Epicondylitis / Tennis & Golfer’s Elbow

I have a painful elbow

If you have experienced onset of pain at the inside or outside of your elbow, you might have epicondylitis (Tennis or Golfer’s elbow).

What is epicondylitis?

Epicondylitis describes a state of inflammation locally where tendons have their origins at the bone. At theses locations the bone has a prominence which serves as the anchor point for a tendon or a group of tendon and muscles. Which starts as a circumscribed inflammation can extend in chronic cases into the tendon and cause partial as well as full thickness tears in the tendon origin.

What is Tennis elbow?

Tennis elbow describes lateral epicondylitis at the outside of your elbow. The humerus (upper arm bone) has a prominence (epicondyle) which serves as the origin and fixation for the ‘common extensor group’. This is a system of muscles and tendons that run along the backside of the forearm and in part into the tip of the fingers. This muscle-tendon unit generates all motions that extend wrist and fingers. The origin of the ECRB muscle (extensor carpi radials brevis muscle) is most commonly affected by inflammation and tearing. Historically tennis players aggravated this pathology due to excessive training of their backhand which resulted in overuse of the common extensor group and subsequent inflammation. Rarely these days patients who present with tennis elbow have acquired the condition actually by playing tennis.

What is Golfer’s elbow?

Golfer’s elbow is medial epicondylitis of the inside of the elbow. At a bony prominence (epicondyle) the ‘flexor-pronator’ group has its origin. The flexorpronator group generates wrist and finger flexion as well as forearm inward rotation (pronation), which brings the palm of the hand facing down. The strongest wrist flexor is the FCU muscle (flexor carpi ulnas muscle) and inflammation as well as tearing commonly appear at the FCU origin. Synonymous to tennis elbow the term has historical value as during the golf swing this muscle-tendon unit is stressed. Change in technique has made this condition much rarer amongst golfers and most patients who present with condition theses days are non golfers.

What are the signs of epicondylitis, Tennis and Golfer’s elbow?

Pain at the inside or outside of your elbow is the chief complaint. Tennis elbow aka lateral epicondylitis generates or Golfer’s elbow aka medial epicondylitis can be differentiated. The pain is rarely associated with Tennis or Golf. It can occur as slowly increasing pain over time to patients who are exposed to repetitive and monotonous manual tasks. The pain is increasing in nature and gets aggravated when using hands and fingers. Advanced stages also produce night pain and elbow stiffness. Lateral and medial epicondylitis can also occur after acute trauma directly to the elbow or indirectly when falling onto the outstretched hand.

Who gets epicondylitis, Tennis and Golfer’s elbow?

Epicondylitis occurs most often to workers who are exposed to repetitive and monotonous manual tasks.

How is epicondylitis, Tennis and Golfer’s elbow diagnosed?

Next to typical pain patterns and provocative test, ultrasound and MRI scan are able to show changes in the tendon tissue. They can also differentiate between inflammation (tendinosis) and tendon tear. In chronic cases Xray might show calcification or bony spurs at the epicondyle.

I need treatment for epicondylitis, Tennis or Golfer’s elbow

Treatment for epicondylitis requires pain medication, anti-inflammatories and physiotherapy. Most hand therapists are also highly qualified to treat the condition where rebalancing both groups of forearm muscles is key. Stretches and resisted exercises next to deep tissue massage are part of treatment. If there is no progress after six to eight weeks with this management, cortisone or better PRP injection (platelet rich plasma injection) can be considered. The injection requires immobilisation of the elbow for up to 3 weeks to enhance it’s potential.

My epicondylitis, Tennis or Golfer’s elbow is not improving

Epicondylitis should be managed non-operatively for three to six months. If the condition has not resolved despite all measures mentioned above, surgical tendon repair and debridement is an option. Commonly a repeat ultrasound scan at this stage shows progression of inflammation or progression to full thickness tendon tear. This kind of surgery requires a direct incision to the epicondyle and several techniques are available for surgical repair. The elbow requires immobilisation following the procedure. Surgery can be carried out as a day case.

Preparing for epicondylitis surgery

Prior to the procedure, we will arrange for one preconditioning physiotherapy or hand therapy session where we fit a custom brace, explain some simple exercises and give you an ice bladder with icing instructions. If required we will also arrange for a bulk billed pre-admission clinic at the hospital. This is run by a specialist anaesthetist who will gather information and request investigations that are required for safe anaesthesia. Our reception staff will advise of costs, hospital and admission details.

Recovery from epicondylitis surgery

At the end of surgery your elbow will be placed in the previously fitted custom brace. This brace will also hold the wrist in extension for lateral epicondylitis or mild flexion for medial epicondylitis. After ten days the brace will be shortened and elbow exercises commence. Whilst pain and motion recover quickly it is advisable to not lift heavily or push and pull for eight to ten weeks after surgery.

Golfer’s Elbow