Tennis & Golfers Elbow

This condition is classically seen in tennis players although is common in golfers or anyone who has undertaken unaccustomed heavy manual work which involves a lot of lifting and carrying.

Tennis Elbow (Lateral Epicondylitis)

What is it?

This condition is classically seen in tennis players although is common in golfers or anyone who has undertaken unaccustomed heavy manual work which involves a lot of lifting and carrying.

What are the symptoms?

Pain is felt over the outside of the elbow joint. A small area (the lateral epicondyle) is usually exquisitely tender. The pain may spread down into the forearm. Gripping and carrying make the pain worse.

How is the diagnosis made?

The doctor will listen to the description of events and examine the elbow. X-rays will also be taken to determine whether there is a piece of bone involved. Usually no further investigation is needed although sometimes, in difficult cases, ultrasound or MRI scanning may be helpful.

What is the initial treatment?

Firstly, it is important to determine why the condition occurred so that recurrence may be avoided. If it is sports related, the equipment or grip must be altered. Often the racquet handle is too small or too big for the hand.

An injection of local anaesthetic and steroid into the most tender spot (the lateral epidcondyle) gives instant relief and allows therapy to begin.

Exercises to improve wrist flexibility and increase the wrist flexor and extensor muscle strength must then be started as these are part of the initial problem.

A further 1-2 injections may be given if the symptoms recur.

A number of bands and devices are available to place round the forearm. These aim to “offload” the insertion of the extensor muscles into the lateral epicondyle. They are not a substitute for therapy but do provide symptomatic relief.

If the initial treatment does not work, what is next?

If injections and therapy fail to settle the symptoms then surgery may be required to excise the scar tissue over the lateral epicondyle.

How can further injury be prevented?
  • Keep the wrist and elbow supple.
  • Keep the flexor and extensor muscles strong.
  • Have sports equipment checked to ensure that the grip is appropriate for the hand size.
  • Do not suddenly increase the demands on the area (i.e. build up to sports and no sudden
    weekends of heavy manual labour).
  • Be aware of any pain, stop the activity.

Golfers Elbow (Medial Epicondylitis)

What is it?

This condition is classically described in golfers although is common in anyone who has undertaken unaccustomed heavy manual work, which involves a lot of lifting and carrying, particularly with the palm turned up. Golfers may also get Tennis Elbow (lateral epidcondylitis).

What are the symptoms?

Pain is felt over the inside of the elbow joint. A small area (the medial epicondyle) is usually exquisitely tender. The pain may spread down into the forearm. Gripping, carrying and flexing the wrist all make the pain worse.

How is the diagnosis made?

The doctor will listen to the description of events and examine the elbow. X-rays will also be taken to determine whether there is a piece of bone involved. Usually no further investigation is needed, although sometimes, in difficult cases, ultrasound or MRI may be helpful.

How is the diagnosis made?

As with the traumatic type of dislocation the history of the events will be taken and the shoulder examined. Investigations are performed as for the traumatic type.

What is the initial treatment?

Firstly, it is important to determine why the condition occurred so that recurrence may be avoided. If it is sports related the equipment or grip must be altered. Often the racquet handle is too small or too big for the hand.

An injection of local anaesthetic and steroid into the most tender spot (the medial epicondyle) gives instant relief and allows therapy to begin.

Exercises to improve wrist flexibility and increase the wrist flexor and extensive muscle strength must then be started as these are part of the initial problem.

A further 1-2 injections may be given if symptoms recur.

If the initial treatment does not work, what is next?

If injections and therapy fail to settle the symptoms then surgery may be required to excise the scar tissue over the medial epicondyle.

How can further injury be prevented?
  • Keep the wrist and elbow supple.
  • Keep the flexor and extensor muscles strong.
  • Have sports equipment checked to ensure that the grip is appropriate for the hand size.
  • Do not suddenly increase the demands on the area (i.e. build up to sports and no sudden
    weekends of heavy manual labour).
  • Be aware of any pain, stop the activity.

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