Tennis Elbow (Lateral Epicondylitis)

Tennis Elbow (Lateral Epicondylitis)

Tennis elbow, or lateral epicondylitis, is a painful condition of the elbow caused by overuse. Not surprisingly, playing tennis or other racquet sports can cause this condition. However, several other sports and activities besides sports can also put you at risk.  Tennis elbow is inflammation or, in some cases, microtearing of the tendons that join the forearm muscles on the outside of the elbow. The forearm muscles and tendons become damaged from overuse — repeating the same motions again and again. This leads to pain and tenderness on the outside of the elbow.There are many treatment options for tennis elbow. In most cases, treatment involves a team approach. Primary doctors, physical therapists and, in some cases, surgeons work together to provide the most effective care.

Anatomy

Your elbow joint is a joint made up of three bones: your upper arm bone (humerus) and the two bones in your forearm (radius and ulna). There are bony bumps at the bottom of the humerus called epicondyles, where several muscles of the forearm begin their course. The bony bump on the outside (lateral side) of the elbow is called the lateral epicondyle.

ECRB muscle and tendon

The ECRB muscle and tendon is usually involved in tennis elbow.
Reproduced and modified from The Body Almanac. © American Academy of Orthopaedic Surgeons, 2003.

Muscles, ligaments, and tendons hold the elbow joint together.

Lateral epicondylitis, or tennis elbow, involves the muscles and tendons of your forearm that are responsible for the extension of your wrist and fingers. Your forearm muscles extend your wrist and fingers. Your forearm tendons — often called extensors — attach the muscles to bone.  The tendon usually involved in tennis elbow is called the Extensor Carpi Radialis Brevis (ECRB).

Cause

Overuse

Recent studies show that tennis elbow is often due to damage to a specific forearm muscle. The extensor carpi radialis brevis (ECRB) muscle helps stabilize the wrist when the elbow is straight. This occurs during a tennis groundstroke, for example. When the ECRB is weakened from overuse, microscopic tears form in the tendon where it attaches to the lateral epicondyle. This leads to inflammation and pain.

The ECRB may also be at increased risk for damage because of its position. As the elbow bends and straightens, the muscle rubs against bony bumps. This can cause gradual wear and tear of the muscle over time.

Activities

Athletes are not the only people who get tennis elbow. Many people with tennis elbow participate in work or recreational activities that require repetitive and vigorous use of the forearm muscle or repetitive extension of the wrist and hand.

Painters, plumbers, and carpenters are particularly prone to developing tennis elbow. Studies have shown that auto workers, cooks, and even butchers get tennis elbow more often than the rest of the population. It is thought that the repetition and weight lifting required in these occupations leads to injury.

Tennis player

Playing tennis is a possible cause of tennis elbow, but other activities can also put you at risk.

Thinkstock © 2015.

Age

Most people who get tennis elbow are between the ages of 30 and 50, although anyone can get tennis elbow if they have the risk factors. In racquet sports like tennis, improper stroke technique and improper equipment may be risk factors.

Unknown

Lateral epicondylitis can occur without any recognized repetitive injury. This occurrence is called “idiopathic” or of an unknown cause.

Symptoms

The symptoms of tennis elbow develop gradually. In most cases, the pain begins as mild and slowly worsens over weeks and months. There is usually no specific injury associated with the start of symptoms.

Common signs and symptoms of tennis elbow include:

  • Pain or burning on the outer part of your elbow
  • Weak grip strength
  • Sometimes, pain at night

The symptoms are often worsened with forearm activity, such as holding a racquet, turning a wrench, or shaking hands. Your dominant arm is most often affected; however, both arms can be affected.

Location of pain in lateral epicondylitis.

Location of pain in lateral epicondylitis.

Doctor Examination

Your doctor will consider many factors in making a diagnosis. These include how your symptoms developed, any occupational risk factors, and recreational sports participation.

Your doctor will talk to you about what activities cause symptoms and where on your arm the symptoms occur. Be sure to tell your doctor if you have ever injured your elbow. If you have a history of rheumatoid arthritis or nerve disease, tell your doctor.

