Know your Elbow

by Dr. Chandler Turnipseed

Two of the most common diagnoses for elbow pain are Tennis Elbow and Golfer’s Elbow. Often, when someone is told they have one of these conditions, their reply is “I don’t play golf” or “I don’t play tennis.” And then sometimes a golfer will get tennis elbow and vice versa. This can be confusing for a patient, especially if they don’t play that sport.

First, here are some other names that these conditions may go by, and as you can see, there are quite a few names for just two conditions.

· Golfer’s Elbow - Medial Epicondylitis, Wrist Flexor Tendonitis, Wrist Felxor Tendonosis/Tendinopathy, Pitcher's Elbow, Weightlifter's Elbow

· Tennis Elbow - Lateral Epicondylitis, Wrist Extensor Tendonitis, Wrist Extensor Tendonosis/Tendinopathy

So now, what is the difference between the two? As you may have seen from the above list, the difference is in the structures that they affect. For Golfer’s Elbow, the problem is in the muscles that control wrist flexion and pronation (turning your hand from palm up to palm down). Tennis Elbow is concentrated in the muscles that control wrist extension and supination (turning your hand from palm down to palm up). Some other excessive or repetitive motions that may irritate these conditions include using a screwdriver or wrench, throwing a ball, weightlifting, or archery. Other irritation factors include using a computer excessively, repetitive vibration, heavy lifting, and forced pronation or supination of the arm. The repetitive stress in these areas can cause inflammation – especially in the initial stages of injury – microscopic tears in the involved muscles, as well as soft tissue adhesions and scar tissue.

Treatment of these conditions will be similar in style and approach. However, the difference is again with the location of the affected structures. Initially, the goal of treatment will be to decrease the pain and manage the inflammation. This is usually done with the use of ice, rest, compression, and other passive therapies. Also, stopping the activities that create irritation is vital for healing to occur. You wouldn’t dig into a cut in your arm would you? Then why would you keep doing something that is damaging a muscle?

As the inflammation is being managed, treatment, such as Active Release Techniques, will help with adhesion and scar tissue breakdown and chiropractic adjustments will help restore any lost range of motion or correct dysfunctional movement . As the range of motion continues to improve in the elbow, it will be important to perform proper strengthening exercises for the weakened areas in the elbow. Also, it is important to look at the function in the wrist and shoulder as well. If there is an issue in either one of these areas there can be some extra stress transmitted to the elbow and can actually be the cause of the elbow pain. One example we see a lot when dealing with elbow pain in weightlifters is a decrease in shoulder motion which makes holding a barbell across the chest in the front rack position very difficult. If the shoulder is not able to be in a proper position then the stress is transmitted to the elbow and can create pain.

(Left) Bad- Elbows are down and weight is not supported by shoulders. (Right) Good - Elbows are parallel with floor and weight is supported by shoulders.

This brings up our last point of activity modification. Initially, we needed to stop all movements that created pain. During the exam we discovered why these motions create pain. Now is the time to reinforce the proper mechanics and positioning so the pain does not return and become a chronic issue. If the shoulder was the beginning of the problem, we need to correct the shoulder position to lessen the stress on the elbow. If the pain started after playing a sport, working with a coach on mechanics would be in order.

So, just because you may be told you have one of these conditions, realize that is just a generic term for irritation to one side or the other of the elbow. Many times, elbow pain is a secondary problem from a bigger problem in the shoulder. That’s why at Active Care Atlanta, we use full-body movement analysis that allows us to see the bigger picture and help return you to activity faster.

Summary:

· Golfer’s Elbow is an issue in the wrist flexor attachment in the elbow

· Tennis Elbow is an issue in the wrist extensor attachment in the elbow

· Rest from irritating activity

· Control inflammation with ice or other passive therapy such as ultrasound or e-stim

· Treatment of involved soft tissue and joints with Active Release Technique and adjustments

· Strengthen weakened areas and correct dysfunctional movement