Sports Injuries and Prevention

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Sports Injuries and Prevention

Elbow (Tennis and Golfer's Elbow)

NEWS:

Don't Blame Racket for Tennis Elbow "Your swing, not your racket, may be the culprit when it comes to developing tennis elbow (tendonitis), experts report. An improperly-sized -- either too small or too large -- tennis racket grip does not cause the common malady, according to a study in the December issue of the American Journal of Sports Medicine. … "Clinicians who treat patients with tennis elbow often tell them to try a different size grip in order to alleviate muscle fatigue. Our study demonstrates that those recommendations have no scientific basis. Therefore, it is reasonable to recommend whatever grip size feels most comfortable for them," Hatch said.”

Elbow Injuries on Rise Among Young Athletes “One of the country's leading sports doctors reports that he's performing more surgeries on sprained elbows in young athletes, a fact that reflects higher numbers of children focusing on just one sport.”

'Tommy John' Surgery For Elbow Reconstruction Effective, But Number Of Baseball Players Requiring It Alarming “ "Tommy John" surgery is a procedure where a damaged elbow ligament (Ulnar Collateral Ligament or UCL) is replaced with a tendon from elsewhere in the body. The surgery is named for Hall of Fame pitcher Tommy John, who was the first person to have the surgery in 1974. John returned to the major leagues and went on to win 164 games after the surgery. Prior to this historic surgery, a UCL injury was a career-ending injury. … "The increase in the number of UCL reconstructions being done now can be attributed to many things: improved diagnostic techniques, heightened awareness, increased chance of positive outcome with current surgical techniques, but most importantly, the overuse of young throwing arms," said Dr. Cain. "In the past 10 years, year-round baseball leagues have proliferated. So the best young pitchers are throwing many more pitches and learning to throw more difficult pitches. It's great that the surgery is successful, but prevention of the injury should be the goal. Kids should be urged to rest and be careful about saving their arms, rather than leading to long-term problems at a young age." “

For Long-Term Relief From Tennis Elbow Steroid Injections Not Recommended, BMJ “Initially, corticosteroid injections were the most successful treatment, with 78% of those in the group reporting improvements, followed closely by physiotherapy with a 65% success rate when compared to just 27% in the 'wait and see' group. However, after 52 weeks the injection group rates of improvement were significantly worse than those of the physiotherapy group. The injection group also had the most reported recurrences, with 72% of participants' condition deteriorating after three or six weeks - which could be due, in part, to a quicker initial recovery leading to greater use and over-taxing of the elbow.”

Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial (BMJ 2006) “Conclusion Physiotherapy combining elbow manipulation and exercise has a superior benefit to wait and see in the first six weeks and to corticosteroid injections after six weeks, providing a reasonable alternative to injections in the mid to long term. The significant short term benefits of corticosteroid injection are paradoxically reversed after six weeks, with high recurrence rates, implying that this treatment should be used with caution in the management of tennis elbow. “

Physical Therapy Corner: Tennis Elbow “Epicondylitis often becomes a chronic problem if not cared for properly. For this reason, it must be stressed that the rehabilitation process should not be progressed until you experience little or no pain at the level you are performing. Regaining full strength and flexibility is critical before returning to your previous level of sports activity. In general, the rehabilitation process can be divided into three phases: …”

Sonographically guided percutaneous needle tenotomy for treatment of common extensor tendinosis in the elbow: is a corticosteroid necessary? (J Ultrasound Med. 2008)

[Surgical treatment of tennis elbow] (Ugeskr Laeger. 2008)

Tennis Elbow “In most cases, symptoms go whether it is treated or not. One large study reported that in about half of cases the symptoms were either gone, or much improved, within four weeks. And within one year, symptoms were gone or much improved in more than 8 in 10 cases. Anti-inflammatory painkillers may ease the pain until symptoms go. A steroid injection often eases pain in the short term. However, there is concern that having a steroid injection may slightly reduce the chance of having a good long-term outlook. Surgery may be an option if symptoms persist.”

Tennis Elbow “You can start treating tennis elbow at home right away. • Rest your arm, and avoid any activity that makes the pain worse. • Apply ice or cold packs for 10 to 15 minutes at a time, up to 2 times an hour, for the first 3 days. Keep using ice as long as it helps. • Take over-the-counter pain relievers such as ibuprofen or naproxen (NSAIDs) or acetaminophen if you need them. • Wear a "counterforce" brace when you need to grasp or twist something. This is a strap around your forearm placed about an inch below your elbow. It eases the pressure on the tendon and spreads force throughout your arm. After the pain eases, your doctor or physical therapist can teach you rehab exercises to stretch and strengthen your tendon. Doing these exercises at home can help your tendon heal and can prevent further injury. “

Tennis Elbow Treatment “Tennis elbow is the common name for the inflammation of the tendons (also know as tendonitis ) attached to the lateral, or outside, of the elbow at the bony bump of the humerus. ( upper arm bone ). The medical term for this bony prominence is called the lateral epicondyle, which is the reason that the condition is also refered to as 'lateral epicondylitis'. The muscles that move the wrist and fingers attach to a tendon that is connected to the bone structure in this area. Tennis elbow patients suffer experience pain on the outer or top part of the elbow. This pain may be experienced farther up the forearm and occasionally even in the hand.”

