Epicondylitis – Tennis Elbow / Golf Elbow

Janet D. Pearl, MD, MSc

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Epicondylitis (Tennis Elbow / Golf Elbow)

Epicondylitis of the elbow can be either Lateral Epicondylitis (tennis elbow or Medial Epicondylitis (golf elbow). These conditions can be acute, when there is inflammation and swelling due to an injury (tendonitis) or can be chronic, when muscles and tendons that are in poor health are overused resulting in continual pain (tendinopathy).

Lateral Epicondylitis

Lateral Epicondylitis or tennis elbow is a painful condition of the elbow caused by overuse of the tendons that join the forearm muscles to the lateral epicondyle, the outside bony portion of the elbow.  It is caused by overuse of the extensor tendons of the forearm, especially trying to stabilize the wrist when the elbow is straight.  Tennis elbow is not just an ailment of tennis players.  Painters, plumbers, and carpenters are particularly prone to developing tennis elbow. Studies have shown that auto workers, cooks, and even butchers get tennis elbow more often than the rest of the population.  Common symptoms of tennis elbow are:  Pain or burning on the outer part of the elbow and weak grip strength.

tennis elbow

Medial Epicondylitis

Medial epicondylitis or Golfer’s elbow is a painful condition felt at the  medial epicondyle, a bony bump on the inside of the elbow, where the  muscles that flex your wrist and fingers attach. Golfer’s elbow is caused when more wrist flexion force is applied than the muscles and tendons can handle. Golfer’s elbow occurs not only in golfers, but also is those who practice trades where gripping is involved.   It can occur at any age, however, sufferers are generally between the ages of 35 and 50.  Males and females are affected equally.   Common symptoms are: tenderness directly over the bony medial epicondyle, and often points of tenderness in the wrist flexor muscles.

epicondylitis

Treatment of Epicondylitis

Conservative treatment options for acute epicondylitis include rest, ice, or immobilization of the elbow. Commonly used medications includes non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen, and diclofenac. Physical therapy using specific exercises to strengthen and stretch the muscles of the forearm is important to treat the tendinopathy. When tendonitis pain is severe and not improving with conservative measures , ultrasound guided corticosteroid injections to the covering tissue (sheath) of the tendon can be helpful.  In chronic tendinopathy, dry needling of the tendon can help restart the healing process.  Ultrasound or extracorporeal shock-wave therapy have also shown to be effective to treat tendonpathy.  Platelet rich plasma  (PRP) injections are an excellent treatment of tendinopathies.  PRP can be very helpful in accelerating the healing process when previous treatment options have not proved effective.

Medications for epicondylitis:

medications for epicondylitis

Physical Therapy for epicondylitis:

epicondlyitis PT

Ultrasound guided corticosteroid injections for epicondylitis:

ultrasound guided injection for epicondylitis

PRP for epicondylitis:

PRP

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