Tennis Elbow and Golfer’s Elbow are tendinopaties on the lateral and medial epicondyles, respectively. Epicondyles are the bony proeminences around your elbow.
These conditions are also known as Epicondylitis. The main clinical symptoms are pain on resisted movements (extension and flexion) and tenderness at the lateral or medial epicondyle. Previously thought to be an inflammatory process, these tendinopathies are now thought to be on a continuum of change. This is now thought not to begin with an inflammatory reaction; rather, it is thought to be the result of a proliferative reaction due to overload. This causes a thickening of the tendon which, if not treated, can progress to tendon disrepair and eventual degeneration. The term ‘Epicondylitis’ is increasingly thought to be a misleading, with clinicians reverting to the informal names of tennis/golfer’s elbow.
What causes it?
- Tennis – classically, although less so since the advent of lighter tennis rackets and two-handed backhands. Tennis is not the cause in the majority of people with tennis elbow.
- Jobs involving repetitive heavy lifting or the use of heavy tools.
- Jobs involving movements in an awkward posture – ie.: arms lifted in front of the body, hands bent or twisted, and precision movements, particularly squeezing and twisting movements.
- New and unaccustomed strains such as DIY, gardening, lifting a new baby, moving house, carrying luggage.
- Golf and other sports involving gripping or throwing.
- Jobs and hobbies using repetitive elbow movements – ie.: DIY, computer use, gardening, chopping, climbing or painting.
- Use of vibrating tools.
- Usually gradual onset, worsened with use of affected muscles – ie.: opening jars, unable to hold items due to pain.
- Usually unilateral but some cases are bilateral. The dominant arm is involved in 75% of people.
- Pain and tenderness over the lateral epicondyle of the elbow, radiating into the forearm, and pain on resisted extension of the wrist, middle finger or both. A tender spot can usually be identified just below the lateral epicondyle on the outside of the elbow.
- Pain and tenderness are maximal over the medial epicondyle, radiating into the forearm.
- Pain when flexing and twisting wrist (pronation).
- Dull ache at the medial epicondyle.
- The onset of pain is usually gradual and aggravated by trying to grasp objects and shaking hands.
- It is worsened with affected muscle use, such as forearm rotation or grasping, opening jars