennis elbow” can occur in people when performing any activity that is accompanied by repeated flexion and extension of the forearm at the elbow with stress. Medial , commonly referred to as “golfer’s elbow”, can occur in athletes, discus throwers, tennis players, and workers in repetitive occupations (such as carpenters).Lateral epicondylitis occurs 7-10 times more often than medial epicondylitis. Both types (lateral and medial) are most common between the ages of 40 and 50, both in women and men.

Lateral epicondylitis is most often the result of repetitive microtrauma, but may result from direct trauma. It is quite common among tennis players, especially non-professionals, in whom the lack of normal technique of movements is a provoking factor. Lateral epicondylitis is caused by repetitive contractions of the extensor muscles of the extensor forearm, especially at the insertion site, resulting in micro-ruptures followed by degeneration, insufficient regeneration, and, as a consequence, tendinosis.The lack of vascularization on the inferior surface of the tendon further contributes to degeneration and tendinosis.

Initially, it is believed that the disease arises from an inflammatory process involving the radial humeral bursa, synovium, periosteum and annular ligament. In 1979, Nirschl and Pettrone described their observations as disorganization of the normal architecture of collagen by fibroblasts, which, with insufficient vasculature in this area, cause a process they called angiofibroplastic hyperplasia, later described as “angiofibroplastic tendinosis.”Over time, scar tissue from these processes replaces normal tissue, which further weakens the tissue and puts it at greater risk of damage. The continuation of this cycle of injuries and imperfect regeneration impair biomechanics, disrupt muscle function and lead to symptoms.

Epicondylitis is a degenerative-dystrophic process with the involvement of the extensor tendons in the lateral and the tendons of the flexor-pronator muscle group in the medial. It is believed that systematic stress leads to tendinosis.Microtrauma and partial tears can lead to significant thickening of the tendon. The diagnosis is made on the basis of a thorough history of physical and instrumental examination. In most patients, it is possible to relieve the inflammatory process by prescribing a short course of NSAIDs and using orthoses. Treatments also include injections of autologous blood or platelet-rich plasma, extracorporeal shock wave therapy, iontophoresis and phonophoresis with drugs that penetrate deep into tissues.

In addition, rehabilitation program includes measures that contribute to a gradual increase in muscle strength, elasticity and functionality in order to restore the ability to work or the ability to continue playing sports. In rehabilitation, it is important to eliminate any biomechanical disorders that could lead to the initial trauma.

While conservative treatment is often successful, sometimes there is a need for instrumental examination methods, such as MRI or ultrasound.These studies are necessary to verify the presence of calcifications, the degree of tendon damage, the presence of bone growths and when planning surgical treatment methods. Differential diagnosis is sometimes necessary for lateral epicondylitis with fracture, osteoarthritis, tunnel syndrome. If medial epicondylitis is suspected, medial osteoarthritis, medial ligament injury, and ulnar neuropathy should be ruled out, although these conditions may occur concurrently with epicondylitis.

Symptoms and Diagnosis

Patients with lateral epicondylitis are characterized by the presence of pain in the elbow, which increases when the weight is held in the arm during extension. Playing tennis or similar athletic movements can actually cause epicondylitis, but it is often associated with other activities. On palpation in the area of ​​attachment of the tendons, about 1 cm distal to the middle part of the epicondyle, compaction and soreness are noted. In addition, there is a decrease in muscle strength with resistance to grip and with supination of the hand.There are also tests such as chair lift (with arm pronation) and coffee cup test (in which the patient lifts a full cup of coffee). Elbow pain usually occurs with these tests. The diagnosis of lateral epicondylitis is usually clinical. Epicondylitis can be moderate or severe in degree.

With medial epicondylitis, the pain is localized in the medial part of the elbow. Symptoms (pain) develop gradually in patients with medial epicondylitis (except for acute trauma).Muscle weakness during grasping is also noted. Patients may have a history of golf, basketball, volleyball. On palpation in the area of ​​flexor-pronator tendons (5-10 mm and distal to the middle part of the medial epicondyle), induration and tenderness are noted. In addition, the pain is exacerbated by the resistance of the wrist to flexion of the forearm and pronation at a 90 ° angle. Flexion contractures can develop in professional athletes due to muscle hypertrophy. It is necessary to differentiate medial epicondylitis with tunnel syndrome and ulnar neuritis.There is a simple “milking” test (simulated milking), which causes increased pain in medial epicondylitis.