During the examination, your doctor will use a variety of tests to pinpoint the diagnosis. For example, your doctor may ask you to try to straighten your wrist and fingers against resistance with your arm fully straight to see if this causes pain. If the tests are positive, it tells your doctor that those muscles may not be healthy.

doctor pressing lateral epicondyle

During the exam, your doctor will apply gentle pressure to the lateral epicondyle, checking for pain and tenderness.

Tests

Your doctor may recommend additional tests to rule out other causes of your problem.

  • X-rays. These tests provide clear images of dense structures, such as bone. They may be taken to rule out arthritis of the elbow.
  • Magnetic resonance imaging (MRI) scan.  MRI provides images of the body’s soft tissues, including muscles and tendons. An MRI scan may be ordered to determine the extent of damage in the tendon or to rule out other injuries. If your doctor thinks your symptoms might be related to a neck problem, he or she may order an MRI scan of the neck to see if you have a herniated disk or arthritic changes in your neck. Both of these conditions can produce arm pain.
  • Electromyography (EMG). Your doctor may order an EMG to rule out nerve compression. Many nerves travel around the elbow, and the symptoms of nerve compression are similar to those of tennis elbow.

Treatment

Nonsurgical Treatment

Approximately 80% to 95% of patients have success with nonsurgical treatment.

Rest. The first step toward recovery is to give your arm proper rest. This means that you will have to stop or decrease participation in sports, heavy work activities, and other activities that cause painful symptoms for several weeks.

Medications. Acetaminophen or anti-inflammatory medications (such as ibuprofen) may be taken to help reduce pain and swelling

Physical therapy. Specific exercises are helpful for strengthening the muscles of the forearm. Your therapist may also perform ultrasound, ice massage, or muscle-stimulation techniques to improve muscle healing.

Wrist stretching exercise

Wrist stretching exercise with elbow extended.

Brace. Using a brace centered over the back of your forearm may also help relieve symptoms of tennis elbow. This can reduce symptoms by resting the muscles and tendons.

Counterforce brace

Counterforce brace.

Steroid injections. Steroids, such as cortisone, are very effective anti-inflammatory medicines. Your doctor may decide to inject the painful area around your lateral epicondyle with a steroid to relieve your symptoms.

Platelet-rich plasma. Platelet-rich plasma (PRP) is a biological treatment designed to improve the biologic environment of the tissue. This involves obtaining a small sample of blood from the arm and centrifuging it (spinning it) to obtain platelets from the solution.  Platelets are known for their high concentration of growth factors, which can be injected into the affected area. While some studies about the effectiveness of PRP have been inconclusive, others have shown promising results.

PRP injection

An injection of PRP is used to treat tennis elbow.
Courtesy of Allan K. Mishra, MD, Menlo Park, CA.

Extracorporeal shock wave therapy. Shock wave therapy sends sound waves to the elbow. These sound waves create “microtrauma” that promotes the body’s natural healing processes. Shock wave therapy is considered experimental by many doctors, but some sources show it can be effective.

Equipment check. If you participate in a racquet sport, your doctor may encourage you to have your equipment checked for proper fit. Stiffer racquets and looser-strung racquets often can reduce the stress on the forearm, which means that the forearm muscles do not have to work as hard. If you use an oversized racquet, changing to a smaller head may help prevent symptoms from recurring.

Surgical Treatment

If your symptoms do not respond after 6 to 12 months of nonsurgical treatments, your doctor may recommend surgery.

Most surgical procedures for tennis elbow involve removing diseased muscle and reattaching healthy muscle back to bone.

The right surgical approach for you will depend on a range of factors. These include the scope of your injury, your general health, and your personal needs. Talk with your doctor about the options. Discuss the results your doctor has had, and any risks associated with each procedure.

Open surgery. The most common approach to tennis elbow repair is open surgery. This involves making an incision over the elbow.

Open surgery is usually performed as an outpatient surgery. It rarely requires an overnight stay at the hospital.

Arthroscopic surgery. Tennis elbow can also be repaired using miniature instruments and small incisions. Like open surgery, this is a same-day or outpatient procedure.

