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'FORE' ON YOUR FOREHAND
Golfer's elbow may not get the attention of its painful sibling, tennis elbow, but it can be as debilitating, especially when you're hitting forehands.

By: Joshua S. Dines, MD

October 12, 2012 — (Editor's note: This is the first in a series of regular medical columns by Donnay consultant Dr. Joshua S. Dines, anorthopedic surgeon and one of the world's leading authorities on tennis-specific injuries. Dr. Dines works with United States Davis Cup tennis team and is a member of the Sports Medicine and Shoulder Service at the Hospital for Special Surgery in New York City. Beyond his work with professional tennis players, he is also a consultant team doctor for the Los Angeles Dodgers and a team orthopedist for the Long Island (NY) Ducks minor league baseball team.)

People talk about "tennis elbow" all the time, the popular laymen's term for "lateral epicondylitis" -- lateral-sided elbow pain. The condition has become part of the vernacular, even among people who have never touched a racquet. But less talked about, though no less debilitating to those affected by it, is “golfer’s elbow” or "medial epicondylitis."

Golfer's elbow is similar to tennis elbow. But it occurs on the inside, rather than the outside, of your elbow.

And, despite its name, this is a condition that also affects tennis players.

Golfer's elbow/medial epicondylitis refers to inflammation, tendon degeneration, or less commonly to tearing, of the tendons that attach to the medial epicondyle of the humerus (or arm bone). These tendons are attached to the muscles responsible for flexing your wrist and pronating your forearm (rotating your forearm palm down). This inflammation commonly occurs in golfers, but it can affect anyone who performs the motions described above repetitively.

The majority of cases are due to chronic overuse, but acute epicondylitis can occur. Because tennis requires repetitive and strenuous forearm and wrist movements, tennis players are at risk of developing the condition.

Tennis players with golfer's elbow complain of pain along the medial aspect of their elbow (the side of your elbow closest to your body when your palm is facing up). Pain can sometimes radiate down the forearm, making it most painful on serves and forehand overheads.

Usually the symptoms will subside with avoidance of the inciting activity. If they persist, you should probably see your orthopedic surgeon to make sure something else isn’t causing the pain. Typically, the surgeon will prescribe anti-inflammatory medications, ice, and stretching and strengthening exercises. Most cases will respond these treatments within about 4 to 6 weeks. It is extremely important, however, to avoid returning to tennis before the symptoms have resolved, otherwise it can be a set-up for further injury.

More chronic cases and cases that don't respond to stretching and strengthening exercises may benefit from an injection of cortisone or Platelet-Rich Plasma into the area.

Cortisone is a steroid that helps reduce inflammation. Though it may help the symptoms, it shouldn’t be done as a first-line treatment because it can actually weaken muscle and tendon tissue.

More recently, platelet rich plasma, which involves the isolation of the growth factors from one’s own blood and injecting it into the site of maximal tenderness, has been used with some success. And, it is less damaging to the tendon than cortisone. In about 10 percent of cases, patients will require surgery for the condition. Surgery involves removing the inflamed area of tendon and, if a tear is present, repairing it.

Clearly, the best treatment is prevention. Warm up and stretch appropriately before playing, and listen to your body.

You don’t want to make a relatively minor condition into something more severe by playing through pain.
 
   
 
 
 

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