Continuing on our series of sports injuries we will turn our focus to the elbow.
Thankfully, elbow injuries in athletes are less commonly observed than in the other major joints of the body.
Problems in the elbow tend to take the form of repetitive strain injuries leading to inflamed tendons or sudden tendon tears.
The elbow joint allows movement in one plane and can either be bent (flexed) or straightened (extended).
From the elbow joint, we are also able to turn the forearm allowing the palm of the hand to point either upwards or downwards.
All of these movements are co-ordinated by different sets of muscles which arise around the elbow.
Inflammation of tendons
Sports that involve repetitive twisting of the forearm whilst gripping something in the hand (e.g. racket) are likely to lead to inflammation of these tendons.
The two most common conditions are “tennis elbow” and “golfer’s elbow.”
Tennis elbow occurs when the tendons on the outside of the elbow get inflamed.
It is also known as ‘lateral epicondylitis’ which describes the elbow region where the pain is felt.
These tendons function to pull the wrist backwards which is a position frequently observed when playing racket sports particularly tennis.
With tennis elbow, the pain observed can be fairly severe affecting the grip strength in the hand.
When examined, there is sharp pain on pressing over the tendons at the elbow or the lateral epicondyle.
Diagnosing tennis elbow normally requires a good clinical assessment and examination. X-rays and MRI scans are rarely required.
Management of the tennis elbow requires an initial period of rest and icing to help relieve the acute pain.
Gentle stretching exercises where the wrist is flexed are important to manage the pain.
Studies have also shown that use of a band at the elbow just below the point of maximum discomfort helps in reducing pain from tennis elbow.
The exercises should be supervised by a physiotherapist at least once to confirm the correct technique.
In those rare cases where the discomfort fails to settle down with rest and stretching, a physician/orthopaedic assessment is advised.
In addition to the stretches and bands, injections with platelet rich plasma have been shown to aid recovery.
Rarely surgery is required to remove the inflamed/damaged tissue and to release the tendons.
Golfers elbow or ‘medial epicondylitis' occurs on the opposite side of the elbow. The tendons that arise from this region are the tendons that bend the wrist towards the palm (flexion).
The condition gets its name from the fact that its seen in golfers’ swing arm.
It is also observed in racket sports if the athlete has a suboptimal technique or in weightlifters who have to grip firmly.
It is seen much less frequently than tennis elbow and unfortunately harder to treat as well.
Around the medial epicondyle there is an important nerve called the ulnar nerve which may be irritated causing tingling in the fingers.
The management of Golfers elbow requires a 2-4 months period of rest initially.
Physiotherapy is then commenced with exercises that extend the wrist without any resistance.
Additionally, supervised taping and bracing has been found to be helpful.
The symptoms settle down with time in most people.
When there is tingling in the fingers or extreme weakness of grip, nerve tests may be required to assess the health of the ulnar nerve.
These more complicated cases tend to have a poorer long term outcome and the symptoms should not be ignored. Surgery has a less predictable outcome in the treatment of golfers elbow and is thus only considered as a last resort.
In summary, tennis elbow and golfers elbow are repetitive strain injuries.
Despite their names, these conditions are seen in a variety of sports participants and manual workers.
The key to management is making an early diagnosis, having a period of rest and then beginning a stretching programme.
Both conditions are easier dealt with at the beginning of the process before they become chronic.
Mordicai is an orthopaedic surgeon specialising in sports injuries. [email protected]