Tennis Elbow
Jonathan Hersch, M.D. { Orthopaedic Associates USA }
Tennis elbow is a very common problem in recreational tennis players, but in fact is an infrequent problem in accomplished tennis players. It?s rare on the professional circuit to see a player with this condition. This injury occurs as a result of repetitive overload. The extensor tendon attachments to the elbow become injured over time. The symptoms include point tenderness over the lateral aspect of the elbow, pain with resisted wrist extension, pain upon gripping objects (lifting a gallon of milk is a common complaint) and pain on the backhand stroke.
Mechanical and technical factors play a major role in the development of this problem. Unskilled players may have alterations in stroke technique that can place excess stress on the elbow. Leading with the elbow during the backhand and trying to place underspin on the ball with excessive pronation of the forearm are examples of techniques that can lead to this problem. Many amateur player lack shoulder strength needed for continued play especially the external rotators (part of the rotator cuff). This lack of strength caused the elbow extensor muscles to work harder causing fatigue and tendon injury.
Treatment focuses on reducing symptoms and improving mechanics. Therapy starts with reducing the stress on the elbow and reducing inflammation which is present in the early phase. That may mean complete stoppage of play for several weeks, or in mild cases cutting back on the days and hours played until resolution of the pain. Early use of a counterforce tennis elbow strap can be helpful to reduce the stress on the involved tendons. This brace can also be used when returning to play as a preventive devise. To reduce inflammation and pain, a cortisone injection may be recommended but requires rest from tennis for at least 10 days to be effective. Multiple injections are discouraged due to the damage it can cause to tendons worsening the problem.
In most athletes, rest ice and anti-inflammatory medicines can cure this problem. Rehabilitation focuses on strength deficits in the shoulder, elbow and forearm. Working with a certified physical therapist is recommended to ensure proper technique. Working with a tennis teaching professional can be a major help to improve mechanics to prevent further injury or recurrence.
Failure to respond to treatment occurs in about 10% of athletes. For some surgery is eventually recommended when all else fails. The surgical procedure can be done open or arthroscopically to remove the degenerative tissue involved. Arthroscopic surgery has the benefit of also allowing visualization of the inside of the elbow joint. Many people have other associated problems within the joint that can be treated simultaneously. Return to tennis averages about 3 months after surgery.
If you believe you are suffering from tennis elbow you should discuss this with a sports medicine professional. Early detection and treatment can result in resolution of the problem and minimal time from the game you love.
Dr Jonathan Hersch is an Orthopaedic Surgeon specializing in sports medicine and arthroscopy. His offices are located in Plantation and Miami Lakes, Florida. He is a member of the ATP medical committee and is the medical director of the International Tennis Championships in Delray Beach and the BMW Tennis Championships in Sunrise.
