TENNIS ELBOW AND GOLFER'S ELBOW
What causes tennis elbow?
Tennis elbow (lateral epicondylitis) is due to a strain on the tendon of the extensor carpi radialis, the muscle which extends the hand and tilts it towards the thumb. This tendon attaches on the outside of the elbow just above the elbow crease and its muscle travels down the forearm, ending in a tendon that goes past the wrist and attaches to bones at the back of the hand.
If you extend your hand forcefully over and over again, for instance if your backhand is poor in tennis or you lift heavy suitcases, paint, type, or use a screwdriver for long periods of time, you may develop tennis elbow. You will feel the pain from tennis elbow on the side of the elbow above the elbow crease where the overstrained, injured and weakened tendon attaches.
What causes golfer’s elbow?
Golfer's elbow (medial epicondylitis) is caused by damage, usually from overuse, to the muscles and tendons that turn your wrist palm down, flex your fingers and close your hand. These tendons attach on the inside of the elbow on the bump just above your elbow crease. This is where you'll feel the pain from golfers elbow. At times the pain spreads into your forearm and wrist. Golfers, tennis players, baseball pitchers, painters, carpenters, weightlifters and others who repeatedly use their wrists or clench their fingers can develop golfer's elbow.
Injury to the nerves that supply the skin of the shoulder or the elbow can also cause elbow pain. Pain due to loose ligaments or tendons or arthritis only comes when you move the ligaments or tendons or the joints. Nerve pain, on the other hand, can be severe and happen at any time even when you are not moving at all. If you press lightly on an area with nerve pain, the pain gets worse.
How can you treat tennis or golfer’s elbow?
Change your activities: If you are a tennis player, improve your strokes, loosen your racquet strings. If you are a golfer, get instructions on how to use your body instead of your arms for your swing. If you are not, avoid activities which cause the pain.
Try an elbow brace: by squeezing down on the forearm, the brace reduces the pull on the muscle’s tendon attachment where you feel the hurt.
A physiotherapist can prescribe exercises to stretch and strengthen your forearm muscles and reduce the strain on your tendons.
Acetaminophen, Tylenol, which has a mild anti-inflammatory effect, and anti-inflammatory medications such as aspirin, ibuprofen, Advil, Motrin have, until now, been the mainstay of treatment to relieve elbow pain. They all relieve the symptoms that occur with overstretched and worn ligaments and tendons. They work by relieving inflammation which is a cause of pain. Unfortunately, inflammation is the mechanism the body uses to repair itself, and using these medications interferes with the process which would help regrow the affected ligaments and tendons.
Icing has been suggested, but it too reduces the pain by reducing inflammation.
Surgery has been used to remove a portion of the damaged tendon or to cut the attachment of the affected tendon. This may weaken the muscles involved, as part of the tendon that holds the muscle on the bone has been severed but is likely to relieve the pain, as the painful tendon is no longer pulled on by the muscle.
Is prolotherapy useful in treating tennis elbow or golfers elbow?
Prolotherapy, a series of injections of growth promoting substances has been shown to be effective in stimulating the growth and repair of ligaments and tendons. Injections to the elbow ligament and tendon insertions strengthen and thicken them. These stronger ligaments and tendons will help restore the strength of your hand and wrist and help correct the cause of elbow pain.
Prolotherapy has recently been shown to be extremely effective in the treatment of tennis elbow. Of 24 people suffering from tennis elbow pain from six months to 10 years, 12 got prolotherapy and 12, who got saline injections instead, were the control group. All the treated subjects and none of the controls were better by 16 weeks. This would make prolotherapy the treatment of choice for tennis elbow. It is just as likely to be effective for golfer’s elbow as it helps rebuild the damaged tendons of the elbow.
Scarpone M., Rabago D., Zgierska A, Arbogest J, Snell E. The efficacy of prolotherapy for lateral epicondylosis: a pilot study. May 2008 clinical Journal of sports medicine volume 18(3), pp 248 -254.
Can neural prolotherapy help your elbow pain?
Neural prolotherapy is likely to help if your pain is coming from the nerves that supply your skin Nerve pain can be severe even when you are resting and can be made worse by pressing lightly on the affected areas. See A new treatment for chronic pain and Frequently asked questions about prolotherapy and neural prolotherapy. For more information, go to www.painrelief.be
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