People talk about tennis elbow all the time. It has become part of the vernacular with people who have never touched a racket, who use the term to describe pain on the lateral side of the elbow. Less talked about, but no less debilitating to those affected by it, is “golfer’s elbow” or medial epicondylitis. And, despite its name, this is a condition that can also affect tennis players.
Medial epicondylitis refers to inflammation of the tendons that attach to the medial epicondyle of the humerus or arm bone. These tendons are attached to the muscles responsible for flexing your wrist and pronating your forearm (rotating your forearm palm down). This inflammation commonly occurs in golfers, but it can affect anyone who performs the motions described above repetitively. Tennis players are particularly susceptible on forehands and serves.
The majority of cases are due to chronic overuse, but acute epicondylitis can occur. Because tennis requires repetitive and strenuous forearm and wrist movements, tennis players are at risk of developing the condition.
Tennis players with medial epicondylitis will complain of pain along the medial aspect of their elbow (the side of your elbow closest to your body when your palm is facing up). Pain can sometimes radiate down the forearm. Again, typically forehands, serves and overheads are the most painful strokes.
Usually the symptoms will subside with avoidance of the inciting activity. If they persist, you should see an orthopedic surgeon to make sure something else isn’t causing the pain. Typically, they will prescribe anti-inflammatory medications, ice, and stretching/strengthening exercises. Most cases will respond to the above treatments within about 4 to 6 weeks. It is extremely important, however, to avoid returning to tennis before the symptoms have resolved, as this can be a set up for further injury.
More chronic cases and cases that are recalcitrant to the above-mentioned treatment modalities may benefit from an injection of cortisone into the area. Cortisone is a steroid that helps reduce inflammation. Though it may help the symptoms, it shouldn’t be done as a first-line treatment, as it can actually weaken muscle and tendon tissue. More recently, platelet-rich plasma, which involves isolating of the growth factors from one’s own blood and injecting into the site of maximal tenderness, has been used with some success and it is less damaging to the tendon than cortisone. In about 10% of cases, patients will require surgery for the condition. Surgery involves removing the inflamed area of tendon and, if a tear is present, repairing it.
Clearly, the best treatment is prevention. Warm up and stretch appropriately before playing and listen to your body. You don’t want to make a relatively minor condition into something more severe by playing through pain. Always consult a physician before starting an exercise regimen and for treatment for your elbow pain.
Dr. David Dines is an orthopedic surgeon at Hospital for Special Surgery. He serves as the medical director of the Association of Tennis Professionals (ATP Tour), the team physician for the US Davis Cup tennis team and an orthopedic consultant for the US Open Tennis Tournament.
Dr. Joshua Dines is an orthopedic surgeon and member of the Sports Medicine and Shoulder Service at Hospital for Special Surgery. He serves as a team physician for the US Davis Cup tennis team.