Tennis Elbow (Lateral Epicondylitis) “The pain of tennis elbow generally subsides within a few weeks, although it sometimes can last for months. Continuing to use the injured muscles can prevent healing and may result in a long-lasting (chronic) condition. … The most important treatment for tennis elbow is rest, because the condition will not improve if the activity that caused it continues. Ice packs and nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen (Advil, Motrin and others) or naproxen (Aleve, Naprosyn and others), may provide some relief from pain. A forearm band or strap wrapped around the forearm just below the elbow may provide significant relief. This rests the inflamed tendon. People with severe pain may have the elbow immobilized in a sling or splinted at a 90-degree angle, although the elbow should not be immobilized for prolonged periods.”

GUIDELINES:

NGC - Elbow (acute & chronic). (2007)

INTERNET SITES:

A Patient's Guide to Lateral Epicondylitis (Tennis Elbow)

A Patient's Guide to Medial Epicondylitis (Golfer's Elbow)

A Patient's Guide to Radial Tunnel Syndrome

Arthritis: Tennis Elbow

Bursitis / Students elbow “The elbow pain originates from below the tip of the elbow where there is a sack of fluid called a bursa. A bursa is used to help lubricate the movement of tissues in joints. However if you take a hard impact onto the back of the elbow or are constantly leaning on the elbows the bursa can become inflamed or bleeding can occur in the bursa. The result is elbow pain and swelling on the bony bit at the back of the elbow.”

Inflammation and rupture of the triceps tendon “The triceps tendon is the one at the back of the upper arm - as shown opposite. It inserts into the back of the elbow. If you fall onto your hands you can rupture this tendon. If you over-do the weights or try to push something too heavy you can also rupture the tendon or it could become inflamed through over use.”

Entrapment of the radial nerve “The radial nerve passes just below the bony bit on the outside of the elbow (lateral epicondyle). The symptoms of radial nerve entrapment are very similar to those of tennis elbow. If the muscles and tendons in the forearm become inflamed they can trap the nerve.”

Entrapment of the ulnar nerve “The ulnar nerve runs down the inside of the elbow. If you knock the inside of the elbow you can get a numbness or buzzing down the forearm into the forth and fifth fingers (hitting your funny bone). It is the ulnar nerve that is being hit when this happens. If the muscles in the forearm become inflammed they can trap the ulnar nerve causing symptoms that can be similar to Golfers elbow.”

Golfers Elbow / Throwers Elbow / Medial Epicondylitis “Golfer elbow is a similar injury to tennis elbow only it affects the inside of the elbow instead. Golfer elbow is more common in throwers and golfers hence the 'nicknames'. Also known as flexor / pronator tendinopathy this elbow pain is seen in tennis players who use a lot of top spin on their forehand shots.”

Inflammation of the biceps tendon at the elbow. “This elbow injury is more likely to affect weight lifters who over do the biceps curls. People who do a lot of writing such as students can also be prone to this elbow injury. Very simply the tendon of the biceps muscle inserts into the inside of the elbow and can become inflamed if it is overused.”

Lateral Epicondylitis (Tennis Elbow)

Medial Elbow Collateral Ligament Sprain “The medial elbow ligaments are situated on the inside of the elbow and help provide stability to the joint. Damage to these ligaments can occur through impact injury or accident or from repetitive oversuse for example throwing with poor technique. For example Javelin throwers who throw with a low elbow.”

NIH - Elbow Injuries and Disorders

NIH - Tennis elbow Medical Encyclopedia “Tennis elbow is an inflammation, soreness, or pain on the outside (lateral) side of the upper arm near the elbow. There may be a partial tear of the tendon fibers, which connect muscle to bone, at or near their point of origin on the outside of the elbow. … Possible Complications • Recurrence of the injury with overuse • Rupture of the tendon with repeated steroid injections • Failure to improve with nonoperative or operative treatment; these may be due to nerve entrapment in the forearm “

Tennis Elbow

Tennis elbow

NIH – Tennis Elbow Tutorial

NIH - Tennis elbow (Medical Encyclopedia)

Tennis Elbow (Lateral Epicondylitis)

Tennis elbow (Mayo)

Tennis elbow / Lateral epicondylitis “Tennis elbow or lateral epicondylitis is an extremely common injury that originally got its name as it appeared in a high proportion of tennis players. Nevertheless it commonly manifests in a vast proportion of people who do not play tennis at all. Tennis elbow occurs most commonly in the tendon of the extensor carpi brevis muscle at approximately 2cm below the outer edge of the elbow joint or lateral epicondyle of the humerus bone. Specific inflammation is rarely present in the tendon but there is an increase in pain receptors in the area making the region extremely tender.“

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