Tennis Elbow, Inflammation and Fractures


Epicondylitis is the name for inflammation of the tendons that attach the forearm muscles to the epicondylitis. These muscles flex and extend the wrist and fingers. One form of epicondylitis affects the lateral, or outer side of the elbow, which is the attachment site for muscles that extend the wrist. The condition is commonly called tennis elbow because it tends to affect racket sports players, but it can also be a problem for golfers and individuals involved in repetitive use of the hands and wrists such as typing. The combination of tightly gripping a racket or golf club while simultaneously stressing the wrist extensors creates an overload that eventually causes inflammation of the tissue. Other movements can also trigger the condition, such as rowing or paddling. One way to diagnose tennis elbow is by experiencing pain when simultaneously grasping and lifting something, such as a full cup of coffee, or when shaking hands. The second form of epicondylitis, medial epicondylitis, which is pain and inflammation along the inner elbow knob, commonly affects golfers, and is often referred to as golfer’s elbow. It also affects pitchers and throwers.

The main cause of epicondylitis is usually overuse, often coupled with poor or improper technique. When playing tennis 3 times a week at a high level of intensity, swinging with the arm and wrist alone rather than engaging the hips and shoulders, will eventually place too much stress on the muscles and tendons of elbow and forearm. Gripping the racket, or the oar handle, if a rower or paddler, too tightly, will also place too much stress on these same muscles and tendons and lead to pain, inflammation and injury.

Rest from the aggravating activity is paramount. Either form of epicondylitis, lateral or medial, lingers and becomes chronic if adequate rest is not allowed for proper healing. Cold therapy should be applied between 2 and 4 times a day to reduce pain and inflammation. Light stretching exercises performed frequently will help rehabilitate the elbow. Strengthening movements should be started when the pain dissipates. Wearing an elbow brace or elbow support in an attempt to bypass the inflammation will not prevent recurrence, and only helps once the inflammation has completely subside. Chronic cases may require medical attention.

Bicep tendinitis and ruptures occur with repetitive lifting or pulling, the biceps tendon can become inflamed, causing pain along the front crease of the elbow or closer to the shoulder. Ruptures of the tendon can occur, causing a noticeable cosmetic defect in the biceps as well as weakness, especially with the forearm rotated in the palm-upward position, or supination. As with other forms of tendinitis, rest from the offending activity, use cold therapy and NSAIDs to decrease pain and inflammation, and a gradual return to activity and strengthening once the pain has subsided. A rupture requires medical attention and usually necessitates surgery.

A break can occur in any of the three bones that meet at the elbow; the radius, in which case the fracture is known as a radial head fracture; the ulna, a olecranon fracture; or the humerus, supracondylar fracture. Radial head fractures usually occur as a result of falling on an outstretched arm. Supracondylar fractures are rare in adults and occur as a result of a hard impact with the elbow bent, fracturing the area of the humerus just above the elbow. Olecranon fractures occur as a result of falling directly on the bony point of a bent elbow. Radial head and supracondylar fractures bring with them the potential for serious complications to the nerves and blood vessels that cross through the elbow joint supplying the forearms, wrists, hands and fingers.

Elbow fractures should be considered medical emergencies because of the threat to the nerves and blood vessels that run through the joint and because of how close they are to the surface. The arm should splinted and or immobilized and kept cool until examined by a physician.

Inflammation of the fluid-filled sac at the olecranon, the bony tip of the elbow, is known as olecranon bursitis. It can be caused by a single, sharp blow to the tip, causing bleeding within the bursa, called hemobursitis; or it can result from overuse if the edge of the elbow is subjected to repeated stresses that cause the bursa to become inflamed. Pain and swelling are localized at the pointy tip of the elbow. The swelling can be profuse and radiating heat will be felt. Cold therapy and compression will facilitate healing. If the condition interferes with range of motion, the bursa can be drained by a doctor.

Partial or complete tearing of the ulnar collateral ligament, on the inside of the elbow joint, happens most commonly in throwers. Injury to this ligament may also affect the ulnar nerve, causing pain and tingling that radiates to the ring finger and little finger. Rest and ice are help ease pain and inflammation. The ulnar nerve runs in a groove along the medial, or inner, side of the elbow; thus, excessive tension or inflammation in this area can cause the nerve to become irritated, causing a sharp, tingling pain that radiates down toward the ring finger and little finger. RICE, topical pain gel and or over-the-counter NSAIDs will generally lead to complete resolution, though in severe chronic cases, surgery may be needed to relieve pressure on the nerve.