Tennis elbow and golfer's elbow

Tennis elbow (lateral epicondylitis) and golfer's elbow (medial epicondylitis) are overuse conditions of the tendons that attach the forearm muscles to the bony bumps on either side of the elbow. Tennis elbow affects the outer side; golfer's elbow affects the inner side. Despite the names, many people who develop them do not play tennis or golf: repeated gripping and wrist motion at work or at home are common causes.

• Pain or burning on the outer side (tennis elbow) or inner side (golfer's elbow) of the elbow, sometimes spreading into the forearm
• Pain when gripping, lifting, shaking hands, turning a doorknob, or opening a jar
• A weaker grip
• Tenderness over the bony bump on the affected side
• Stiffness, often worse in the morning

With golfer's elbow, numbness or tingling in the ring and small fingers can occur if a nearby nerve is irritated.

Repeated gripping and wrist movements strain the tendon where it attaches to the bone. Over time, small tears and wear develop faster than the tendon can repair them, causing pain.

• Racquet sports, golf, and throwing
• Jobs and hobbies with forceful or repetitive hand use, such as painting, carpentry, plumbing, gardening, and heavy tool use
• Equipment and technique, such as a racquet grip that is the wrong size or a poor backhand stroke
• Sudden increases in a repetitive activity

Diagnosis is usually based on symptoms and an examination, including pain when the wrist is bent back (tennis elbow) or forward (golfer's elbow) against resistance. X-rays may be used to rule out arthritis or other problems. An ultrasound or MRI is occasionally used when symptoms do not improve, and nerve testing may be done if there is numbness or tingling.

Most people improve without surgery, though improvement is often gradual. Non-surgical treatment includes:

• Rest from, or changes to, the activities that bring on pain
• Ice and anti-inflammatory medication when appropriate
• Physical or occupational therapy and a home program of stretching and progressive forearm strengthening
• A counterforce brace worn on the forearm, or a wrist splint
• Changes to equipment and technique
• A steroid injection in selected cases; it can ease pain for a short time, but it does not repair the tendon and symptoms may return

Surgery is considered only when significant pain continues despite many months of non-surgical treatment. The surgeon removes damaged tendon tissue and, when needed, reattaches healthy tendon to the bone, through an open incision or arthroscopically for tennis elbow.

With non-surgical care, symptoms usually ease over weeks to months, and activity is resumed gradually as strength returns. After surgery, the arm is protected for a short time, followed by exercises to restore motion and then strength over several months.

Warming up, strengthening the forearm muscles, using correct technique and properly fitted equipment, taking regular breaks during repetitive tasks, and using the larger muscles of the shoulder and upper arm when lifting can reduce strain on the elbow tendons.