Tennis Elbow and Golfers Elbow Symptoms, Treatment and Surgery

Tuesday, May 15, 2018

Tennis Elbow and Golfers Elbow

Problems of the elbow that typically occur where the tendon attaches to the bone. If the pain occurs on the lateral side of the elbow it is called the tennis elbow, while when the pain occurs on the medial side or inside of the elbow it is called the golfer's elbow. These pain occurs due to repetitive stress to the elbow which result in interstitial tearing, inflammation and swelling of the tendon.

Tennis Elbow

Tennis elbow is also called the lateral epicondylitis. This pain is due to inflammation, soreness or pain on the lateral side of the elbow and there is a degeneration of the extensor carpi radialis brevis. Tennis elbow is usually seen in patients who perform manual labor or sports which require twisting and extension of the wrist against resistance.

tennis elbow

Differential Diagnosis Radial Tunnel Syndrome

The pain of radial tunnel syndrome is very similar to the symtoms of tennis elbow. However the location of the pain is distal to the lateral epicondyle and it radiates down into the forearm. If the symptoms of the tennis elbow is not improving with treatment rule out radial tunnel syndrome.

Golfer Elbow or Medial Epicondylitis

The golfer’s elbow is the inflammation, soreness, or pain on the medial side or inside of the elbow. The pain of golfer elbow is due to repetitive overuse or overload activities which is aggravated by movement of the wrist.

Ultrasound Evaluation of the Tennis Elbow

Ultrasound is commonly used to diagnose tennis elbow, the elbow is placed into a semiflexed position with the hand pronated. Ultrasound is used to visualize and inject the tendon. The transducer is positioned parallel to the lateral epicondyle and the radial head. The radial head is identified by the ultrasound. The bony cortex of the epicondyle is identified and it is usually very smooth. The origin of the tendon is also seen in the ultrasound it is usually smooth and homogeneous and has no doppler flow.
The effected tendon may show tears, calcification or thickening. Below a sample picture of ultrasound of the tendon with tear in the tendon and the Doppler shows an increased flow.

tennis elbow
Ultrasound Guided Injection

Treatment of Tennis Elbow

The treatment of tennis elbow is usually to take a rest and job modification. The patient may also need to take some nonsteroidal anti-inflammatory drugs and send the patient to physiotherapy for accentric exercises. When the treatment doesn’t work the patient may need to be given an injection, it can be blind injection or ultrasound guided.

What do they inject?

They usually inject a steroidal drug to provide short term relief in the affected elbow. PRP platelets with needle fenestration is probably the best treatment for the tennis elbow, but it is expensive and require more than one injection.

Surgery of Tennis elbow

Surgery on tennis elbow is the last resort, it is used when the conservative treatment fails. It entitle the debribement of the involved tendon. Surgery is usually successful in about 85% of patients, and it avoid injury to the lateral collateral ligament that can cause elbow instability.

tennis elbow

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