Summer sports and simple overuse can cause elbow injuries

Now that summer is in full swing, so to speak, injuries related to outdoor sports, like tennis and golf elbow, are more common. In fact, up to 50 percent of all tennis players will develop tennis elbow and it is the most common [PDF] overuse injury of the elbow.

The popularity of pickleball has also added to the problem of elbow injuries, but Orthopedic Surgeon Jesse Affonso, MD, at Cape Cod Orthopaedics and Sports Medicine in Hyannis said they can also occur from repetitive work or even sitting for too many hours a day at a computer desk typing.

“Both tennis elbow and golfer’s elbow are overuse injuries that historically happen in someone who is doing repetitive forearm and wrist motion,” he said. “You often see it in people who take up a sport for the first time or who haven’t played in several months because of the seasonality issue.”

Both are caused by inflammation of the tendon. Tennis elbow, or lateral epicondylitis, is pain and inflammation along the outside of the elbow. Golfer’s elbow, or medial epicondylitis, is pain and inflammation along the inside of the elbow. Both can be frustratingly stubborn injuries.

“Just like plantar fasciitis in the foot and low back pain in the spine world, the elbow inflammation issues are frustrating both for patients and even orthopedic surgeons because many times it’s rather tenacious,” Dr. Affonso said. “Oftentimes by the time a patient gets to me they’ve been dealing with this for four to six months already.”

Identifying and Treating

The first step is identifying that you are in pain and then trying to identify the root cause. Once you have done that, resting the elbow, avoiding the offending activity and managing the pain with an anti-inflammatory medicine like Motrin, Aleve or ibuprofen are effective at-home options.

“That can be very helpful for many people,” Dr. Affonso said.

The next step is to get a brace or a strap that can support the elbow and take stress off of the tendon. These devices are readily available at local pharmacies or online at Amazon. A few sessions of physical therapy can also help.

“Any time you have an injured joint, strengthening the joint above and below can be helpful, so physical therapy can most definitely be helpful,” he said. “Most of the physical therapy for tennis elbow and golfer’s elbow centers around wrist extension, wrist flection and then conditioning the whole entire arm which can help quite a bit.”

In addition to teaching you exercises, physical therapists can use ultrasound, icing and muscle stimulating techniques, but the good news is that once you learn the exercises, you can continue to do them at home on your own. Dr. Affonso recommends doing them in the morning and again before bed.

Steroid injections are usually the next level of care if the previous techniques don’t work to eliminate the pain. Steroids can be very effective at treating inflammation, but Dr. Affonso doesn’t believe in overdoing them.

“We don’t often lead with a steroid injection but if we’ve tried a couple of things and you ultimately were not happy with the result, a steroid injection is something that is worth considering,” he said. “I’m not a huge fan of giving multiple injections into the tendon itself but maybe just an injection or two in conjunction with physical therapy or the strap or a brace, hoping that can calm things down.”

Surgery as a Last Resort

There are also other therapies like platelet-rich plasma (PRP) injections that you can discuss with your orthopedic surgeon. If all else fails, surgery is an option. Dr. Affonso usually makes patients wait six to nine months while they try other interventions before considering surgery.

It’s a relatively minor outpatient surgery that he does at Cape Cod Hospital. The surgery is done under local anesthesia and takes about 20 to 30 minutes. Dr. Affonso makes a very small incision along the outside or inside of your elbow. Patients have to wear a sling for about a week and then do some physical therapy. Recovery takes about six to eight weeks.

“For those patients who have tried everything else, it’s been a very good option,” he said. “I would say that a high 90 percentile of patients that had the surgery are happy they did it.”

For more information on the conditions and their treatment, Dr. Affonso refers patients to the American Academy of Orthopedic Surgeons information website. He also gives patients print-outs from that source.