Tennis and golfer’s elbow in focus

The frequent medical complaint of a tennis elbow, with pain on the outer side of the elbow (called epicondylitis humeri radialis), and the slightly less common problem of a golfer’s elbow, with pain on the inner part of the elbow (epicondylitis humeri ulnaris) are caused by painful tissue changes in the tendons of the elbow through repetitive movement of the wrist – and hand extensors and flexors.

Often, this complaint is caused by playing tennis and golf, but it is also found in people working in maintenance, long hours on a computer keyboard, in cleaning jobs and athletes in ball sports. However, it is also more generally caused by intense monotonous straining of the corresponding muscles of the forearm.
An uncommon exposure (for example, while doing a house renovation) or a rapid increase of a particular strain (for example, starting training after a break) are the cause of the complaints.

This strain might lead to inflammation of the sinewy area at the transition of bones to muscle structure at the elbow.

Reasons that can lead to longer lasting symptoms of epicondylitis include the shortening and the hyperextension of the muscles of the forearm, as well as absent stabilisation and unfavourable coordination of the shoulder girdle or changes in the cervical spine caused by degeneration or blockages.

Pain caused by inflammatory processes and tiny injuries, so called micro-injuries, initially start while straining the arm and later will also occur in resting mode. Typically, the pain radiates along the muscular tissue to the forearm.

A diagnosis can be made with a thorough examination.

In the examination and in subsequent treatment, it is important to include the shoulder girdle, the cervical spine and the nerve function.

The treatment should be holistic. Measures to ease the pain like applying local heat or cold and anti-inflammatory creams, for example with comfrey extract, or nightly curd compresses are beneficial.

Plant-based anti-inflammatory preparations to take internally, like bromelain or curcurmin, and, in persistent cases, the intake of traditional anti-inflammatory painkillers like Ibuprofen are commonly advised.

This should be accompanied by manual treatment of the tendon insertions and treatment of tensed muscles by a physiotherapist, preferably in combination with physical methods like ultrasound therapy.

Special stretching and relaxation exercises are important, also in the form of daily self-practice (concentric muscle training). The increasingly popular fascia roll can help relax tensed muscles and will help to continue the work of the therapist.

Also, the so-called epicondylitis brace, worn close to the elbow on the forearm, diverts the pull of the muscles from the origin at the elbow to less strained areas and can provide relief.

Well applied kinesio tapes bring about an increased blood circulation of the affected area and increase relaxation of the strained muscles through permanent relocation of connective tissue.

Athletes should always have their techniques inspected by an experienced coach in order to correct postural deficits.

Osteopathy with local and holistic treatment is very helpful to shorten the duration of symptoms, which often last several months.

A set of specific exercises to practice at home are often recommended to the patient.

Shots of cortisone and operations are recommended only very rarely.

For athletes, a slow progression of strain of any kind (so called pacing) and continuous stretching and relaxation of muscles proved very effective to prevent recurring injuries.

By Dr Lisa Buddrus
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Dr Lisa Buddrus is a doctor specialising in orthopaedic and trauma surgery, as well as a trained osteopath, with additional specialisation in manual medicine, foot surgery and emergency medicine. She is also a trained yoga teacher. She lives in the Algarve and has weekly consultation hours in the Deutsches Facharztzentrum Carvoeiro.