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ELBOW INJURIES

Lateral epicondylitis

Doctors first identified tennis elbow (or lateral epicondylitis) more than 100 years ago. Today nearly half of all tennis players will suffer from this disorder at some point. Interestingly though, tennis players actually account for less than 5 percent of all reported cases making the term for this condition something of a misnomer.

There are 2 additional strain related conditions which are often mistaken for Tennis Elbow. These being Golfer’s Elbow & Bursitis. Before we delve into the details of what Tennis Elbow actually is and options that are available for relieving & preventing the pain...let’s look at the distinguishing characteristics of each of these 3 ailments.

Tennis Elbow
(lateral epicondylitis)
Outside of Elbow
Cause & Symptoms

The onset of pain, on the outside (lateral) of the elbow, is usually gradual with tenderness felt on or below the joint's bony prominence. Movements such as gripping, lifting and carrying tend to be troublesome.

Golfer’s Elbow
(medial epicondylitis)
Inside of Elbow
Cause & Symptoms

The causes of golfer's elbow are similar to tennis elbow but pain and tenderness are felt on the inside (medial) of the elbow, on or around the joint's bony prominence.

Bursitis
Back of Elbow
Cause & Symptoms

Often due to excessive leaning on the joint or a direct blow or fall onto the tip of the elbow.
A lump can often be seen and the elbow is painful at the back of the joint.


Symptoms Of Tennis Elbow

The damage that tennis elbow incurs consists of tiny tears in a part of the tendon and in muscle coverings. After the initial injury heals, these areas often tear again, which leads to hemorrhaging and the formation of rough, granulated tissue and calcium deposits within the surrounding tissues. Collagen, a protein, leaks out from around the injured areas, causing inflammation. The resulting pressure can cut off the blood flow and pinch the radial nerve, one of the major nerves controlling muscles in the arm and hand.

Tendons, which attach muscles to bones, do not receive the same amount of oxygen and blood that muscles do, so they heal more slowly. In fact, some cases of tennis elbow can last for years, though the inflammation usually subsides in 6 to 12 weeks.

Many medical textbooks treat tennis elbow as a form of tendonitis, which is often the case, but if the muscles and bones of the elbow joint are also involved, then the condition is called epicondylitis. However, if you feel pain directly on the back of your elbow joint, rather than down the outside of your arm, you may have bursitis, which is caused when lubricating sacs in the joint become inflamed. If you see swelling, which is almost never a symptom of tennis elbow, you may want to investigate other possible conditions, such as arthritis, infection, gout or a tumor.

Relief Of Tennis Elbow

The best way to relieve tennis elbow is to stop doing anything that irritates your arm — a simple step for the weekend tennis player, but not as easy for the manual laborer, office worker, or professional athlete.

The most effective conventional and alternative treatments for tennis elbow have the same basic premise: Rest the arm until the pain disappears, then massage to relieve stress and tension in the muscles, and exercise to strengthen the area and prevent reinjury. If you must go back to whatever caused the problem in the first place, be sure to warm up your arm for at least 5 to 10 minutes with gentle stretching and movement before starting any activity. Take frequent breaks.

Conventional medicine offers an assortment of treatments for tennis elbow, from drug injections to surgery, but the pain will never go away completely unless you stop stressing the joint. Re-injury is inevitable without adequate rest.

For most mild to moderate cases of tennis elbow, aspirin or ibuprofen will help address the inflammation and the pain while you are resting the injury, and then you can follow up with exercise and massage to speed healing.

For stubborn cases of tennis elbow your doctor may advise corticosteroid injections, which dramatically reduce inflammation, but they cannot be used long-term because of potentially damaging side effects.

Another attractive option for many sufferers, especially those who prefer to not ingest medication orally, is the application of an appropriate and effective topical ointment. CT Cream with A.C.P. was specifically designed to reduce inflammation and does so by taking advantage of well known elements Arnica, Choline and Vitamin B6.

