Lateral & Medial Epicondylitis

Tennis Elbow

Lateral epicondylitis, also known as tennis elbow, is an elbow injury that occurs as a result of the overuse of the muscles and tendons of the forearm and elbow. The pain associated with this condition affects the lateral epicondyle, the area where the tendons of the forearm connect with the bony outer portion of the elbow. Repetitive movement and constant use during certain types of activities may put excessive strain on the elbow tendons. Tennis elbow may occur in tennis players or individuals who participate in certain athletic activities, but may also occur in people who have jobs that involve repetitive motions of the wrist and arm, such as carpenters, or people in construction related trades.

Symptoms of Tennis Elbow

The symptoms of tennis elbow affect the inside of the elbow, and may include:

  • Forearm weakness
  • Pain when the wrist is extended
  • Pain that spreads from the outside of the elbow into the forearm and wrist

Pain may occur when performing even simple tasks such as turning a doorknob or shaking hands.

Diagnosis of Tennis Elbow

Tennis elbow is diagnosed through a physical examination of the arm and elbow, and a review of the patient’s medical history. To assess pain, pressure may be applied to the elbow and the individual may be asked to move the arm, wrist and elbow in different ways. Additional diagnostic tests may include:

  • X-ray
  • MRI scan
  • EMG

These tests may be performed to rule out other conditions that may be responsible for causing elbow pain.

Treatment for Tennis Elbow

The initial pain caused by tennis elbow can often be managed with rest, ice and over-the-counter pain medication. In many cases, tennis elbow heals on its own. Cases of tennis elbow that do not respond to conservative measures may require additional treatment that may include:

  • Physical therapy
  • Corticosteroids
  • Exercises
  • Forearm brace

Severe, persistent cases of tennis elbow may require surgery. Surgical procedures may be performed to remove damaged tissue, remove bone spurs or to split the tendons to alleviate pressure.

Medial Epicondylitis

Medial epicondylitis, also known as golfer’s elbow, is a painful condition in which the tendons connecting the forearm to the elbow have become damaged due to injury or overuse. Previously thought to be a form of tendonitis, or inflammation of the tendon, medial epicondylitis is now considered to be a form of tendonosis in which the collagen fibers making up the tendon have deteriorated. Patients with this condition experience pain on the inside of the elbow that may radiate into the forearm. This pain results when the epicondyle puts pressure on the ulnar nerve, a nerve in the forearm. Most often, medial epicondylitis can be treated successfully by simple measures like resting the arm and applying ice. In some cases, however, it requires surgical correction.

While it may be caused by a single injury, medial epicondylitis is usually caused by repetitive gripping, flexing and swinging of the arm. These actions, common in golfers, cause the targeted tendons to stretch and tear. Medial epicondylitis is also frequently diagnosed in baseball pitchers, bowlers, tennis players, swimmers and individuals who do painting, raking or hammering since all of these activities involve similar arm motions. This condition is much more common in men than in women, but much less common in either than tennis elbow.The difference between the two conditions is that tennis elbow occurs on the outside of the elbow while golfer’s elbow occurs on the inside.

Symptoms and Diagnosis of Medial Epicondylitis

Symptoms of medial epicondylitis may appear suddenly or gradually. These symptoms may include:

  • Pain on the inside of the elbow or forearm
  • Weakness or stiffness in the wrists and hands
  • Tingling or numbness in the hand or fingers, particularly the ring finger or pinkie

The pain of medial epicondylitis may worsen with certain actions, such as swinging the arm, squeezing the hand, turning a doorknob or lifting something heavy, especially when the palm is facing downward.

Diagnosis of Medial Epicondylitis

Medial Epicondylitis is diagnosed through physical examination, the use of X-rays and, on occasion, other diagnostic tests such as MRIs or ultrasound.

Treatment of Medial Epicondylitis

There are several simple treatment options for medial epicondylitis. The treatments for medial epicondylitis may include:

  • Resting the arm
  • Wearing a bandage or splint on the wrist or elbow
  • Icing the affected region
  • Taking over-the-counter pain relievers
  • Doing therapeutic exercises
  • Receiving electrical stimulation treatments
  • Taking prescribed corticosteroids orally or by injection
  • Receiving shock wave treatments of the area

The symptoms of medial epicondylitis may resolve in weeks or may persist for months. As the pain subsides, a physical or occupational therapist may suggest different ways of moving the arm to avoid a recurrence of symptoms. If the condition lasts more than 3 to 6 months, becoming chronic, surgery may be considered.

Surgical Repair of Medial Epicondylitis

There are several types of surgery performed to repair medial epicondylitis. Such surgeries may be performed arthroscopically or as open surgery and are normally done outpatient with a local anesthetic. They usually take between 3 and 4 hours to complete. Most patients may return to a relatively normal routine in about 4 weeks, but may have residual discomfort, weakness or numbness for several months following surgery. Post-surgical physical therapy is usually required.

Types of procedures used for surgical repair of medial epicondylitis may include:

Tendon Debridement – in which only the affected tissues within the tendon are removed, or debrided
Medial Epicondyle Release or Epicondylectomy and Ulnar Nerve Release – in which the medial epicondyle is removed, allowing the ulnar nerve to glide freely, releasing it from what is known as ulnar nerve entrapment
Ulnar Nerve Transposition – in which the forearm muscles are cut and temporarily disconnected from the epicondyle so that the ulnar nerve can be moved from behind the elbow to in front of it

Risks of Surgical Repair of Medial Epicondylitis

While the surgical procedures discussed are considered safe, there are potential risks with any surgery which may include:

  • Excessive bleeding
  • Blood clots
  • Adverse reactions to anesthesia or medications
  • Post-surgical infection
  • Breathing problems

Risks of the specific surgeries discussed may include a condition known as chronic regional pain syndrome, or CRPS. This complication, which is rare, may cause ongoing swelling, pain, skin discoloration and stiffness.

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