• www.sportordination.at
  • www.sportordination.at
  • www.sportordination.at
  • www.sportordination.at
  • www.sportordination.at

The elbow

Tennis elbow:

 

Tennis elbow is caused by overstraining of the hand and finger extensor muscles, which originate in the elbow. This results in a painful inflammation of the tendon attachment on the lateral side of the elbow, which is also called epicondylitis. Sporting activities, mostly an incorrect playing technique when playing tennis, trigger the symptoms of tennis elbow. It is astonishing for many of my patients that 80% of all cases of “tennis elbow” are not caused by tennis but by other types of sport – or even by repetitive movements when working with a computer, other hand activities or by excessive exertion at work.

The cause of the overexertion of the extensor musculature is the reversal of the long finger extensor muscles when making a fist. When making a fist, the long finger extensor muscles, namely in the middle joint of the finger become flexor muscles. When gripping a tennis racket, almost all the muscles in the forearm are tensed and are therefore active for the purpose of finger flexion (you can try it easily yourself and feel it in your own forearm). When the tennis racket receives a hit in this pretension position, the flexor musculature can be easily overstretched. The results are typical pain in the lateral elbow region (tennis elbow).

Tenderness in the lateral region of the elbow, sometimes in combination with hardening of the tendons of the extensor musculature in the forearm is common. Typical movements, such as gripping, carrying or lifting of objects lead to pain.

Other pain conditions must definitely be evaluated and ruled out before the diagnosis of tennis elbow is confirmed:

  • Epicondylitis on the lateral side of the elbow (thrower’s or golfer’s elbow)
  • Muscular hardening in the shoulder or neck that can radiate to the elbow
  • Nerve pressure symptoms in the cervical spine (cervical disc prolapse) and the arm (sulcus ulnaris syndrome; supinator tunnel syndrome)
  • Direct joint pain (e.g. caused by cartilage damage, loose bodies, etc.)


Sports ointments (note: must discuss with the treating doctor: not every "sports ointment" is actually really suitable as such) must be used locally without fail, cryotherapy and cold compresses should be used during the night for an acute episode. Moreover, repetitive arm movement must be changed. When playing tennis, an enlargement of the racket grip, reduction in the racket tension, softer balls and a correction in the striking technique (position laterally to the ball) can significantly improve the symptoms; in the case of computer work, the position of the hand over the keyboard should be changed (wrist rest, modified desk height, angled keyboards etc.).

Consistent physiotherapy is crucial for successful treatment of the tennis elbow (iontophoresis, ultrasound treatments, + training of the upper arm and shoulder musculature, which then relieve the forearm muscles, cross frictions, etc.) and a break from sport help, preferably in combination with treatment with analgesic and anti-inflammatory medication.

The lateral forearm extensor muscles that are often in permanent contraction as a result of the pain can be stretched again very gently using stretching exercises. This should also be continued when the patient is free of pain for a long period of time, as prophylaxis against another episode. Wearing a tennis elbow bandage under the elbow can also lead to a reduction in pain.

Cortisone

 

Cortisone injections are the last resort, as cortisone can inhibit the inflammatory reaction very well. Cortisone injections, however, are also not without risks (see also achillodynia). If two injections have no effect, you should refrain from further injections, otherwise you risk melting of the tissue or even tendon ruptures.

ACP - autologous conditioned plasma:

 

Treatment with autologous conditioned plasma (ACP) represents a new type of treatment procedure for the treatment of chronic achillodynia and insertion tendinopathy. It has been known for a long time that the growth factors contained in human blood can positively affect different healing processes. ACP therapy works on the basis of this knowledge. Healing and construction processes in damaged or tendon tissue changed as a result of inflammation can be stimulated using concentrated growth factors. What happens during ACP therapy? A small amount of blood is taken from the arm vein for a blood test. Using a special separation process, the portion of the blood containing the autologous regenerative and arthrosis-inhibiting components is obtained. The autologous solution obtained in this manner is injected into the affected tissue using a specially developed double syringe (Arthrex Double Syringe). This newly developed double chamber system ensures that the growth factors are obtained and injected in sterile form and therefore offers the highest possible level of safety. Note: There is still no scientific proof that this treatment helps or to what percentage healing success can be achieved, however patients suffering from arthrosis are familiar with the positive effect and there have been positive reports regarding application in the meantime.

Extracorporeal shock wave therapy:

 

Extracorporeal shock wave therapy is a newer method of pain relief. It is suspected that the pain alleviating effect is not based on the fragmentation but rather the shock waves appear to activate the self-healing of a cell. Moreover, shock wave therapy improves the cell metabolism and deactivates the pain fibres. Following multiple treatments, 60-80% of patients achieved alleviation of pain or even complete improvement in the symptoms.

Operation

 

Only once all conservative (= non-surgical) treatment methods have been carried out consistently for six months and despite this, no success is visible, should an operation (revision of the extensor carpi radialis brevis) then be considered. The periostomy of the tendon attachment carried out previously has indeed helped in many cases, however it has also very often led to functional deficits. It has been shown that the main cause of the pain in the case of tennis elbow is degeneration of the attachment of the extensor carpi radialis brevis muscle. This muscle lies under the aponeurosis of the extensor carpi radialis longus. During the operation, the superficial aponeurosis has to be split. This way, there is a good view of the degeneratively changed and often broken tendon sections of the extensor carpi radialis brevis muscle. Damaged tendon sections must be surgically removed and the bone bed freshened up. As a result, rapid freedom from symptoms is achieved in the majority of cases, however a short period of postoperative immobilisation and a ban on sports (tennis) is advised for three months.

Golfer’s elbow

 

Golfer’s elbow is also caused by overstraining of the musculature, however this concerns the musculature that originates on the medial side of the elbow. This results in a painful inflammation of the tendon attachment on the medial side of the elbow, which is also called epicondylitis (or rather medial epicondylitis). One-sided sporting overexertion is a trigger for the symptoms of golfer’s elbow. Treatment as in that administered for tennis elbow.

Bursitis

 

Bursitis is understood to be an inflammation of the bursa. The bursa is located on the posterior side of the elbow (there are also bursas in other places on the body, which should serve to improve sliding function, such as in the knee or shoulder for example). A typical swelling occurs at the elbow. The bursa is often really swollen in a lump-like manner. In the acute stage, the bursa inflammation is very painful, the elbow is hot, and we talk about acute bursitis.

The cause can be injury as a result of a fall onto the elbow. Bacteria can enter the bursa even through a small laceration and lead to infection and inflammation. Immediate surgical removal of the infected bursa may then be required. In less dramatic cases, immobilisation in a cast and antibiotic treatment suffice.

Mechanical overstimulation or blunt injuries can, however, also lead to bursitis, which we then refer to as chronic bursitis. This may not be as painful but it is just as uncomfortable. Treatment consists of cryotherapy and cold compresses. If the pain is very severe, the bursa can be punctured - this leads to a rapid improvement in the symptoms, however the bursa often fills up with fluid again and then additional punctures may be required. In the case of persistent symptoms, immobilisation in a cast can be necessary and sometimes surgical removal is also required here.

 

Please note that medical indications and treatments change constantly. Sometimes these changes occur more rapidly than I am able to update on my homepage. Some information regarding dosage, prescription and compositions of medications may have changed in the meantime. Reading an internet page cannot replace visiting a doctor - it may be that during an examination and subsequent discussion with your doctor, other information is also communicated as a result of new scientific knowledge.