Tennis elbow is an inflammation of the extensor tendon (epicondylitis humeri radialis) on the outer side of the elbow. Golfer’s elbow is an inflammation of the flexor tendon (epicondylitis humeri ulnaris) on the inner side of the elbow. The terms tennis elbow and golfer’s elbow result stem from the fact that the tendons on the elbow are often overstrained.

Hirslanden Orthopädie, Anatomie der Hand.
Legend
1. Ulna
2. Radius
3. Humerus

An overview of the elbow

The elbowis a complex joint consisting of three bones: the upper arm bone (humerus) and the two forearm bones, the radius and the ulna. These bones are connected by muscles, ligaments and tendons. The muscles that move the elbow are divided into two groups: the flexors, which flex the arm, and the extensors, which extend the arm. These muscles are attached to the bones by tendons that attach to the bony prominences of the elbow, known as epicondyles. Overuse of these structures can lead to pain and injuries such as epicondylitis humeri radialis (also known as tennis elbow) or epicondylitis humeri ulnaris (also known as golfer’s elbow).

Causes

Both tennis elbow and golfer’s elbow are caused by repetitive strain and overuse of the forearm muscles. This can lead to irritation of the tendon insertions on the elbow as a result of one-sided or incorrect loading, causing small micro-tears that can result in inflammation. In addition to typical sports such as tennis, rowing or golf, workplace activities or playing musical instruments can cause tendonitis in the elbow.

In the case of tennis elbow (epicondylitis humeri radialis), the extensor tendons on the outside of the elbow are inflamed. In contrast, golfer’s elbow (epicondylitis humeri ulnaris) affects the flexor tendons on the inside of the elbow.

Both tennis elbow and golfer’s elbow often develop gradually over a period of weeks or months. Initially, the pain is usually mild, but can increase in intensity over time and restrict range of motion considerably.

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Symptoms

The symptoms of golfer’s or tennis elbow can vary depending on the severity of tendonitis. The most common symptoms of tennis elbow or golfer’s elbow include:

Pain around the elbow joint

Severe pain around the elbow joint, which may radiate into the forearm, wrist and upper arm, is a typical symptom of tennis elbow or golfer’s elbow. In addition, increased pain can occur when making a fist and when the wrist is flexed or extended.

Weakness in the affected hand

Loss of strength in the affected hand can make it difficult to shake hands and grasp objects.

Sensitivity to pressure

In the case of tennis elbow, pain and tenderness typically occur around the outside of the elbow, whereas golfer’s elbow causes sensitivity on the inside of the elbow.

Diagnosis

The diagnosis of tennis or golfer’s elbow is usually made based on a physical examination, during which the doctor applies pressure to the affected area and tests specific movements to reproduce the pain. A specialist in orthopaedics can make a precise diagnosis of tennis or golfer’s elbow based on the typical symptoms, such as the characteristic pressure pain on the outside or inside of the elbow. Imaging techniques such as X-rays may be required in order to rule out other conditions such as osteoarthritis or bone fractures.

Treatment

Conservative treatment

Both tennis and golfer’s elbow are usually treated conservatively. The main aim is to immobilise the affected joint and protect the forearm muscles and elbow.

Other conservative treatment options may be used to support the healing process, including:

  • Immobilisation with a splint: helps to stabilise the affected area and prevent further strain on the tendons.

  • Painkillers and anti-inflammatory medication: these relieve pain and reduce inflammation in the affected area.

  • Ice and heat treatment: the application of ice reduces swelling and inflammation, while heat promotes blood circulation and relieves muscle tension.

  • Massages and ultrasound treatment: these promote circulation and accelerate the healing process by gently stimulating the tissue.

Surgical treatment

Surgical treatment is only sensible in individual cases. If it is the case the treatment would be in an outpatient basis. For example, if the pain does not improve after extended conservative treatment. The goal of the surgery is to alleviate muscle tension to prevent irritation of the tendon insertions on the elbow.

Prevention

To prevent tennis or golfer’s elbow, it is crucial to avoid overuse, especially during repetitive movements.  The following preventive measures are therefore particularly important:

  • Warm-up and stretching before sporting activities
  • Using the right equipment
  • Learning the correct technique
  • Taking regular breaks during repetitive activities
  • Strengthening the forearm muscles with strength exercises

 

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