SPORTS INJURIES
Tennis Elbow, Golfer's Elbow and Tommy John Surgery
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.
If ligaments and tendons are the cause of the problem, Prolotherapy
injections are given. 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." (Tullos, H. Elbow
instability. In Baker, C. (ed.), The Hughston Clinic Sports Medicine Book. Philadelphia,
PA. 1995. pp. 317-323.) 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." (Tullos, H. Elbow instability. In
Baker, C. (ed.), The Hughston Clinic Sports Medicine Book. Philadelphia, PA.
1995. pp. 317-323.)
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.
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