Health of Elbow

Mark Lorenze, MD

Tendonitis of the elbow is a medical condition that affects nearly 50% of all avid racquet sports players at some point in their career.

In a typical general orthopaedic practice, a physician may evaluate up to 3-5 patients a day with the symptoms and exam findings consistent with lateral epicondylitis, a.k.a. tennis elbow. However, only 5% of the patients with tennis elbow will actually be involved in racquet sports -the term tennis elbow is somewhat of a misnomer. Surprisingly, a majority of patients with the diagnosis of tennis elbow are manual laborers, machinists or office workers.

The symptoms of tennis elbow include recurring pain on the outside of the upper forearm just below the elbow joint. The pain tends to radiate down the top of the forearm to the wrist. Pain can be exacerbated by simple activities such as lifting a gallon of milk or light objects such as a coffee cup. In the morning, patients often experience stiffness and pain in the elbow. Tennis elbow can be a chronic condition that can last briefly (3-12 weeks) or several years.

Anatomically, tennis elbow occurs because of small microscopic tears in the muscle that helps extend the wrist. The location of these microscopic tears is at the lateral epicondyle, which is a honey prominence on the outside of the elbow. After the initial injury occurs, the muscle is subjected to repeated injury and bleeding. The body has a difficult time healing this injured area because of poor local blood supply, and chronic inflammation results. In medical terminology, the condition is called lateral epicondylitis, which indicates inflammation at the site of tendon attachment at the elbow.

If the condition becomes chronic and does not respond to rest, an injection of corticosteroid can be extremely effective in relieving pain and helping with the healing process. Occasionally, several injections are needed to achieve long term relief. A total of three injections can be safely given. Also, the use of a tennis elbow brace can be effective. If the condition persists despite conservative treatment, surgery may be recommended. Surgical treatment is generally very successful, but often takes 6-9 months before patients can comfortably resume racquet sport activity.

To prevent tennis elbow from recurring, several activity modifications and exercises are recommended. When you are performing repetitive lifting activity, lift objects with your palm up. Also, try strengthening exercises with hand weights. With your elbow bent at 90 degrees and Your palm down, repetitively bend the wrist with a 3-5 lb weight in Your hand - stop if you feel any discomfort. To stretch before an activity, grasp the top of your fingers with your other hand and firmly flex them back towards your palm (keeping your arm fully extended). You should feel a stretching sensation in your elbow. Another recommendation for platform tennis players is to try to change the grip size and/or decrease the density of the paddle racquet. Changing the density of the racquet may act to absorb the shock of the ball when it contacts the racquet and therefore reduce stress on the elbow.

Call your orthopaedist if pain in the elbow lasts for two weeks or longer or if the elbow begins to swell. Other conditions that may affect the elbow include arthritis, gout, infection or so-called "golfer's elbow". Golfer's elbow is another form of tendonitis that occurs on the inside of the elbow. I have seen this condition afflict racquet sports players as well. An orthopaedist can easily distinguish between various elbow conditions in addition to providing treatment recommendations.

Listen to what your body is telling you. If you are an active tennis/ platform tennis player and you develop elbow pain, try to treat the condition early before the condition becomes chronic and more difficult to treat. If tennis elbow is recognized early, the player has the best chance of recovery and the best chance to avoid a trip to the operating room. If you have any questions regarding this common condition, please contact me at mlorenze@aol.com.