Tissues affected by overuse and repeated damage can cause fibrosis and micro lacerations. Micro lacerations and internal vascular growth of affected tissues can ultimately lead to what is called vascular fibroblastic hyperplasia. A Golfer's Elbow is a problem that involves the flexor muscles in the wrist, while a Tennis Elbow is a problem that involves the extensor in the wrist. An epicondylitis can be confirmed with clinical symptoms in which pain stemming from the inside or outside of the elbow extends to the lower arm. The degree of pain for a Tennis Elbow and Golf's Elbow can range between a mild nuisance to severe enough that it inhibits sleeping at night. Some patients may even find it difficult to carry out daily activities such as washing and eating.