Tennis Elbow and Golfer's Elbow
Ross Hauser, M.D.

The anatomical structures involved in tennis elbow (lateral epicondylitis) and golfer's elbow (medial epicondylitis) are structures located very close to the skin-in some people only two or three millimeters-that traditional treatments such as physical therapy, heat, ultrasound, and massage should very quickly resolve. These treatments greatly increase the metabolic rate in the muscle attachments at these sites, so recovery should be quick and easy. Because these conditions do not recover quickly, this tells us that the muscles are not the problem, but the underlying ligaments. The athlete does not recover because tennis elbow and golfer's elbow, known as epicondylitis, are way overrated as a cause of chronic elbow problems.

The inherent stability of the elbow, because of the unique interlocking features of the humerus into the ulna, cause most orthopedic surgeons, physical therapists, and athletic trainers to doubt that the ligaments in the elbow are easily injured. Most believe that elbow instability or ligament injury in the elbow occurs primarily when the athlete sustains a fracture to the elbow.

One sports medicine text put it this way, "Elbow instability is an uncommon clinical concern in sports medicine, except for throwing athletes." 1

This is a false notion and one of the reasons why athletes around the country are not receiving cures for their chronic elbow pain and injuries.

An orthopedic surgeon will nearly always give a surgical option for the condition of elbow instability. This is because the only treatment surgeons have to offer for unstable joints is surgery. This involves taking a tendon from the wrist (palmaris longus tendon) and grafting this on the lateral or medial elbow, depending on which side is unstable.

This radical surgery is explained this way, "The decision to treat valgus instability with surgical reconstruction depends on the patient's career expectations. Should the patient have a long-term goal of extending his or her career years, and should he or she be willing to undergo the one to two year period of healing and rehabilitation, valgus reconstruction is a reasonable option. Unfortunately, elbow instability, even if managed optimally, is often a career-altering or career-ending injury." 1

In other words, if an athlete has a ligament injury or a ligament sprain of the elbow, the orthopedic surgeon is going to cut a tendon out of the wrist and transplant it into the elbow to maintain an ability to play sports. The athlete is then supposed to undergo rehabilitation for one to two years. After all of this, even if it is "optimally" managed, it is often a career-altering or career-ending injury.

1. Tullos, H. Elbow instability. In Baker, C. (ed.), The Hughston Clinic Sports Medicine Book. Philadelphia, PA. 1995. pp. 317-323.