Surgical risks. As with any surgery, there are risks with tennis elbow surgery. The most common things to consider include:

  • Infection
  • Nerve and blood vessel damage
  • Possible prolonged rehabilitation
  • Loss of strength
  • Loss of flexibility
  • The need for further surgery

Rehabilitation. Following surgery, your arm may be immobilized temporarily with a splint. About 1 week later, the sutures and splint are removed.

After the splint is removed, exercises are started to stretch the elbow and restore flexibility. Light, gradual strengthening exercises are started about 2 months after surgery.

Your doctor will tell you when you can return to athletic activity. This is usually 4 to 6 months after surgery. Tennis elbow surgery is considered successful in 80% to 90% of patients. However, it is not uncommon to see a loss of strength.

What’s the Difference Between Carpal Tunnel Syndrome and Cubital Tunnel Syndrome?

What’s the Difference Between Carpal Tunnel Syndrome and Cubital Tunnel Syndrome?

Carpal tunnel syndrome and cubital tunnel syndrome share similar symptoms, but they are distinct conditions affecting different nerves in the elbow and wrist. 

If you’re experiencing pain and numbness in your fingers, you may assume you have carpal tunnel syndrome. But did you know another condition — called cubital tunnel syndrome — could also be the source of these symptoms?

Both carpal tunnel syndrome and cubital tunnel syndrome result from nerve compression; however, the damaged nerve for each is located in a different part of the body. In cubital tunnel syndrome, the ulnar nerve within the elbow becomes compressed due to injury or repeated bending of the elbow. The ulnar nerve sits inside the cubital tunnel, a passageway consisting of bone, muscle, and ligaments.

On the other hand, the compressed nerve causing carpal tunnel syndrome is the median nerve in the wrist. Repetitive motions of the hand and wrist (such as typing), fractures, and sprains are typically to blame. In addition, chronic conditions such as diabetes and arthritis are considered risk factors for carpal tunnel syndrome.

Despite some similarities — compressed nerves, hand pain, weakness when gripping objects — cubital tunnel syndrome and carpal tunnel syndrome are characterized by several differences. Knowing the symptoms for each can help you identify which condition you may have and determine the right treatment.

Carpal Tunnel vs. Cubital Tunnel

Both syndromes affect the hand and fingers, but the pain, tingling, and numbness of carpal tunnel syndrome is felt most acutely in the thumb, index finger, middle finger, and half of the ring finger. It’s also characterized by pain and burning in the hand and wrist that sometimes radiates up the forearm to the elbow.

Meanwhile, cubital tunnel syndrome is marked by numbness, pain, and tingling in the little and ring fingers as well as the inside of the hand. If you have cubital tunnel syndrome, you may notice these symptoms flare up at night when you bend your elbow for long periods as you sleep.

Diagnosing cubital tunnel syndrome or carpal tunnel syndrome begins with a physical examination. An orthopedist may also perform a nerve conduction study to assess nerve impulses in the wrist or elbow. Weak nerve activity in a certain area could indicate, for example, carpal tunnel syndrome.

Treating the Symptoms

Treatment options differ for each syndrome, although conservative therapies are recommended at first to reduce symptoms and restore function to the hand. Because cubital tunnel symptoms are more pronounced at night, you might be advised to wear a brace that straightens the elbow while you rest. Wrapping your arm in a towel to keep it straight can work as well.

If conservative treatments fail to relieve the nerve compression or muscle wasting is severe, surgery is another option. Two types of cubital tunnel surgery are currently performed: a medical epicondylectomy and an ulnar nerve transposition. In a medial epicondylectomy, the bony bump inside the elbow (the medial epicondyle) is removed. This allows the ulnar nerve to flex and straighten without pain. For an ulnar nerve transposition, the surgeon creates a new cubital tunnel and moves the ulnar nerve to the recreated tunnel.

Treating carpal tunnel syndrome non-surgically usually entails resting the hand, avoiding activities that aggravate symptoms, wearing a splint for several weeks, and applying ice to reduce swelling. Anti-inflammatories and steroids may also be prescribed. Once the pain subsides, you can practice exercises to stretch and strengthen the wrist and hand.

