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Elbow pain can be agonizing making simple movements of your arm almost impossible  What is the difference between Tennis Elbow vs Golfers Elbow?  Can someone have Tennis Elbow and Golfers Elbow at the same time?  How do you treat Tennis and Golfers Elbow?  What is the best treatment?   Let’s dig in.

Elbow Anatomy

The elbow joint is a hinged joint that also has the unique ability to rotate.  It is composed of three principal bones: the arm bone (humerus) and the two bones that make up the forearm, the radius, and ulna.  There are two important boney surfaces on the humerus that are called epicondyles.  The medial epicondyle is on the inside of the elbow joint whereas the lateral epicondyle is on the outside. The epicondyle is where tendons and ligaments attach.  Tendons are thick bands of connective tissue that connect muscle to bone whereas ligaments connect bone to bone.  The lateral epicondyle is where the extensor and supinator tendons and collateral ligaments attach.  The medial epicondyle is where the flexor and pronator tendons attach.  Tendons are susceptible to injury including inflammation, tears, and ruptures.

What Is the Difference Between Tennis Elbow vs Golfers Elbow?

Both conditions involve inflammation, microinjury and degeneration of the tendons at their attachment on the epicondyle which is also called epicondylitis (1).  The difference is in the location.  Tennis Elbow, also know as lateral epicondylitis, is inflammation and injury and pain on the outside of the elbow whereas Golfers Elbow which also known as medial epicondylitis, affects the inside of the elbow.  If it helps Tennis, Lateral and outside all have T‘s and is an easy way to remember that Tennis elbow involves the LaTeral or OuTside of the elbow.  Pain is the primary symptom.

Tennis Elbow (Lateral Epicondylitis)

Lateral epicondylitis occurs in approximately 1-3% of the population annually and is most common in 30-50-year-olds (2).  Symptoms typically occur due to overuse or strain from repetitive gripping or wrist extension.  Risk factors for lateral epicondylitis are increased age, increased BMI, rotator cuff disease, carpal tunnel syndrome, oral steroid use, and smoking (3).

Golfers Elbow (Medial Epicondylitis)

This condition is less common that lateral epicondylitis with a prevalence of less than 1% (4).  Patients at risk include overhead throwers and workers lifting heavy objects (5).  Other important causes of pain on the inside of the elbow include ulnar nerve disorders, neck nerve irritation, and laxity or tearing of the collateral ligament (6).  Pain is typically gradual in onset and may be accompanied by grip strength weakness.

Can Someone Have Tennis Elbow and Golfers Elbow at the Same Time?

While medial epicondylitis, AKA Golfers Elbow, is less common than Tennis elbow it is possible to have both conditions are the same time.

How Do You Treat Tennis Elbow and Golfers Elbow?

Treatment options depend upon the severity of the injury, past medical history, access to medical care and your physician’s preferences.  In general, it is always best to start with conservative therapy.  Treatment options include:

Conservative Treatment

This includes activity modification, ice, heat, physical therapy, and acupuncture. Research has shown that therapeutic tape helps improve both grip strength and pain. (7)

Medications

When conservative treatment options fail, NSAID and steroid injections are often recommended.  NSAIDs are thought to increase viral spread and should be avoided (8).  Steroids compromise our immune function and also cause cell death and therefore should also be avoided (9).

Surgery

Many different surgical options exist depending upon the severity of the injury including stripping away a portion of the tendon sheath to promote healing. The goal is to clean out any dead tissue as well as repair any tendon tears.  Surgery may also involve the nerves especially with medial epicondylitis where the ulnar nerve is oftentimes decompressed or repositioned (10).  Comp[lications occur and include loss of grip strength (11), infection, escalation of pain, ligament instability, neuroma formation and late return to work due to prolonged postoperative recovery time (12).

Does Cortisone Shot Help Golfers Elbow?

Steroids are powerful anti-inflammatory agents that can provide short term benefits.  Unfortunately, they can also cause cell death, compromise immune system function and repair and should be avoided.