However, sometimes there is a need for instrumental diagnostics (imaging) for differential diagnosis with other diseases. It is noted that 5% of people with a primary diagnosis of lateral epicondylitis have radial tunnel syndrome. Radial tunnel syndrome is compression of the posterior interosseous nerve (deep branch of the radial nerve) in the radial tunnel.Many patients with this syndrome have a history of activity associated with frequent pronation and supination of the forearm. The most common finding on MRI in radial tunnel syndrome is edema, denervation, or atrophy in the muscles innervated by the posterior interosseous nerve.

MRI – diagnostics helps to make an accurate diagnosis. But normal visualization is possible only on high-field devices (magnetic field strength is 1 Tesla or more).

Ultrasound is a rather informative research method that allows visualizing this pathology.

EMG – the study is necessary only for signs of conduction disturbances (with tunnel syndromes and neuritis).

Treatment of epicondylitis

Treatment of epicondylitis is mainly conservative: the use of orthoses during exacerbation and at night, shock wave therapy, ultrasound therapy or galvanization, sometimes local administration of corticosteroids, drug treatment (NSAIDs). In addition, exercise therapy is needed to restore function (a gradual increase in the load on the forearm).Conservative treatments are effective in 90% of cases. In the absence of the effect of conservative treatment within 3-6 months, surgical treatment is recommended.

90,000 Epicondylitis: What Is It And How To Treat It?

What is lateral epicondylitis of the elbow?

Your elbow joint is made up of 3 bones: your humerus and two bones in your forearm (radius and ulna). In the lower part of the humerus there are bony tubercles, called epicondyles, in which several muscles of the forearm begin to move.The bump on the outside of the elbow is called the lateral epicondyle.

A tendon adjoins this epicondyle of the humerus, which continues with the muscle of the outer surface of the elbow and its main task is to lift the hand.

Elbow epicondylitis is an inflammation or, in some cases, a microcracked tendon that connects to the muscles of the forearm on the outside of the elbow. Inflammation can be acute and chronic, lateral and medial.

Reasons

The muscles and tendons of the forearm are damaged from overuse – repeating the same movements over and over again for 2 hours or when moving loads over 20 kg at least 10 times a day.Direct elbow strikes or sharp jerks can also be unsuccessful. All this can lead to inflammation and microcracks in the tendon and, as a result, to epicondylitis.

Disease incidence

Tennis elbow is one of the most common diseases of the hand. The incidence ranges from 3 to 11 patients per 1000 per year. The prevalence ranges from 1% to 3% in the general population and can be as high as 23% in workers and athletes. People of the following professions are especially prone to the development of epicondylitis: painters, plumbers, carpenters, butchers, cooks.The peak prevalence of “tennis elbow” is estimated at 1.3% in people aged 45 to 54.

Symptoms

Symptoms of lateral epicondylitis (LE) of the elbow joint develop gradually. In most cases, pain starts out mild and gets worse slowly over weeks to months. The dominant hand is most commonly affected, but both hands can be affected. Usually, no specific trauma occurs with the onset of symptoms.

More often, patients complain of lateral pain in the elbow joint, which often radiates to the muscles of the proximal extensor of the forearm:

• Pain or burning sensation in the outer part of the elbow;
• Weak grip strength;
• Pain at night;
• Sharp pain with forearm activity: holding the racket, turning a wrench, or shaking hands.

With severe inflammation, the pain can be so severe that even holding a cup of coffee will be a test.

Treatment of epicondylitis

When making a diagnosis, your doctor will take many factors into account: how your symptoms developed, how active you are, what sports you do, how old you are, and whether you have had an elbow injury.

For an accurate diagnosis, the doctor may prescribe additional tests: ultrasound of the elbow joint, x-rays to clearly display dense structures, magnetic resonance imaging (MRI) to image the soft tissues of the body, including muscles and tendons.If your doctor thinks your symptoms may be related to a neck problem, an MRI of the neck may be done to see if you have a herniated disc or arthritic changes. Both of these conditions can cause pain in the arm.

