Tennis Elbow and Golfer's Elbow - Causes, Symptoms, Treatment and Prevention

Tennis elbow occurs due to a small tear/microtear in the tendon(s) on the outside of the elbow (lateral side) that attach the forearm muscles to the elbow joint (lateral epicondyle). Excessive use of the wrist and fingers results in inflammation and tiny tears at the muscle tendons located at the outer side of the elbow. Repeated tears lead to the development of damage in the tendon known as angiofibroblastic hyperplasia. The microtear and subsequent development of the damaged tissue is due to forceful and repetitive forearm use.

Golfer's elbow is similar to tennis elbow, but excessive use of the wrist and fingers results in inflammation and tiny tears at the muscle tendons located at the inner side of the elbow rather than the outer side.

Tennis Elbow Symptoms

• Pain and tenderness over the lateral epicondyle (elbow joint), often radiating down the forearm
• This causes pain and tenderness over the outer side of the elbow, especially when lifting loads and during forceful gripping of the fingers
• Pain is worse on resisted wrist and finger extension with the elbow in full extension
• Initially, symptoms may be activity related but in chronic cases, the pain and tenderness may become constant

Golfer's Elbow Symptoms

• Pain and tenderness over the inner side of the elbow, especially when lifting loads and during forceful gripping of the fingers

Age: You are at higher risk if over 40 years old.

Activity: Regular tennis of more than two hours playing time each session, or a similar activity.

Technique: Tennis players with poor stroke technique (hitting the ball with a flexed elbow) and improper grip size.

Other factors: Hard court players are more likely to develop a problem compared to those who use other surfaces.

When the pain and tenderness become frequent, and recur despite adequate rest and analgesics, you should seek medical advice.

Diagnosis of this condition is essentially made on clinical signs and symptoms. X-rays are done more to evaluate the bone surrounding the muscles and to exclude other potential causes of pain. An x-ray may also reveal calcification or the development of bone spurs of the lateral epicondylar region in chronic cases.

Generally, a period of observation with conservative management of at least 6 months' duration is recommended.

Management Strategies

Treatment approaches vary depending on pain level and the affected area (tendon at elbow or muscle in forearm):

For Severe Pain:

• Tendon (Elbow): Cold compress (5 minutes) if there is warmth and swelling. Wear armband as advised by therapist and rest for pain relief.
• Muscle (Forearm): Heat therapy and massage.

For No or Slight Pain:

• Tendon (Elbow): Heat therapy (hot pack/warm towel), stretching exercises, wear armband at work.
• Muscle (Forearm): Heat therapy and massage.

Conservative Management

Conservative management includes:

• Activity modification
• Correction of playing technique in sports
• Improved ergonomics in work-related tennis elbow
• Analgesics
• Stretching exercises
• Counterforce bracing (armband)
• Topical injections of steroids

Surgical Treatment

Failure of a trial of conservative management may require surgery to treat symptoms. There are various surgical options available, including open release of the affected tendon with excision of the damaged tissue, arthroscopic release, and newer techniques that stimulate improved blood supply to the affected area.

• Avoid carrying heavy objects
• Minimise heavy pushing, pulling and grasping activities
• In general, avoid all activities that would cause pain

Make sure that you do adequate warm-up exercises and stretching before any strenuous or repetitive activity to the forearm. Also limit continuous duration of play or activity, and use correct technique. The proper sizing of racquets is important.