Elbow Injuries

1)  Tennis Elbow (Lateral Epicondylitis)
This is an overuse syndrome caused by continued stress on the grasping muscles and supination muscles, which originate on the lateral epicondyle of the elbow. First, there is pain in the extensor tendons when the wrist is extended against resistance. With continued stress, the muscles and tendons hurt even at rest, and there is progression to subperiosteal hemorrhage, periostitis, calcification and spur formation on the lateral epicondyle.

During a backhand return, the elbow and wrist are extended, causing the extensor tendons, particularly the extensor carpi radialis brevis, to be damaged when they roll over the lateral epicondyle and radial head. Contibuting factors are poor backhand technique and weak shoulder and wrist muscles. Other factors include using a too-tightly-strung racket, using too small a handle, hitting heavy wet balls, and hitting "off-center" on the racket.

The first symptom is pain along the lateral epicondyle when the patients hits a backhand shot. Often this is ignored and exercise is continued. Eventually, the pain becomes constant and can extend from the lateral epicondyle to the wrist.

On examination, if the patient is asked to extend his fingers against resistance when the elbow is held straight, pain will occur along the common extensor tendon. Treatment is to avoid any activity that hurts on extending or pronating the wrist, and to substitute any exercise that does not cause pain, eg, jogging, cycling, basketball (even racquetball or squash, as the force of the ball on the rackets is less than in tennis). With healing, exercises to strengthen the wrist extensors can be started. Generally, exercises to strengthen the wrist flexor pronators are also recommended.

2)  Golfers Elbow (Medial Epicondylitis)
Forceful wrist flexion and pronation can damage the tendons that attach to the medial epicondyle; eg, serving in tennis (with too heavy a racket, heavy balls, an undersized grip, a spin serve, or having too much tension on the strings, together with weak shoulder and hand muscles), pitching in baseball, throwing the javelin, and carrying a heavy suitcase or playing golf. If the athlete continues to stress the wrist flexors, the tendon can be pulled from the bone, causing subperiosteal hemorrhage, periostitis, spur formation and tearing of the medial collateral ligament.

The patient complains of pain in the flexor pronator tendons (that attach to the medical epicondyle) and in the medial epicondyle when the wrist is flexed or pronated against resistance or when a hard rubber ball is squeezed.

To confirm the diagnosis, the patient sits in a chair with his arm from the elbow to the wrist resting on a table. The hand is supinated, and the patient is asked to try to raise his fist by bending the wrist, while the examiner holds it down. Pain will be elicited on the medial epicondyle and in the flexor pronator tendons.

The patient should avoid performing any activity that hurts on flexing or pronating the wrist and should try an alternative sport, as for lateral epicondylitis, above. Later, he should learn how to hit the ball by applying more force from the wrist and shoulders and do exercises to strengthen the muscles in the hand, wrist, elbow and shoulder. Generally, exercises to strengthen the wrist extensors should also be done.
Reference Source 7,91