Elbow/ Forearm

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Elbow/ Forearm 

Tennis Elbow (Lateral Epicondylitis)

"Tennis elbow", or lateral epicondylitis, is a common term for a condition caused by overuse of arm, forearm, and hand muscles.  It specifically involves the area where the muscles and tendons of the forearm attach to the outside bony area (called the lateral epicondyle) of the elbow and results in pain at the outside of the elbow. Tennis elbow actually involves the muscles that lift the wrist up, towards the back of the hand, and stabilize the wrist when you use your fingers. You don't have to play tennis to get this, but it can be a significant problem for some tennis players, and half of all tennis players will experience tennis elbow at some point in their careers. Others who experience tennis elbow are baseball players, golfer’s, people who spend most of their time working on keyboards, musicians, carpenters, and gardeners. 

Causes include either abrupt or subtle and  repetitive injury of the muscles and tendons area around the outside of the elbow. A weak shoulder girdle, poor posture, and problems attributed to the neck commonly play a role as well.

Symptoms include pain at the outside of the elbow, and may be made worse with using the hand to grip, shake hands, squeeze, open lids, work at a keyboard, and lift with a stabilized wrist, such as a coffee pot or even a cup.

A physical therapist can determine and address the underlying issues contributing to the irritation in the elbow,  as well as analyzing the daily habits that could be causing the problem. 

Treatment consists initially of resting the elbow, ice, and taping or splinting with a brace; modalities may be used such as US, laser, and electrical stimulation; manual therapy such as mobilization, and ASTYM or Graston for the neck, elbow, and wrist; exercises for shoulder girdle strength and stability, posture, normal mobility, and grip and wrist strengthening, as well as functional strengthening and addressing the mechanics of the activity  causing the pain, such as the tennis swing or the arm positon when playing an instrument.

Golfers Elbow (Medial Epicondylitis)

“Golfer's elbow”, or medial epicondylitis, is similar to tennis elbow, but occurs on the opposite side of the elbow. The pain or soreness is in the inner part of the elbow from movement of muscles and tendons in the arm that lift the wrist towards the palm, clench the fingers, or rotate the palm down. Although common to golfers due to the motion of the golf swing, it is more often seen in non-golfers, especially pitchers and climbers, and people who frequently hammer or garden.

Causes for Golfer's elbow include: overuse by putting too much stress on your muscles, joints, or other tissues without allowing them to recover; inadequate strength in the shoulder girdle; and faulty or very repetitive mechanics with an activity such as golf or pitching.

Treatment consists initially of resting the elbow, ice, and taping or splinting with a brace. Modalities may be used such as US, laser, and electrical stimulation, as well as manual techniques including mobilization, ASTYM or Graston. Focus is on strengthening the upper body, especially the shoulder girdle and core as well as the elbow, wrist and hand; addressing mobility issues that prevent normal movement; as well as functional strengthening and addressing the mechanics of the activity causing the pain, such as the golf swing or pitch delivery. (SOMEWHAT Copied the one from lateral epicondylitis, as they are so similar in treatment approach)

Golfer’s elbow needs to be differentiated from ulnar collateral ligament (UCL) injury and  little league elbow.

Little League Elbow (Ulnar Collateral Ligament Sprain)

Little Leaguer's elbow occurs in young baseball players, typically age 9-14, who throw the ball too hard or too often, and lack the skeletal maturity to do so.  The growth plate at the inside knob of the elbow, called the “apophysis”, widens and enlarges  that part of the elbow bone called the medial epicondyle. Repetitive stress pulls at the ligaments and tendons that attach here, causing inflammation, pain, and potentially fragmentation of the bone and detachment of the growth plate.

The most common causes are throwing too many pitches, throwing breaking pitches, lacking the strength or endurance for the type and number of pitches, and repetitive overhead throwing.

Symptoms include swelling and pain on the inside (medial) part of the elbow, quicker fatigue with throwing, and loss of distance or speed.  Arm motion may be decreased because of pain.

Physical Therapists can correct poor joint mechanics, address strength deficits in the shoulder girdle and core, and educate athletes, parents and coaches on the number of throws that are appropriate for their age.

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