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.
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.
Golfers Elbow (Medial Epicondylitis)
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
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
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.
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.