If these conservative treatments don’t alleviate carpal tunnel symptoms, surgery to relieve pressure on the median nerve by cutting the transverse carpal ligament may be necessary. This procedure is followed by physical therapy to strengthen the wrist.

What’s Causing Your Hand Pain?

If you’re experiencing hand and finger pain, you may be suffering from either cubital tunnel syndrome or carpal tunnel syndrome. The doctors at Comprehensive Orthopaedics can diagnose your condition and prescribe the proper treatment regimen. Whether through conservative therapy or surgery, our goal is to help our patients live pain-free. Contact us today for an appointment.

How to Prevent Golfer’s Elbow This Year

How to Prevent Golfer’s Elbow This Year

Don’t let elbow pain keep you from enjoying a day at the golf course.

Avid golfers eagerly anticipate the start of spring so they can once again head to the golf course and enjoy an afternoon in the sun. Yet as you inspect your clubs to make sure they’re in top shape for the first swings of the season, you should also pay attention to any aches and pains in your body.

If you’ve played golf for many years, you’ve probably heard the term golfer’s elbow — or even may have suffered from the condition. Golfer’s elbow, known medically as medial epicondylitis, stems from repeated movements that inflame the tendons in the inner elbow. A burning pain centered on the inside of the elbow is the most prominent symptom, but you may also experience stiffness in the joint, weakness in the wrist and hand, as well as numbness in the fingers.

Fortunately, golfer’s elbow can be prevented with a few simple measures. And even if you do experience pain in the inner elbow, it shouldn’t keep you off the links for long, as the condition generally responds well to conservative treatment methods.

Preventing Golfer’s Elbow

As with any sport or physical activity, proper warm-up is key to avoiding injury. For golfers in particular, that means strengthening your forearm muscles by lifting light weights or squeezing a tennis ball. You can also ask a golf instructor for tips on how to improve your form. If you lock your lead arm when you swing, for instance, you’ll put too much torque on your elbow and strain the tendons. Lastly, you might want to consider switching from older golfing irons to graphite clubs.

Treating Golfer’s Elbow

If you believe you may have golfer’s elbow, your doctor will perform a physical examination to assess your level of pain and stiffness by applying pressure to the joint and having you move your elbow, wrist, and fingers. An X-ray can help determine if there is another cause of the pain, such as arthritis or a fracture.

The first step in addressing golfer’s elbow is to stop playing golf or any activity that causes discomfort until the pain subsides. During this time, you can try some at-home treatments, such as covering the elbow with an ice pack three or four times a day for 15 minutes. Your doctor may also outfit you with a customized brace to provide extra support to the elbow tendons. Over-the-counter pain medication helps reduce discomfort, and in some cases, your doctor may recommend a steroid injection.

After a rest period of three to six weeks, you’ll begin physical therapy to stretch and strengthen the muscles and tendons and improve your range of motion. You can expect a complete recovery with conservative treatment in four to six months.

Surgery is only advised if conservative treatments have not been able to eliminate pain. In this minimally invasive operation, a surgeon cuts two small incisions into the elbow and views the joint through a telescope. Any damaged tendon tissue is then removed. Physical therapy follows about two months after the surgery, and full recovery takes between four to six months.

Get Back Into the Swing of Things

Summer is on it’s way, and if you’re a golfer, you’ll want to enjoy your favorite sport without any pain. At Comprehensive Orthopaedics, our staff of doctors will help you overcome any discomfort, and show you ways to keep your arms healthy for the swings you’ll take this season. Contact us today to set up an appointment.

Living With Repetitive Strain Injury

Living With Repetitive Strain Injury

MONDAY, July 29, 2019 (HealthDay News) — Repetitive strain injury (RSI) can affect anyone who uses his or her hands a lot and repeats the same movements over and over again. It can develop whether you’re working at a computer all day or spending hours of leisure time immersed in handicrafts.

At first, symptoms — like pain and tingling — may go away once you stop the motions or the activity. But without treatment, including lifestyle changes, symptoms are likely to become so severe that you could become unable to continue with your work or hobby.

Recognizing RSI Symptoms

  • Pain or burning
  • Tingling
  • Numbness
  • Weakness
  • Swelling
  • Soreness

Don’t hesitate to see your doctor if you experience one or more of these symptoms — don’t assume that a few days off is enough to stop RSI. If the source of pain isn’t addressed, symptoms can become irreversible.

