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.
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.
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| 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.
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