If rest, anti-inflammatory medications, and a stretching routine fail to cure your tennis elbow, you may have to consider surgery, though this form of treatment is rare (fewer than 3 percent of patients). One procedure is for the tendon to be cut loose from the epicondyle, the rounded bump at the end of the bone, which eliminates stress on the tendon but renders the muscle useless. Another surgical technique involves removing so-called granulated tissue in the tendon and repairing tears.

Even after you feel you have overcome a case of tennis elbow, be sure to continue babying your arm. Always warm up your arm for 5 to 10 minutes before starting any activity involving your elbow. And if you develop severe pain after use anyway, pack your arm in ice for 15 to 20 minutes and call your doctor.

 

Prevention

To prevent tennis elbow:

 

Caution!

To prevent a relapse:

 

Call Your Doctor If....

 

Tennis Elbow (Lateral Epicondylitis)

Tennis Elbow or Lateral Epicondylitis is a condition when the outer part of the elbow becomes painful and tender, usually as a result of a specific strain, overuse, or a direct bang. Sometimes no specific cause is found.

Tennis Elbow is similar to Golfer's Elbow which affects the other side of the elbow.

Symptoms

The outer part of the elbow is painful and tender to touch. Movements of the elbow, and also movements which involve lifting, with the hand on top, hurt.

Causes

Although called tennis elbow, lateral epicondylitis is much more commonly seen in people who are over using their arm doing something else. It could equally well be called "plasterer's elbow" or "mechanic's elbow" or "painter's elbow".

The most common cause is over use of the muscles which are attached to the bone at this part of the elbow. That is to say, the muscles which pull the hand backwards (the wrist extensors). All the extensor muscles of the hand attach to the elbow at the outer part (the lateral epicondyle). If they are strained or over used they become inflamed, which means they are swollen, painful and tender to touch.

Sometimes the inflammation is caused by a direct injury or bang. Sometimes, especially when the cause is direct injury or strain, the muscles are actually partially torn.

Rarely the inflammation comes on without any definite cause, and this may be due to an arthritis, rheumatism or  gout. Sometimes the problem is partly or completely due to a neck problem, which is causing pain in the elbow via the nerves from the neck.

Diagnosis

The doctor or physiotherapist will test for tenderness over or near to the bony bump on the outside of the elbow. He or she will also test to see whether the pain gets worse when you bend the wrist back (extend it) against resistance. In the event of both these signs being present, it is likely that you have tennis elbow.

Your doctor may also examine your neck, as this may be the cause, or part of the problem. After all many of the things that might strain your elbow might also put a strain on your neck.

Treatment


Tennis Elbow

Tennis elbow is somewhat of a misnomer since many people with this diagnosis don't play tennis. There is usually no history of trauma and repetitive use seems to make the pain worse. Discomfort is most often located over the outside or lateral bony prominence of the elbow, (called the epicondyle), with a similar but less frequent condition seen on the inside or medial joint area, just in front or anterior to the "funny bone." This problem area over the outside of the elbow is where a large tendon attaches to bone. Functionally, it helps lift your wrist up (extension).

 You can usually reproduce the symptoms by forcefully extending the wrist joint against resistance. X-rays are of very little benefit and treatment is best implemented with a trial of  NSAIM, ice massage, and physical therapy modalities. I believe cortisone shots should be delayed until more conservative measures are tried, since frequently patients get relief without the injection, which can be very uncomfortable.

Although some  physicians are quick to splint people with tennis elbow, or stop their activities, I find this only temporarily masks the pain which almost immediately returns with use. Therefore, my recommendation is that the patient cut back on the offending source causing the pain while simultaneously undergoing treatment and then work back to the initial level of activity, slowly.

Tennis elbow bands wrapped around the area below the joint may be helpful but care must be taken to avoid putting these on too tight and possibly compromising circulation. In my experience, less than five percent of patients with this annoying problem come to surgery, although many people with this aggravating problem have gotten significant relief from this small out-patient procedure that carries with it very little risk. You won't play tennis or many other sports for two to three months.

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