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Exercise, PRP, surgery linked to presentation of elbow problems in golfers and tennis players
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BARCELONA — Elbow problems and tendinopathies can arise from too much practice and play in professional golfers and tennis players, as well as in “weekend warriors” who overdo it at the gym and stress the biceps tendon or grip playing equipment too hard, according to a presenter, here.
At the European Society of Sports Traumatology, Knee Surgery and Arthroscopy Congress, Adam C. Watts, MRCS, of the Upper Limb Unit at Wrightington Hospital in Wigan, United Kingdom, discussed appropriate elbow exams, imaging and treatment for tennis players and golfers at all levels of play. He also urged orthopedic surgeons to gather a complete patient history and carefully diagnose these elbow injuries in order to safely return athletes to play.
“For those with reactive tendinopathy and early tendon disrepair, which will be your elite athletes who will present early, remove the trigger. Look at what has changed in their program that has caused the symptoms and remove that,” Watts said.
Such changes might include the incorporation of different equipment or new techniques. Most tendinopathies in the elbow have an insidious onset. Therefore, it should raise a red flag when someone presents with acute or traumatic onset of symptoms, he said.
“Tendon avulsions do occur around the elbow, just as they do in the shoulder, and they will present with similar symptoms and signs, but the history will be different,” Watts said.
For patients who present early, Watts noted NSAIDs may have an effect, but only in the first 4 weeks. He also recommended isometric exercises be performed on alternate days.
Watts discussed the slightly different management he uses for patients, such as “weekend warriors,” who present with elbow tendon issues later.
“You need to think about an eccentric loading regime on a daily basis three times a day. If that does not work, then autologous blood or [platelet-rich plasma] PRP injection may have a role and, as a last resort, surgery,” he said.
Watts said, physiotherapy, activity modification and rest generally constitute the primary treatment for tendinopathies, including tennis elbow or golfer’s elbow and distal biceps tendinopathy. – by Susan M. Rapp
Reference:
Watts A. Tennis and golf — Lateral epicondylosis, medial epicondylosis. Presented at: European Society of Sports Traumatology, Knee Surgery and Arthroscopy Congress; May 4-7, 2016; Barcelona.
Disclosure: Watts reports his institution received research support from Zimmer Biomet and he has an unpaid role on the Medical Advisory Panel for the European Golf Tour.