TENNIS & GOLFER’S ELBOW
Doctor Knab, MD, Doctor Arora, MD and Physicians Assistant Anthony Gore Provide Treatment for Golfer’s and Tennis Elbow Relief, Therapy, and Exercises
Actual question from a patient
“I haven’t played tennis in 8 years, and I’ve never played a round of golf in my life, so how can I have golfer’s elbow AND tennis elbow??”
Tennis Elbow
You do not need to be a pro athlete to suffer from lateral epicondylitis (Tennis elbow) or medial epicondylitis (Golfer’s elbow). Each of these annoying conditions may result from overuse or misuse of the affected arm, and can be debilitating no matter what your profession. Let’s look at each condition a little bit further and see what can be done to help.
Lateral Epicondylitis -Tennis Elbow – is probably the more common of the two conditions. Victims typically include construction workers, plumbers, and chefs, as well as the seasonal “Paul Bunyons” or “Tim Taylors” of the world, who might spend an entire weekend chopping wood or acting out an entire week’s worth of “Home Improvement” episodes. As you might expect from its name, this condition affects the lateral (outside) part of the elbow, and is a result of either chronic inflammation or microscopic tears of the common extensor tendons of the forearm. (Tendons are the tissues that attach the muscle to the bone.) The most commonly affected tendon in tennis elbow is the Extensor Carpi Radialis Brevis, or ECRB.
What are the symptoms of Tennis Elbow?
Symptoms typically include a sharp pain that starts at the outside of the elbow, and gets worse with specific activities that require use of the affected muscles, such as twisting motions (using a screwdriver), squeezing motions (pruning roses or bushes), and of course using a racquet such as in squash or tennis.
At-home treatments include the use of ice packs (15 minutes on, 15 minutes off, for 2-3 cycles, 2-3 times a day), NSAIDS (Ibuprofen, etc. for up to 4 weeks), and “counterforce braces” that can be strapped around the elbow to provide stabilization of the affected area. It also makes good clinical sense to avoid doing the things that make the pain worse. At least for a while….
Steroid injections may be very helpful — if your pain is due to inflammation — but may only be partially helpful, or only temporarily helpful —if the symptoms are due to microscopic tears of the tendons. Steroid shots can actually be harmful over time in cases where a person is suffering from microscopic tears since they can interfere with healing and lead to muscle atrophy.
Orthobiologic procedures (using a person’s own platelets or stem cells) are showing real promise in conditions where standard therapies have not been effective. By using either PRP (Platelet Rich Plasma — made from a person’s own blood) or Stem Cells (most commonly taken from a small sample of bone marrow), we can precisely target areas of damage previously identified on MRI or Ultrasound and flood them with millions of the cells needed to “jump-start” the healing process. Occasionally, other natural products such as dehydrated placental tissue (derived from carefully screened maternal placenta) will be added to act as a “scaffold” for the cells to begin the healing process and form new tissue.
Medial Epicondylitis – Golfer’s Elbow is just as painful as tennis elbow, but it occurs on the medial (inside) part of the elbow. Despite its name, the most frequent cause that we hear these days are the pitching injuries in baseball that lead to “Tommy John Surgery” to repair the ulnar collateral ligament (UCL). However the more common version of this disorder typically involves the common flexor tendons (Pronator Teres, Flexor Carpi Ulnaris, Flexor Digitorum Superficialis, Pronator Teres, and Palmaris Longus). While the condition got its name from the game of golf, other activities such as lifting a heavy suitcase awkwardly, bowling, and yes even too much TENNIS can bring on golfer’s elbow!
Symptoms typically involve sharp pain on the inside of the elbow that may radiate down into the forearm or hand, and may be aggravated by hand-shaking or any activity that involves bending the palm of the hand towards the body.
If you’ve already read about treatments for tennis elbow, you can stop reading — they’re the same for golfer’s elbow, including the non-surgical options of PRP and stem cells.
As in most things in medicine, treatment of tennis elbow and golfer’s elbow begins by making the correct diagnosis, and then following the most conservative course of care possible. While in rare instances surgery may be the only permanent solution for persistent tennis elbow or golfer’s elbow, we are now at the point in the evolution of medicine that a patient suffering with these conditions has many non-surgical options as well!