What is the Best Treatment?

PRP injections have been shown to be more effective than steroids (13).  PRP studies have shown PRP to be so effective in the treatment of lateral epicondylitis that is is now the standard of care (14).

At the Centeno-Schultz Clinic,  we are experts in the treatment of Tennis and Golfers elbow.  Under ultrasound guidance, super-concentrated PRP is injected into the areas of injury and tears to reduce swelling, promote healing and accelerate recovery.  Board-certified, fellowship-trained physicians are available to evaluate your elbow pain in addition to assessing your shoulder and neck as both my be contributing to your elbow pain.  Using the SANS approach which evaluates stability, symmetry, neurologic function and articulation, can optimize your clinical outcome.

 


1.Taylor SA, Hannafin JA. Evaluation and management of elbow tendinopathy. Sports Health. 2012;4(5):384-93.

2. Garg R, Adamson GJ, Dawson PA, Shankwiler JA, Pink MM. A prospective randomized study comparing a forearm strap brace versus a wrist splint for the treatment of lateral epicondylitis. J Shoulder Elbow Surg. 2010;19(4):508–512.

3..Lai WC, Erickson BJ, Mlynarek RA, Wang D. Chronic lateral epicondylitis: challenges and solutions. Open Access J Sports Med. 2018;9:243-51.

4. Prevalence and determinants of lateral and medial epicondylitis: a population study. Shiri R, Viikari-Juntura E, Varonen H, Heliövaara M Am J Epidemiol. 2006 Dec 1; 164(11):1065-74.

5. David TS. Medial elbow pain in the throwing athlete. Orthopedics 2003;26:94-105.

6.Barco R, Antuña SA. Medial elbow pain. EFORT Open Rev. 2017;2(8):362-71.

7.George CE Sticking to the facts: A systematic review of the effects of therapeutic tape in lateral epicondylalgia. Phys Ther Sport. 2019 Aug 27;40:117-127. doi: 10.1016/j.ptsp.2019.08.011. PMID:31518778 https://www.ncbi.nlm.nih.gov/pubmed/31518778

8.Russell B, Moss C, Rigg A, Van Hemelrijck M. COVID-19 and treatment with NSAIDs and corticosteroids: should we be limiting their use in the clinical setting. Ecancermedicalscience. 2020;14:1023.

9.Pace CS Soft Tissue Atrophy Related to Corticosteroid Injection: Review of the Literature and Implications for Hand Surgeons. J Hand Surg Am. 2018 Jun;43(6):558-563. doi: 10.1016/j.jhsa.2018.03.004. Epub 2018 Apr 3. PMID: 29622410 https://www.ncbi.nlm.nih.gov/pubmed/29622410

10. Reconstruction of the ulnar collateral ligament in athletes. Jobe FW, Stark H, Lombardo SJJ Bone Joint Surg Am. 1986 Oct; 68(8):1158-63.

11.Donaldson CT Lateral Epicondylitis Debridement and Repair Using Knotless Suture Anchor. Arthrosc Tech. 2019 Jul 17;8(7):e775-e779. doi: 10.1016/j.eats.2019.03.016. eCollection 2019 Jul. PMID: 31485406 https://www.ncbi.nlm.nih.gov/pubmed/31485406

12.Amroodi MN, Mahmuudi A, Salariyeh M, Amiri A. Surgical Treatment of Tennis Elbow; Minimal Incision Technique. Arch Bone Jt Surg. 2016;4(4):366–370. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5100454/

13.Barnett J, Bernacki MN, Kainer JL, Smith HN, Zaharoff AM, Subramanian SK. The effects of regenerative injection therapy compared to corticosteroids for the treatment of lateral Epicondylitis: a systematic review and meta-analysis. Arch Physiother. 2019;9:12. Published 2019 Nov 13. doi:10.1186/s40945-019-0063-6

 

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