The most common methods for treating tennis elbow:

1. Restriction of movement, rest and rest . These are the first steps towards reducing inflammation. You will have to stop / reduce sports, hard work and other activities that cause painful symptoms for several weeks.
2. Cold compresses .
3. Medicines . An anti-inflammatory drug such as acetaminophen or ibuprofen can be taken to reduce pain and swelling. Non-steroidal anti-inflammatory drugs (NSAIDs) containing diclofenac, ketoprofen, or others that act symptomatically and do not cause tissue regeneration may also be prescribed.
4. Physiotherapy . Special exercises help to strengthen the muscles of the forearm.Massage, iontophoresis and laser therapy are effective to improve muscle healing.
5. Wearing bandages and orthoses . Using a brace centered on the dorsum of the forearm promotes rapid recovery. The brace massages the tissues during exercise, stimulates metabolism and circulation, and helps relieve swelling.
6. Steroid Injection . Steroids (cortisone) are very effective anti-inflammatory drugs.They are injected into the area around the lateral epicondyle to relieve symptoms.
7. Plasmolifting . Blood is taken from the patient, then the resulting material is centrifuged to obtain plasma. Platelet-rich plasma (PRP) injections are intended to improve the biological environment of the tissue. Platelets are known for their high concentration of growth factors that can be injected into the affected area.
8. ESWT (Extracorporeal Shock Wave Therapy) – shock wave therapy.Sound waves of various frequencies create “microtraumas” that promote the body’s natural healing processes. Shockwave therapy is considered experimental by many doctors, but numerous studies support the effectiveness of the method.

Approximately 80% to 95% of patients succeed with conservative treatment. If symptoms persist after 6–12 months of conservative treatment, surgery will be required.

Tennis Elbow

Are you worried about acute pain in the elbow area? In a few days, the pain increases to such an extent that it is impossible to work with the hand normally.Beware, it could be tennis elbow or epicondylitis. If the diagnosis and treatment are neglected, the problem can lead to joint destruction and patient disability.

Specialists of the Freedom of Movement Medical Center will make an accurate diagnosis, prescribe treatment and prophylaxis in order to eliminate the problem as quickly as possible.

Tennis elbow is an inflammation that develops against a background of tendon sprains. Because of this, a person feels pain in the elbow, and in the absence of medical care, he can seize the synovial bag.The disease is also fraught with destruction of the joint, which in itself leads to disability.

Causes of tennis elbow disease

• Constant loads on the elbow;
• violation of blood flow;
• repetitive hand actions;
• osteoporosis;
• osteochondrosis;
• joint injuries, etc.

This is important! The disease is not exclusively professional for tennis athletes.The disease got its name because of the main reason for its occurrence – the stereotyped hand movements, as in the game of tennis. It is found in both athletes and patients of working specialties, as well as massage therapists, musicians, drivers, that is, with constant overload of the elbow joint.

Make an appointment

Symptoms of the disease “tennis elbow”

• severe joint pain;
• numbness of the hand in this area;
• tingling, creeping sensation in the elbow area;
• muscle tension or, on the contrary, the powerlessness of the affected arm;
• acute pain in the elbow.

This is important! To diagnose tennis elbow, special tests and mobility tests are performed. In some cases, MRI diagnostics may be prescribed.

How to treat tennis elbow?

• therapeutic massage;
• physiotherapy procedures;
• physiotherapy exercises;
• medications can be prescribed to relieve pain;
• joint rest mode, a fixing bandage is applied to the elbow so that in everyday life a person does not subject his hand to stress.

When contacting a doctor, acute symptoms will be relieved in a few days.

Where to start treatment?

From an appointment at the Freedom of Movement Medical Center, where experienced neurologists are treated. Experts in their field will assist in the treatment: massage therapists, chiropractors, orthopedists. Sign up for a consultation by phone: +7 (495) 212-08-81. Do not waste time – contact for a speedy recovery!

Elbow arthroscopy

European standards for the treatment of injuries and diseases of the musculoskeletal system in Kiev!

