Roger Federer vs. Tiger Woods

Roger Federer and Tiger Woods are two iconic players that have taken the sports world by storm. Roger Federer is a world tennis champion, and Tiger Woods has won 13 major PGA events. What has this article got to do with these personalities? The answer is nothing and everything. We are not talking about either their stories or their careers. We are talking about some of the physical aspects of their sporting activities that can also lead to physical problems. The specific infirmities that are paired with tennis and golf are lateral epicondylitis and medial epicondylitis, respectively, but they are more familiar to most of us as “tennis elbow” and “golfer’s elbow.” These two sports-related infirmities are the top two diagnoses for elbow pain.

Lateral epicondylitis (tennis elbow) is characterized by pain from the outer side of the elbow. According to Dr. Ray Sahelien, tennis elbow occurs in 1% to 3% of the U.S. population. Out of that group, only 5% are actually diagnosed. Although associated with tennis, this source of elbow pain can also be caused or exacerbated by work-related activities and heavy lifting. “Tennis elbow” is a more frequent occurrence in women than in men. So far, Roger Federer hasn’t suffered from tennis elbow as far as we know, but he confirms in his official website that he has often experienced extreme pain in his arm. He says that the pain usually starts in his shoulder and goes all the way through the elbow down to the hand. He reports that he usually gets it from serving and from playing forehand shots, but it goes away after awhile.

In “golfer’s elbow” (medial epicondylitis) the pain is in the inner elbow region. Baseball pitchers can also suffer from “golfer’s elbow” (so maybe we could also call it “pitcher’s elbow). It can also be caused by working out in a gym or even spending long hours in front of a computer. This ailment occurs more often in men than in women. However, Tiger Woods has developed a very straight technique, so that his elbow and upper body are correctly positioned, making him a golfer who actually avoids the pain of golfer’s elbow.

Out of 24 million record counts of extremities found in the PearlDiver database, lateral and medial epicondylitis account for approximately 1.2 million. Table 1 shows the top three diagnoses in the elbow region. Lateral epicondylitis is diagnosed more often than medial epicondylitis. As shown in Figure 1, lateral epicondylitis represents about 85% of the 1.2 million records, and medial epicondylitis represents slightly more than 14%

Table 1 – Top Diagnoses Elbow Region

Figure 1 – Comparison Between Lateral and Medial Epicondylitis

A look at the vast difference of occurrence between lateral epicondylitis and medial epicondylitis shows that tennis elbow is more prevalent than golfer’s elbow in the United States. Tables 2 and 3 summarize the 2005 demographics broken down by gender for the two diagnoses. Data from PearlDiver show that tennis elbow occurs most often in patients aged 40 to 60 years.

According to statistics from the U.S. Department of Health and Human Services, during 2005, the two elbow-related diagnoses occur more often in individuals aged 45 to 64 years than in any other age range. The government data also reveal that golfer’s elbow occurs almost equally in men and women (50.05% and 49.95%, respectively). In contrast, tennis elbow is diagnosed in 9% fewer men than women.

Table 2 – Occurrences of Tennis Elbow by Gender – 2005

Table 3 – Occurrences of Golfer’s Elbow by Gender – 2005

All of this means that Roger Federer has a better chance of getting diagnosed with tennis elbow than Tiger Woods has with golfer’s elbow. Tennis is a more fast-paced game, so that the elbow is constantly in motion. Golf, on the other hand, is a slow-paced, relaxed game. Fifty percent of tennis players during their careers will feel the pain and weaknesses that are associated with tennis elbow. This percentage is significantly higher in proportion than golfers affected by golfer’s elbow.

According to the Ortho Fact Book, published by Knowledge Enterprises, Inc., treatment of tennis elbow and golfer’s elbow is done nearly twice as often on an outpatient than it is on an inpatient basis. Treatment usually consists of physical therapy and specific exercises, including stretching. These therapeutic measures, along with drug treatment, should be tried before surgery is considered. Anti-inflammatory drugs and cortisone injections are common ways to relieve pain and inflammation. When these treatments are not effective, surgery can be considered. Tables 4 and 5 show the top 10 procedures for infirmities of the elbow, extracted from the PearlDiver database.

Table 4 – Top 10 Outpatient Procedures for Tennis Elbow – 726.32

Table 5 – Top 10 Outpatient Procedures for Golfer’s Elbow – 726.31

Arthrocentesis and injections are among the most common procedures for infirmities in the extremities. People with ailments of the shoulders, wrists, leg and ankle, and hand undergo arthrocentesis or injection in a major joint, intermediate joint, or bursa. Arthrocentesis is a common procedure that involves aspiration and injection of the joint. Arthrocentesis works more than 90% of the time and is considered a primary procedure for both tennis and golfer’s elbow. Tables 6 and 7 break down procedure by gender and region. Table 8 summarizes the costs of each procedure based on amounts from 2005. Charges are very nominal compared with those for other surgical procedures, as shown later in this article.

Table 6 – Occurrences of Arthrocentesis Procedure by Gender – 2005

Table 7 – Occurrences of Arthrocentesis Procedure by Region – 2005

Table 8 – Average Charge for Arthrocentesis Procedure by Region – 2005

An investigative team led by Dr. Champ L. Baker III, an orthopedic resident at the University of Pittsburgh, followed 30 patients who underwent arthroscopic surgery for 11 years after the operation and obtained positive results. They found that surgery can lead to long-term pain reduction and increased mobility for people with these diagnoses. Dr. Baker recommends arthroscopic surgery for patients who have suffered this condition for more than a year. His study was one of the first to collect longitudinal data for arthroscopic treatment of tennis elbow.

The PearlDiver database shows that more men than women undergo treatment, although women are diagnosed with tennis elbow slightly more often than men. The other common procedure for these elbow infirmities is fasciotomy—lateral or medial with partial ostectomy. This procedure is more expensive than arthroscopic surgery and is one of the top five procedures performed in the United States for both tennis and golfer’s elbow. In fasciotomy, the surgeon tries to remove a 2 mm-fragment from the epicondyle. This procedure is more frequently performed in patients diagnosed with lateral epicondylitis than in those with medial epicondylitis. Tables 9, 10, and 11 break down the procedures performed by gender and region.

Table 9 – Occurrences of Fasciotomy Procedure by Gender – 2005

Table 10 – Occurrence of Fasciotomy Procedure by Region – 2005

Table 11 – Average Charge for Fasciotomy Procedure by Region – 2005

Tennis elbow and golfer’s elbow represent a growing market in the orthopedic industry. Although physical and pharmacologic therapies are most common, surgery has been performed successfully in the past, and many promising new procedures are now being investigated. Extracorporeal shockwave therapy and autologous blood injection are two novel treatments that have generated a great deal of interest and curiosity in the elbow market. With these promising new treatments, we might even see Tiger Woods and Roger Federer win championships in their respective sports at age 60—or even beyond.