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Tennis Elbow and Epicondylitis

Lateral and medial epicondylitis are commonly associated with golf and tennis. Although, there are many other situations where you can get this disorder. Lateral epicondylitis is sometimes called "tennis elbow". Medial epicondylitis is sometimes called "golfers elbow."  And thatís because the activity, the actual swing of the golf club and the stroke of the tennis racquet you put stress on these respective structures. Of course itís a repetitive thing. If you go out and play golf or tennis you do this hundreds and hundreds of times. One thing that Iíve noticed is that if you have ever bought one of these computer desks or a cabinet from one of these furniture companies where it comes in a box.

You figure you will just do it with your hand screwdriver and you turn and turn and turn. You know, hundreds of screws. And thereís always a big bag of parts left over and you donít really know what they are for, but at the end of a day like that sometimes you will feel it in your elbow because of the constant pressure on the muscles where they insert on the elbow; either the ulna or the radius. One thing to remember, this is not a true tendonitis. The bellies of the muscles actually insert on the bone and what happens is there are sort of micro-evulsions and hemorrhage and thatís what causes the pain. Patients often complain of pain when they shake hands, when they try to open or close a door or a jar, or any repetitive motion like turning a screw, or if they are golfers or tennis players. Those are their biggest concerns.

When you examine them you will find point tenderness over the respective epicondyle and also if you do certain maneuvers. For epicondylitis - and thatís what this is showing. In my experience thatís more common, and thatís not because my patients are big tennis players. I donít know why it is but I think itís just maybe the activities that they do at home cause it more. What you can see here is the forearm is supinated and the wrist is extended. You ask the patient to push up on your hand to fully extend that wrist and they will have a lot of pain right over the lateral epicondyle and if you do the exact opposite maneuver for medial epicondylitis where you pronate the forearm and bend the wrist up, and push down on the wrist, you will get pain over the medial epicondyle.

The treatment of these things is to refrain from these activities. If they are a tennis player or a golf player, tell the patient not to do it for a few weeks and give it a chance to heal up. If itís like a one-time episode, it may not come back again. Antiinflammatory drugs are very helpful if the patient can tolerate them. Injections - now this is one instance where I prefer not to use an injection unless the more conservative measures donít help. Because, if you just feel over your elbow, the lateral and medial epicondyle, there is hardly any soft tissue there. If you stick corticosteroids and lidocaine, corticosteroids can cause a little bit of a reaction. Sometimes it will even make the symptoms worse. So I donít necessarily do this right off the bat. Again, there are other rheumatologists and orthopedists who, when they see a patient like this, they just give an injection. If you have a patient who has persistent or recurrent symptoms - say they play golf, and particularly with tennis - this forearm splint can help.

When a patient has epicondylitis related to an occupation, thatís a little more difficult problem, especially if their employer is hard-driving. Sometimes modifying what they do can help. If they can use their other hand for that activity - it depends on their job. What I would like is to rest them until they are symptom-free. Because if they still have symptoms that means there is still some hemorrhage and inflammation there. That might take a couple of weeks. On the other hand, employers might even be reluctant to have them go back because they donít want to have a disability situation on their hands. Obviously, each employer is going to be different. Some of them will just try to find them a job where they donít have to do the same exact thing. Others of them care a lot less and just make them go back again and again. But I would wait until they are symptom-free. Probably ten days to two weeks. So antiinflammatory drugs, maybe and injection. Again, the forearm brace may help those patients. Itís not much different really than playing tennis or golf, itís just that these people depend on it to make money. Some people do play golf and tennis to make money.

In the elbow, several structures can be involved. The first is the olecranon bursa, which is right over the point of your elbow. The most common thing that I see is olecranon bursitis due to trauma. Is anybody from Philadelphia, Philadelphia area? Well, Einstein Hospital is affiliated with Moss hospital which is a big rehab hospital and a lot of the patients have had a stroke or theyíve had a hip replacement. And the nurses and therapists are telling them, "Get up, letís move, get dressed" and they use their arms a lot.