Description

Tennis and Golfer’s Elbow

Tennis elbow (lateral epicondylide)

The most common pain problem in the elbow area is tennis
elbow. It occurs after repetitive wrist-elbow movements such as screw
tightening, opening the jar lid, heavy lifting, excessive force on the elbow
with the wrench used by plumbers or repairmen.

It is seen after the repetitive application of the
lifting movement of the hand and wrist towards the back of the hand, excessive
tightening of the hand or the material held, and the rotational movements with
squeezing. The starting place of the muscles that make this movement to
the wrist is the protruding area on the outer side of the elbow and its
front. Your muscles; There is a decrease in the structure of the
adhesion area in this area and the vascularization due to continuous
use. It has been shown that it causes insufficient oxygenation in this
region and thickening with degradation.

Different forms of illness can be seen, from mild pain in
the elbow area to pain that cannot be used in certain movements. Pressing
the outer part of the elbow with a finger is sometimes painful to
touch. It may not be able to lift weights such as cups, teapots, and even
these objects may fall out of the hand. In the beginning, slight swelling may
be seen. If the palm is forced into the drinking position when the forearm
is grasped and fixed while the elbow is in a bent position and the palm is
facing the ground, there will be extreme pain in the elbow.

There is usually a history of straining or overuse before
the pain. These findings may disappear after a while if the repetitive use
or compulsion is temporary. However, as the same tasks continue to be
done, the pain begins to become chronic and persistent.

Diagnosis

It is usually easy to diagnose. Methods such as film
and MR are not required initially. However, if there is no improvement
despite 6 weeks of treatment, 2-way film of the elbow can be taken for differential
diagnosis. Ultrasound or MRI can be performed to distinguish whether there
are other intra-articular or joint disorders.

Treatment at The Beginning;

In its treatment; Limitation is made in the use of
hand and wrist. Wrist and hand movements; It is arranged to rest the
affected muscle group. Drug treatment is regulated. Gel applied to
the painful area and oral anti-rheumatic drug treatment are the drugs used in
the first step.

If there is no improvement with these measures, intra-tensile
elbow tape can be used. The purpose of use of this tape; of this
muscle group, not from the painful area in the elbow when contracted, but from
the painful area,

Taking force from the tape applied on the muscle is to rest
the painful area.

Wrist splints can be used in painful pictures that radiate from the elbow to the wrist.

Defined exercises are not done in the acute period, exercises
are used in the recovery period.

At this stage, those who are in mild form generally have
healed, at least when they are not strained, they become pain-free. Response
to this treatment is obtained in moderate and severe forms, but it is
insufficient, the pain continues, and he has difficulty using his hand. Since
the pain is often on the dominant hand (left-handed left), that is, on the
frequently used side, they have to use their hand in daily life. This
causes the pain to continue.

In Prolonged Cases; Regional injection B

This time, different applications can be made for
patients in this situation or patients whose pain has passed and then recurs. Physical
therapy is applied. Applications such as cortisone injection, PRP
injection, Hyaluronate injection are applied to the painful area. The most
effective method to relieve pain and complaints in a period of 6-8 weeks in the
short term is regional cortisone injection. However, long-term comparative
results of cortisone injection are not at the expected levels compared to other
methods.

PRP injection (the patient’s own thrombocytes) can be
applied. There are publications stating that its long-term results are
more satisfactory than cortisone administration. Hyaluronate injections
are also among the drugs used in practice.

The patient’s own blood can be applied to the painful area
with a local anesthetic drug. Dry needle or saline / sugar water injection
(phototherapy), local anesthetic drug injection applications are available. Local
injection and dry needle application is not applied to a single point, but to
several points. There are publications stating that bleeding and tissue
factors caused by needle tip irritation during this application provide
healing.

Other treatment methods

Pulsed ultrasonic sound wave ESWT applications (exercises
with the application head of the stone crushing device to the muscle tissue)
can be applied in 3-5 sessions. Laser (HILTERAPY) with high intensity is
another method that can be applied.

Among the results, there is not yet a method that will
provide definitive results in the treatment of every patient. If there is
no result from the treatments, surgery can be planned. Surgery is rarely
required for tennis elbow. Those who have to use their hands in the same
way as an occupational disease, in cases resistant to treatment; Whether
there are accompanying intra-articular disorders is investigated by performing
MRI. In these cases, angio-fibroplastic tissue (diseased tissue) is
surgically removed. The adhesion site of the short of the triple muscle
group that adheres here is freed. Then, with physical therapy, the muscles
regain their former strength and joint movements are brought back to normal.

It is very difficult to get an immediate response in tennis elbow treatment. Recovery
may take weeks / months. The biggest reason for this is that it is not
possible to rest the elbow during daily life activities.