The first elbow arthroscopy was performed in 1980 and made the diagnosis, treatment and recovery after surgery easier and faster than with the traditional method of surgery.Improvements in elbow arthroscopy occur every year as new instruments and techniques are developed.

Anatomy

The elbow is a complex joint, which is formed by the junction of three bones: the humerus, ulna and radius.

The surfaces of the bones where they join are covered with articular cartilage. It is a smooth substance that protects bones from damage during movement and acts as a natural shock-absorbing cushion. A thin, smooth tissue called the synovium covers all the remaining surfaces inside the elbow joint.In a healthy elbow, this membrane releases a small amount of fluid that lubricates the cartilage and eliminates almost any friction as you flex and twist your arm. On the inside and outside of the elbow, there are thick lateral ligaments that stabilize the joint and prevent the bones from moving relative to each other. The elbow joint is surrounded by muscles in the front and back. In addition, the three main nerves that cross the elbow joint are located close to the articular surfaces and capsule and must be protected during arthroscopy.

Two main directions of movement occur in the elbow joint: flexion-extension (flexion and extension) and rotational (pronation – palm down and supination – palm up).

When is shoulder arthroscopy recommended?

Your doctor may recommend an elbow arthroscopy if you have a painful condition if conservative treatment is ineffective. Conservative treatment includes relief (rest), physical therapy, pills, and injections that can reduce inflammation in the joint.Inflammation is one of the body’s normal responses to injury or painful conditions. In an injured or sore elbow joint, inflammation causes swelling, pain, and impaired mobility (function).

Injuries and age-related wear and tear (osteoarthritis) are the causes of most problems in the elbow joints. Arthroscopy can relieve the painful symptoms of many pathological conditions that damage articular cartilage and periarticular tissues. Arthroscopy may also be recommended for patients to remove loose intra-articular fragments of bone and cartilage tissue, and remove scar tissue that blocks movement in the joint.Arthroscopic indicated at:

• Treatment of tennis elbow (external epicondylitis).
• Removal of free intra-articular bodies (free cartilage and bone fragments).
• Removal of scar tissue to improve range of motion.
• Treatment of osteoarthritis (joint wear).
• Treatment of rheumatoid arthritis (inflammatory arthritis).
• Treatment of patients with osteochondritis dissecans. (mainly for athletes-throwers and gymnasts).

Surgical procedure

Before surgery, the doctor will prescribe intravenous or intramuscular antibiotics to reduce the risk of infection after surgery.Elbow arthroscopy is usually performed under general anesthesia.

The patient will be positioned on the operating table (lying on his side or on his stomach) so that the surgeon can easily adjust the arthroscope and have a clear view of the inside of the elbow. A tourniquet is applied. The surgical team cleanses the skin with an antiseptic and covers the shoulder and upper body with sterile surgical drapes.

Surgeons usually draw lines on the elbow to indicate anatomical structures (eg, ulnar nerve, olecranon process) and also mark the arthroscope camera and micro-instrument portals.

Your surgeon will first fill the elbow joint with fluid. The fluid helps the surgeon see the structures of the elbow more clearly through the arthroscope camera. This reduces the risk of damage to the blood vessels and nerves surrounding the elbow joint. Your surgeon will make several small incisions to insert the arthroscope and small instruments into the joint.

The same liquid even through the arthroscope, which allows you to control any bleeding. Arthroscope footage projected into a monitor showing your surgeon, inside the elbow, performing joint surgery.

Postoperative period

After the operation, you will stay in the ward for 1 to 2 hours, after which you will be discharged home. Although recovery from arthroscopy is often faster than recovery from open surgery, it can still take several weeks to fully recover. During this time, you will feel discomfort for at least weeks after the operation. … Your doctor will likely prescribe pain relievers and anti-inflammatory medications that you will take regularly for the first few days after your surgery.

It is important to apply ice and raise your elbow regularly for 48 hours after surgery. This will reduce the risk of developing edema and reduce the sensation of underwear. When lifting the arm while doing the exercises, make sure that the elbow is higher than the heart. Depending on the type of surgery, your doctor may have specific instructions for a specific case. You also need to move your fingers and wrist frequently to stimulate circulation and reduce swelling. It is very important to perform early smooth movements in the operated joint, in a certain range and amplitude, in order to prevent stiffness (contracture) of the joint.The time for rehabilitation and return to daily activities will depend on the type of surgery and how well you follow the instructions and instructions. Dressings Performed on an outpatient basis, the stitches are removed on the 14th day.