Part of the solution is to take regular breaks from problematic but necessary activities throughout the day. Get up and move around for at least five minutes every half-hour, and stretch your arms, wrists and fingers.

Practice good posture. When sitting, your head and back should form a straight line from ears to hips. When at the computer, don’t let your wrists bend to one side. Keep them in line with your forearms, fingers slightly curved over your keyboard. Don’t self-treat by wearing a splint or using a wrist rest — both can interfere with natural movement and blood circulation.

More Typing Tips to Try

  • Use all fingers to type, not just one
  • Use keyboard shortcuts
  • Take advantage of voice recognition software

Also, consider investigating the Alexander Technique, an approach to movement aimed at better posture and body mechanics helpful for RSI.

More information

You can learn more about the Alexander Technique online.

Copyright ©2017 HealthDay. All rights reserved.
Health Tip: Joint Popping and Cracking

Health Tip: Joint Popping and Cracking

(HealthDay News) — Most people have popping and cracking of their joints, especially as they age.

Though the reasons behind these sounds are unclear, doctors think they may be caused by ligaments stretching and releasing, or the compression of nitrogen bubbles.

Usually, the phenomenon doesn’t need treatment. However, if these sounds are accompanied by swelling and pain, seeing a doctor is recommended, says Johns Hopkins Medicine.

Copyright ©2017 HealthDay. All rights reserved.
Tendinitis

Tendinitis

Tendonitis can affect anybody, from office workers to athletes. Here’s how to keep your symptoms under control.

Tendonitis is a common problem, affecting athletes, office workers, and musicians alike. Indeed, it can affect almost any part of the body, though it’s most common in the tendons of the shoulders, elbows, wrists, and knees. Some of the most frequent types include patellar tendinitis (or “jumper’s knee”), lateral epicondylitis in the elbow (or “tennis elbow”), and Achilles tendinitis.

As common as it is, however, tendonitis can be a debilitating condition, creating chronic pain and greatly restricting the patient’s range of motion. Fortunately, some basic knowledge of its common causes and symptoms can help you seek relief from this condition.

CAUSES AND SYMPTOMS OF TENDONITIS

Tendons are strands of elastic fibrous tissue that connect muscles to bones, providing stability to the joints and enabling a free range of motion. Any tendon in the body can become inflamed or irritated, causing pain, tenderness, and swelling in the affected tissue.

The most common cause of tendonitis is prolonged stress or gradual wear caused by repetitive movements, though it can also be caused by sudden trauma. As a result, most people develop tendonitis while performing their jobs, enjoying hobbies that rely on a specific joint, or playing sports A typist, for example, is most likely to have tendonitis in the wrist, while weightlifters may suffer from biceps tendinitis. Aging also increases the likelihood of developing tendonitis, since tendons become less flexible with age.

TREATMENT FOR TENDONITIS

The severity of tendonitis can vary greatly depending on the specific cause of the inflammation and the particular tendon affected. Most cases of tendonitis, however, can be successfully treated without surgery. Some of the most common courses of treatment include:

  • Resting the affected area
  • Avoiding activities that cause flare-ups or increased pain
  • Taking over the counter anti-inflammatories like Advil or Aleve
  • Physical Therapy
  • Cortisone Injections

If your tendonitis does not respond to these conservative treatments, the inflamed tendon may need to be repaired with a minimally invasive surgery. During the procedure, your surgeon will mend any tears in the tendon and remove any permanently damaged tissue.

Since tendonitis is an injury that often results from overuse, the best treatment in many cases is simply to refrain from using the joint in question. Some effective preventative measures include stretching before exercise, wearing protective braces, using proper technique when lifting, and always maintaining correct posture.

Whether you suffer from tennis elbow or jumper’s knee, our team at New York Bone and Joint can help. With decades of combined experience in treating injured tendons, our specialists are able to provide comprehensive assistance at every stage of the process, from identifying the source of the problem to crafting a personalized treatment plan. If you worry that you may have tendonitis, contact us today to schedule a consultation.

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