Elbow pain.. are tennis and golf to blame? - Sports Medicine Doctor Malta - Dr Danica Bonello Spiteri

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Elbow pain.. are tennis and golf to blame?

Elbow pain... are tennis and golf to blame? (First published on vida magazine on November 2013)

Lateral Epicondylitis, or as it is more commonly referred to, tennis elbow is an overuse injury of the forearm and its attaching muscles (the wrist extensor muscles) that cause pain at the lateral side of the elbow.
Tennis elbow usually affects the dominant arm in about 75% of people and it arises as a result of repeated wrist extension activities, as would occur in someone who plays tennis using a backhand technique, hence the name. However, in actual fact it is often seen in non-tennis players!

There is never usually any history of direct trauma to the elbow, but the pain is of a gradual onset with no apparent cause, yet if questioned further, a history of increasing use of the wrist extensor muscles can be elicited.  The pain can vary from mild pain that is only present when wrist extension occurs, or it may present with severe pain where even holding up a glass of water may be too painful.

The pain is located at the lateral (outer) side of the elbow and is worse when objects are gripped with the hand, or when shaking hands. Some associated numbness of the forearm may also be present.

The diagnosis is does not usually require any imaging or scanning as the history and examination is adequate in most cases. However, if imaging is required, ultrasound is the best form of imaging, where the tendon of the wrist extensors that attaches to the elbow is seen to be degenerate (tendinopathic). Occassionally specks of calcium may also be seen within the tendon

The tendon that is affected is known to be degenerate (tendinopathic), and not inflammatory, as was previously thought. Hence any form of treatment that involves anti-inflammatories is incorrect and will not help to cure this condition. The same can be said about injecting the tendon with steroid injections, as this will not help the overall outcome in the longer term.

Adequate treatment should focus mainly on removal on the factors that resulted in this injury in the first place. Individual assessment of the cause must be carried out, as it is related to overuse – usually to one’s regular job activities or hobbies.

Definitive possible options for long term treatment may include rest, ice and alteration of activities undertaken. Additional interventions may include:

  • Eccentric loading exercise programme aimed at stretching and strengthening the injured tendon to restore it to its normal strength and form

  • Dry needling of the tendinopathic (degenerative) tendon, with the idea of stimulating an inflammatory response within the tendon, so as to enable healing.

  • Calcium deposits within the tendon may at times need to be broken down to decrease the pain

  •  Extracorporeal shock wave therapy, where shock waves are directed at the tendon to hasten tendon healing

  • Platelet rich plasma injection, where blood is taken out of a normal arm vein, then spun down so as to separate the blood cells from the plasma. The plasma, rich in healing factors, is then injected into the tendon, to enable healing

  • Surgical interventions are reserved as a last resort when all other options have failed.

On the other hand, a golfer’s elbow is much less common, but has the same type of pathology as a tennis elbow. The only difference is that it affects the inner (medial) side of the elbow and the muscles that cause wrist flexion. It is referred to as golfer’s elbow as it is the type of wrist movement that golfer’s carry out, yet it is more often than not, found in non-golfers. Treatment options lie on the same lines as a tennis elbow.

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