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Tennis Elbow

Tennis elbow is one of the more common things we see in an orthopedic clinic. Many sports enthusiasts suffer, but so do people who work with tools and machines and grasp objects for living.

Tennis elbow, or lateral epicondylitis for you "ER" fans, is caused by repetitive stress on the muscles on the top of the forearm. Hold your arm in front of you with the elbow bent 90 degrees. Wiggle your fingers like playing a piano, and watch how the muscles in your forearm move while connected to the bump on the outside of your elbow. All these muscles connect to this bump, called the lateral epicondyle of the funny bone, or humerus.

Too much repetitive stress causes inflammation and micro tears in the muscles and their respective tendons around the elbow. The pain increases with activity, and the simple act of turning a doorknob can be a chore.

No special tests are used to diagnose tennis elbow, as it is pretty straightforward in its history and physical findings. Most of my patients do not recall a precipitating event, but rather remember the pain after hammering nails all day long or grasping a steering wheel for hours.

This is strictly an overuse injury, and there is no clear-cut treatment that is guaranteed. Years ago, corticosteroid injections were considered the norm, but recent studies show that there is no statistically significant improvement in those treated with injections. Some believe that massage therapy, ultrasound and ice therapy are helpful. And in fact, they probably do help to some degree.

Stretching, to mobilize the inflamed tendons in the forearm, is also an accepted treatment. Despite these nonoperative options, many people still suffer and get frustrated as they show little or no improvement. It is one of the more frustrating things I treat, as one can teach these general principals of conservative care, and many patients simply won't improve as quickly as they want. We can be spoiled at times, and we want to be healed yesterday. Tennis elbow is one of those things that takes patience, as most people will heal by themselves over a few months.

A tight velcro neoprene strap can be worn around the forearm, and these do help. Called counterforce braces, they act by decreasing the pull of the muscles from the hand to the elbow. They do work to lessen the pain, by not necessarily to cure.

Sometimes ultrasound and anti-inflammatory medicines play a role, but if the inflammation and swelling is severe, a decreased circulation may diminish the amount of medication delivered to the site. A combination of heat and ice have helped many people as well.

If all else fails, after about one year, if no improvement is shown, a surgical procedure can be performed. Although not perfect, it generally offers some improvement, if not a complete, cure to those who cannot shake this nagging, common elbow problem.

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