Orthopaedic Associates-Injury Facts-Shoulder/Elbow

Back to Injury Facts Table of Contents

Back to Orthopaedic Associates Home Page

Orthopaedic Associates has experts on staff who specialize in shoulder and elbow problems. If you have any questions regarding this or any other topic, please call us at 410-337-7900 or 1-800-678-4671.
You can email us HERE.

Golfer's Elbow and Tennis Elbow

Tennis elbow and golfers elbows (lateral and medial epicondylitis) are conditions that cause problems for many golfers and racquet sport players. These conditions can be caused by other repetitive activity that includes rotating your forearm or extending your wrist (painting, throwing sports, screwdriver action). This is an inflammation of the tendons in the elbow region. This inflammation is attributed to micro-tears of the muscle-tendon attachment caused by the stresses placed on the elbow. Tennis elbow affects the lateral (outside) aspect of the elbow where golfer's elbow affects the medial (inside) elbow.

Golfer's elbow involves the tendons that flex the wrist and fingers. A small tendon attached to the inside of the elbow extends to the forearm and attaches to the large flexor muscles of the forearm. Repetitive use of these muscles will cause them to become overused and inflamed thus causing pain and discomfort on the medial side of the elbow. The same is true for tennis elbow with the exception that the tendons extend the wrist and fingers and pain is produced on the outside of the elbow.

Signs and Symptoms:

Point tenderness at the elbow (medial or lateral)
Inflammation
Loss of function of the wrist/elbow
Muscle weakness
Pain on active and resistive muscle motion at the wrist
Persistent discomfort and stiffness
Radiating pain in the arm

Causes:

Overuse. Repetitive tension at the elbow causing overload on the tendon attachment.
Weak muscles or muscle imbalance.
Improper technique (excessive wrist movement) or improper equipment (incorrect grip size, tight strings).

Treatment:

Rest! Modify the activity that is contributing to this condition. You should allow the elbow adequate time to heal and return to its normal state.
Temporary use of anti-inflammatories (Advil or Aleve) are beneficial to reducing the pain and inflammation at the elbow. Consult your doctor for proper dosage.
Ice massage to the affected area.
A forearm strap or splint may be recommended.
Cortisone shots may benefit some individuals.
Following the initial course of treatment, strengthening exercises should be incorporated to strengthen the forearm muscles to be able to accept the muscle strain placed upon them during activity. Examples include gripping a ball, towel wringing, wrist flexion/extension and supination/pronation with and without weights.

CLICK HERE FOR EXERCISES (PDF)
The exercises are in PDF format. To view this file, you need Adobe Acrobat reader. If you don't have access to Adobe acrobat reader, you can go the adobe website and download it for free HERE.

Impingement Syndrome

Impingement syndrome is a painful condition of the shoulder, resulting from overuse and anatomic constraints. Rotator cuff tendinitis, bursitis, and painful arc syndrome are sometimes used to describe this condition. The rotator cuff tendons, biceps tendon, and subacromial bursa may all be impinged or pinched when the arm is used in overhead motions. The tendons and bursa are pinched between the upper arm bone (humerus) and a portion of the scapula known as the acromion. (See diagram). The impingement leads to repetitive microtrauma and inflammation in the structures involved. This condition is commonly seen in baseball, softball, tennis, and swimming.

Causes:

Chronic, repetitive activities related to sports or a job.
Rapid increases in intensity or frequency of overhead activity.
Acute trauma to the shoulder area that initiates an inflammatory response.

Signs/Symptoms:

Pain in the front or on top of the shoulder during and/or after overhead

A painful arc of shoulder motion (such as reaching behind you in a car,

Shoulder weakness or early fatigue with overhead activity.
Pain at night when sleeping.

Treatment:

Decrease, modify, or rest from overhead activity.
Warm-up and stretch prior to activity.
Apply ice for 15 or 20 minutes following activity.
Treatment with prescription strength anti-inflammatories.
Physical therapy for shoulder strengthening and range of motion exercises.

Rehabilitation/Prevention:

Resistance exercise for weakened muscles (rotator cuff).
Stretching of the shoulder and upper body muscles.
Improve and adapt activity techniques.