It is possible to experience both tennis elbow and golfer’s elbow in the same arm simultaneously, a condition known as dual epicondylitis. Both conditions involve tendinopathy, a pathological alteration at the origin of the forearm muscles where they attach to the bony prominences of the elbow joint. While both involve tendon degeneration from overuse, they affect opposite sides of the elbow and distinct muscle groups. Confirmation of this dual presentation requires a careful clinical assessment to isolate pain to both the inner and outer elbow tendons.
Defining Tennis and Golfer’s Elbow
Tennis elbow, medically termed lateral epicondylitis, involves the tendons on the outside of the elbow joint, specifically the common extensor tendon origin. The primary tendon affected is the Extensor Carpi Radialis Brevis (ECRB), which is responsible for helping to extend the wrist. This condition is caused by repetitive or forceful movements that require wrist extension and gripping, such as using a screwdriver, painting, or performing a tennis backhand stroke.
Golfer’s elbow, or medial epicondylitis, affects the tendons on the inside of the elbow at the medial epicondyle. This involves the common flexor-pronator mass, including the Flexor Carpi Radialis and Pronator Teres muscles, which flex the wrist and pronate the forearm. Repetitive activities involving strong wrist flexion or forearm pronation, like swinging a golf club, throwing a baseball, or using certain hand tools, place excessive strain on these inner tendons. While lateral epicondylitis is far more common, both conditions represent an overuse injury where the rate of tendon damage exceeds the rate of repair, leading to degenerative changes rather than purely inflammation.
The Mechanics of Simultaneous Injury
The simultaneous occurrence of both conditions stems from activities that place high, generalized demands on the entire forearm musculature. Dual epicondylitis typically results from systemic overuse that stresses both the wrist flexor (inner) and wrist extensor (outer) compartments. For example, certain types of manual labor, intense weightlifting that incorporates both heavy gripping and rapid forearm rotation, or complex athletic movements can strain both muscle groups.
The mechanism is not usually a single, isolated movement but rather prolonged, high-force repetitive actions that lead to widespread tendon fatigue. When both the flexors and extensors are repeatedly subjected to microtrauma, the body’s repair process cannot keep up on both the medial and lateral sides of the elbow. This systemic overload causes degenerative changes in the tendons attached to both epicondyles, leading to pain on both the inner and outer aspects of the elbow.
Clinical Diagnosis and Ruling Out Other Issues
A healthcare professional diagnoses dual epicondylitis primarily through a clinical history and physical examination. The doctor will apply pressure directly over the lateral and medial epicondyles to identify tenderness at both specific attachment sites. They will then perform specific maneuvers to isolate and confirm the involvement of the opposing tendon groups.
Lateral epicondylitis is often confirmed with a test where the patient resists the doctor’s attempt to push down on the wrist while the elbow is straight, which stresses the extensor tendons. Conversely, medial epicondylitis is checked by having the patient resist wrist flexion and forearm pronation against resistance. It is important to rule out other conditions that can mimic elbow pain, such as nerve entrapment syndromes, including radial tunnel syndrome on the outside or cubital tunnel syndrome (ulnar nerve compression) on the inside. Referred pain from the cervical spine can also present as elbow pain, requiring a thorough assessment of the neck and shoulder.
Managing Dual Epicondylitis
Management of dual epicondylitis focuses on a comprehensive non-operative approach aimed at reducing the load on both injured tendons and promoting healing. The initial phase typically involves activity modification and rest, meaning the patient must temporarily stop the repetitive actions that caused the dual injury. Ice application can help manage localized discomfort, although the condition is primarily a degeneration (tendinosis) rather than a pure inflammatory process.
Counterforce bracing is a common recommendation, often with one strap placed just below the elbow joint to disperse the force on the extensor origin and another for the flexor origin, or a single brace used strategically. Physical therapy is a component of recovery, focusing on a program of targeted eccentric strengthening and stretching exercises for both the wrist flexors and extensors. This coordinated rehabilitation helps build tendon resilience and improve the overall strength and endurance of the forearm muscles.