Rehabilitation plays an important role in getting you back to your daily activities. The physiotherapy program will help you regain movement, strength and function and will be scheduled on your first postoperative visit to your doctor. The type and duration of therapy will depend on the type of surgery.Returning to driving, working, will depend on a number of factors and should be discussed with your doctor.

Rehabilitation plays an important role in getting you back to your daily activities. The physiotherapy program will help you regain movement, strength and function and will be scheduled on your first postoperative visit to your doctor. The type and duration of therapy will depend on the type of surgery. Returning to driving, working, will depend on a number of factors and should be discussed with your doctor.

Since patients have different preoperative diagnoses of pathologies and conditions of the elbow joint, age, full recovery time is different and individual for each patient and can take from several weeks to several months.

Which doctor should I contact with pain in the elbow joint

Orthopedists in Moscow – latest reviews

The unhurried doctor does everything with a sense of the constellation.The survey is detailed, the inspection is detailed. I liked his comprehensive approach, the doctor does not try to dismiss the patient, works conscientiously. I was at his reception and will be back for sure. The quality of the treatment provided does not cause any complaints, everything was excellent. The doctor coped with the task with a bang.

Gulya,

01 November 2021

I liked the reception and the doctor is wonderful.Sergey Vladimirovich is a professional doctor, I have no complaints against him. At the appointment, he confirmed my diagnosis, and we continue treatment with him. I received everything I needed from the reception.

Moderation,

04 November 2021

At the consultation, the doctor examined me and said that you can do without expensive pills.Received an intensive course of treatment. The doctor selected very good and affordable procedures that had a very positive effect on the body. The results obtained were consolidated with a specialist. Now it is much easier and more painless to move.

Alla,

October 31, 2021

The doctor has extensive practice in the treatment of the cervical spine, this is immediately evident.After examination, he prescribed treatment. The prices are reasonable. I am satisfied with the reception

Moderation,

04 November 2021

I liked everything at the reception.Andrey Igorevich is a very professional, attentive specialist, interested in the patient’s recovery. He devoted much time and attention to the spine, which other osteopaths had never done before. The doctor is looking for the cause of the disease.

Natalia,

01 November 2021

A wise specialist and a good person.Nice to talk to and not scared to tell your complaints. Irina is meticulous, trying to understand the problem and find a comprehensive solution. I came with an aura migraine. I am satisfied with the consultation and the prescribed treatment, it helps me, I have already copied one attack in the bud. I recommend a specialist.

Moderation,

04 November 2021

The doctor is very attentive.The reception went very well. This is not the first time we have contacted this doctor. I am pleased. The child’s got a finger. Sergei Igorevich examined, gave recommendations, prescribed treatment, prescribed a second appointment. The specialist knows how to communicate with children, jokes, speaks teeth. I recommend this surgeon.

Anna,

02 November 2021

The doctor is attentive, neat.The reception went well. Ruslan Vladimirovich examined me, prescribed the procedures that were needed, tests, ultrasound, and consulted. Things are good. The consultation lasted 20-30 minutes. The doctor explained everything in an accessible way. Would apply again, I would like the approach to treatment.

Anonymous,

01 November 2021

A friendly, pleasant doctor, I liked it.A professional in his field. The reception went well. Maria Vladimirovna explained and explained everything competently and in detail, prescribed the necessary treatment. I was satisfied. I will contact this specialist again. I would recommend a doctor to my friends, if necessary.

Natalia,

02 November 2021

I gave the doctor injections into the inside of the joint, my knee joint hurts.came to the appointment with pain, underwent all the necessary examinations and received several treatment options to choose from. I wanted to quickly and effectively, I chose injections. The doctor did all the manipulations carefully, trying not to cause unnecessary pain as much as possible. I am very pleased with the result. I was lucky with a doctor, a nice person and an excellent specialist.

Juliana,

02 November 2021

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