Elbow injuries are common but increase in the springtime as people increase their outside activities such as racquet sports, golf, and yardwork. Two very common sources of elbow pain are tennis elbow (lateral epicondylitis) and less commonly golfer’s elbow (medial epicondylits)

Lateral epicondylitis is much more common than medial epicondylitis, It is known as tennis elbow because if affects 25 to 50 percent of tennis players at some point in their career. However, most patients with tennis elbow are not involved in racquet sports. Anyone using repetitive movement at least two hours a day is at greater risk. People who smoke also have a higher risk of developing tennis elbow. Tennis elbow can result in chronic pain — especially when lifting or gripping objects. The dominant arm is most often involved, and sufferers are usually aged 30 to 50.

The cause of both is repetitive forearm motion causing stress over the outside (lateral epicondylits) or inside (medial epicondylits) of the elbow. Eventually inflammation develops from small “microtears” in the tendon insertions around the elbow, causing pain on the outside or inside of the elbow which worsens over weeks to months. The conditions are diagnosed through a complete medical history and physical exam. The physician will apply pressure to the bony prominences on each side of the elbow to test for pain. He or she will also test for elbow pain with finger, wrist and elbow motion. Usually, imaging tests such as X-ray, CT, or MRI are not necessary for diagnosis.

Nonsurgical treatment is usually very successful. Activity modification, ice, anti-inflammatory medication, cortisone injections and counterforce bracing can all play a role in treatment. Physical therapy consisting of stretching, range of motion exercises and strengthening is sometimes required.

Although 85 to 90 percent of cases are resolved thorough nonsurgical treatment, surgery is sometimes required. Surgical treatment is reserved for severe cases not responding adequately to at least six months of conservative treatment. An outpatient procedure, surgery involves removing the degenerated tendon tissue and reattaching healthy tendon to bone. This is done under either general or regional anesthesia.

After surgery, a splint is worn for approximately one week. Then physical therapy starts for gradual stretching and increasing range of motion. Strength training is gradually added. Full athletic activity is generally permitted after three to six months.

As with most orthopedic injuries, the best prevention is maintaining a healthy lifestyle through an appropriate diet and regular exercise. Golfers and tennis players need to have a professional review their technique. Sports enthusiasts should prepare for any sport season with appropriate conditioning and strength training. Always be sure to warm up properly before a sports activity. Gently stretch the forearm muscles at your wrist before and after use. After heavy use of your arm, apply an ice pack or use ice massage, which can be accomplished by filling a sturdy paper or plastic foam cup with water and freezing it. Then, roll the ice directly on the outside of your elbow in a circular motion for five to seven minutes.

Before the doctor appointment:

Write down any symptoms including any that may  seem unrelated.

Make a list of all your medications as well as any vitamins or supplements.

Write down questions to ask your doctor.

Questions for your doctor include:

What’s the most likely cause of my symptoms?

Are there any other possible causes for my symptoms?

What kinds of tests do I need?

Is my condition likely temporary or chronic?

What treatments are available, and which do you recommend for me?

Are there any exercise restrictions that I need to follow?

Are there any brochures or other printed material that I can take home with me?

What Web sites do you recommend visiting?

What to expect from your doctor:

Your doctor is likely to ask you a number of questions as well, such as:

Where is your pain located?

When did you first begin experiencing symptoms?

Have your symptoms been continuous, or occasional?

How severe are your symptoms?

What, if anything, seems to improve your symptoms?

What, if anything, appears to worsen your symptoms?

Have you had any medical treatment for this condition previously?

What you can do in the meantime:

While you are waiting to see the doctor, stop doing the exercise or activity that worsens your symptoms, if possible. Ice the area several times a day for about 15 minutes at a time. Wrapping the area with an elastic wrap or bandage also may help keep swelling down. Use of over-the-counter anti-inflammatory medications may help temporarily, but they are not recommended for long-term use due to gastrointestinal problems.

Christopher Ferguson, M.D., earned a medical degree from University of Mississippi School of Medicine, in Jackson, Miss., and he completed his residency in orthopaedic surgery there as well. Dr. Ferguson completed a special trauma fellowship in Chur, Switzerland, and is currently earning his board certification.