Epicondylitis (golf or tennis arm)

Epicondylitis: what’s that?

Epicondylitis - also referred to in the vernacular tennis or golf arm. Some of you have likely already been confronted with this diagnosis. But what exactly is behind it?

In case of heavy, single-sided burden of the forearm, pain may be incurred inside or on the exterior of the elbow. To put it more precisely, in such cases normally the muscle tendon origins are irritated on the osseous epicondyles (the prominent osseous protrusions on the inside and the exterior) of the elbow, which is why we describe it as an epicondylitis. The forearm muscles play a decisive role in enabling us to stretch our hand upwards (dorsal extension) or bend it downwards (palmar flexion). These movements are accompanied by pain in case of epicondylitis and restrict the daily activities of the person concerned.

Depending on the localisation of the pain, we distinguish between a tennis or golf arm, that is to say an “epicondylitis humeri radialis” (tennis arm) and an “epicondylitis humeri ulnaris” (golf arm).

Epicondylitis humeri ulnaris (golf arm)

Here, the ulnar tender origins of the forearm muscle located on the inner side of the epicondyles, which bend the hand downwards, are affected. Therefore, the pain incurred is more pronounced when the hand is bent downwards, that is to say in palmar flexion.

Epicondylitis humeri radialis (tennis arm)

Here, the radial tender origins of the forearm muscle located on the outer side of the epicondyles, which move the hand upwards, are affected. The pain incurred is more pronounced when stretching the hand upwards, that is to say during dorsal extension.

The description tennis arm or golf arm is based on frequent occurrence during the respective sports activity. However, epicondylitis is also incurred when practising other sports types or during physical work, for example office work with heavy single-sided burdens.

Symptoms of epicondylitis

The major symptom is the pain which occurs frequently when bending and stretching the hand and can radiate up to the forearm and into the fingers.

If the pain is primarily incurred when bending the hand (the wrist downwards), this indicates golf arm. Here, the already inflamed tendon origin is irritated even more by additional burdening.

If stretching the hand (the wrist upwards) is connected with pain, this normally indicates a tennis arm. Here, too, the tendons which are already damaged are burdened additionally painfully.

In some cases, both bending and stretching can be connected with pain. This speaks for involvement of both the internal and external muscle origins.

In order to avoid pain, persons affected frequently only use a fraction of the actually existing muscular strength. This results in reduction of the strength of the wrist.

Also, the freedom of movement in the elbow joint can be painfully restricted and paraesthesia such as tingling in the hands may occur.

Cause of epicondylitis

All arm, hand and finger movement causes tensile force in the lower arm. This mostly affects the tender origins of the muscle, that is to say where the muscle tendon originates on the bone. In case of lasting, single-sided and monotonous burdens, fine injuries to the tendon origins may be incurred, which can become inflamed in case of sustained burdens.

This can also occur in connection with pain which can already be incurred when moving the wrist gently. Often, the person concerned is severely constrained in everyday life, the simplest movement of the hand is hardly possible.

Diagnosis of epicondylitis

In addition to the case history (e.g. questioning regarding sports or normal daily activities), the treating physician can already diagnose tennis or golf arm with simple examinations such as the provocation test. Here, the examiner requests the patient either to stretch or bend his/her hand against resistance. Depending on the movement during which the pain is incurred, the physician can distinguish between tennis and golf arm.

It is also possible that pain is incurred both when bending and stretching. If that is the case, the tendon origins in the bending and stretching muscle are overburdened.

The treating physician will also rule-out a possible different cause (differential diagnosis) for the pain, e.g. arthrosis or neurological damages for example by X-raying, MRI or ultrasound.

How can epicondylitis be prevented?

As the major reason for epicondylitis is overburdening, this should be avoided. Targeted breaks, stretching and loosening exercises for the arm during work or sports can be effective against the illness. We also recommend preparing the muscle for its use with specific stretching exercises prior to starting sports activities.

Epicondylitis therapy

Normally, conservative therapy is applied (without an operation). Here, the treating physician concentrates primarily on treatment of the swelling and the pain. At the same time, full immobilisation is only necessary in exceptional cases. However, the normal recommendation is targeted avoidance of the burden which has caused the epicondylitis.

As a conservative option, pain relief medication as well as heat and cold treatment may be applied. Forms of therapy such as ultrasound or shock wave therapy can also be prescribed. Injection therapy (autohemotherapy (PRP), cortisone, hyaluronic acid), X-ray stimulation therapy as well as independent stretching exercises belong to the further therapeutic options.

As a measure accompanying the therapy, medical aids specifically for the elbow are often used. These aids such as, for example, the BORT EpiContur®, take effect via individually adaptable pressure on the end of the muscle tendon or like the BORT Epicondylitis brace, for example, which provides targeted pressure on the muscle belly. The use of these braces can achieve the alleviation of symptoms and pain. The pads integrated in the braces provide an additional massage effect.

Epicondylitis supports such as, for example, the BORT EpiBasic provide light relief and stimulate the blood flow due to the compression effect in conjunction with friction pads. They can also achieve pain relief.

Physiotherapy can be applied as a further conservative accompanying measure.

The treating physician can also decide in favour of operational therapy in seldom cases, which can then be applied if conservative treatment fails to achieve any improvement. The objective of the operation is to reduce tensile force at the origin of the tendons, thus banning the cause of pain.