Common elbow injuries

Up until this point we couldn't have asked for better weather at the tournament. Unfortunately, the rain came today delaying the start of the night matches. That left us with lots of time to talk, and one of the things we realized was that despite hitting thousands of tennis balls a week, professional tennis players probably develop "tennis elbow"or lateral epicondylitis less frequently than recreational tennis players. This may seem counterintuitive, but it speaks to the importance of conditioning and proper technique when playing tennis. Below we wanted to review some of the more common elbow injuries that can affect tennis players and discuss treatment options.

"Tennis elbow" or lateral epicondylitis can be a common cause of lateral sided (or "thumb sided") elbow pain in the tennis player. This condition is an overuse injury involving the muscles that originate on the lateral side of the elbow, which are used during backhand strokes. The onset of pain is usually gradual and is typically localized to the lateral elbow during resisted wrist extension. Treatment is usually conservative and involves rest, ice, anti-inflammatory medications, bracing, and, occasionally, a corticosteroid injection. Surgery is rare and only indicated in cases where conservative measures have failed.

The ulnar nerve is a nerve that originates in the neck and travels down the inside of the arm to provide motor strength to the forearm and wrist muscles as well as sensation to the small and ring finger. The repetitive motion of the tennis stroke can lead to compression of the nerve at the elbow termed "ulnar neuritis". The initial presentation of ulnar neuritis can be pain along the inside of the forearm with numbness and tingling involving the small finger and a portion of the ring finger. Hand and/or muscle weakness can also be noticed. Conservative treatment can be successful and consists mainly of splinting; surgical intervention is indicated in cases of progressive muscle weakness, persistent muscle weakness longer than 4 months, and chronic neuropathy.

Posterior elbow pain (pain in the back of the elbow) can be caused by a condition known as "impingement." Posterior impingement is due to repetitive hyperextension and stress along the medial and posterior aspect of the elbow. The repetitive forces lead to the formation inflammed soft tissue and possibly bone, both of which can cause a mechanical "block" in the back of the elbow. Symptoms may include swelling and "locking" or "catching" during elbow motion. Many players will notice an inability to completely straighten the elbow. Posterior impingement can be associated with ligamentous instability of the elbow so it is very important to seek evaluation at the first sign of posterior elbow pain. If conservative treatment of posterior impingement is not successful, arthroscopic debridement of the elbow can be a very successful option provided the elbow is otherwise stable.

Elbow injuries in tennis players are very common and most often the result of overuse and improper technique. Prevention should begin with proper exercise, good stroke technique, and appropriate grip size. However, if a new, persistent elbow pain develops, the one should consult a medical professional for aid in the appropriate diagnosis and treatment.