Hello and welcome.
My name is Doctor J. Michael Bennett.
I'm an Orthopedic Sports Medicine Physician.
I specialize in injuries of the shoulder, elbow,
and knee.
Welcome to the Whiteboard Series.
Today, we're going to talk a little bit about lateral and medial epicondylitis,
also known as tennis elbow and golfer's elbow.
I just want to go over what exactly it is and the
appropriate way to use a counter-force brace or the type of brace that you
would need for any of those tendinitis.
So, basically tennis elbow and golfer's elbow occurs from repetitive use of
the wrist or the elbow.
If you're looking at an elbow, right here, the bony
anatomy, the lateral side, which is the outside area; this is where the
common extensors that lift the wrist insert right here at the bone.
So the muscles come up and insert right here to the
lateral epicondyle.
The medial side, which is the inside of the elbow; the
flexors which allow you to flex the wrist insert right here at the medial
bone.
So what happens is with repetitive, forceful activities you irritate both
of those insertion sites.
Depending on your swing and what type of sport you're playing is going to determine whether
or not you're going to have a medial epicondylitis on the inside or lateral
epicondylitis on the outside.
It's usually due to repetitive, forceful flexing or repetitive forceful
extension.
I've seen medial epicondylitis or golfer's elbow in tennis players as well
usually if they're going through with a fore-hand.
We'll see more tennis elbow when they're going through with the
back-hands.
So, that's using more extensors and when they're going with the
fore-hand that's using more flexors.
Golfers, typically in their swing, when they're coming through
they're flexing their wrists sometimes and that irritates this inside
aspect of the elbow.
When it does become irritated, you get an inflammation.
If it's a long period of time, if it's chronic, sometimes you
can even get partial tears of this tendon.
Many people have partial tears of this tendon and nine times out of ten
this can be treated conservatively with conservative measures and non-
operative measures.
One of those measures is to use appropriate bracing and
the brace that we typically would recommend for these type of tendonitis's
is a counter-force brace.
This is a counter-force brace.
All that this is, is a circumferential brace made of neoprene that actually gives you a
little bit of tension across the irritated area.
The way you use a counter-force brace is you find the area
that's painful, if it's the outside of the elbow or the inside of the
elbow.
Approximately one thumbs breadth below where it hurts you're going
to slide the brace.
You're going to slide it all the way up one finger
breadth or one thumbs' breadth below where it's irritated and then you're
going to wear it snuggly.
You use this throughout the day, during your regular activities.
Use it for a couple of weeks to see if you have an improvement
in your symptoms.
If it does help then that may be all you need to
do; in addition to maybe taking an anti-inflammatory.
Now one thing that's key is make sure you don't have this too tight.
If you have it too tight where you actually feel
numbness or tingling in your hands or you see some discoloration that means
it's too tight and you want to loosen it up a little bit.
This is supposed to be comfortable.
Just be aware of what you're doing repetitively during
the day; make sure you're not repetitively using that wrist, or lifting
that wrist, or flexing that wrist.
Occasionally, you may want to pick up a wrist splint as well.
That also helps immobilize the wrist and keeps you from
using that wrist over and over again and irritating either side of those
tendons.
If you fail conservative measures, then definitely, I
would highly recommend that you be evaluated by an orthopedic specialist;
preferably someone who specializes in shoulders, elbows, and knees
and has experience in dealing with this type of problem.
The good news is that this is a very common problem and most general
orthopedists are familiar with treating this type of pathology.
So, if you have any further questions, feel free to visit
my web site at orthopedicsportsdoctor.com or jmichaelbennett.com
as well.
Thank you very much for this session of the white board series.