Dear Doctor: Several ways to treat tennis elbow
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Q. The outside of my elbow has been hurting during activities for several months. The discomfort started this summer after doing some yard work. I've had similar symptoms in the past, which resolved on their own, but it has been six months now. What should I do?
A. Your story is quite typical of lateral epicondylitis, or tennis elbow. Lateral epicondylitis occurs when a portion of the muscles that pull your wrist and fingers up, tear off of the outer part of the elbow. The partially torn tendons then degenerate over time. Activities that use these muscles become painful.
Daily activities such as pulling a trash bag out of the can, wringing out a towel, typing for extended periods of time, or sports activities such as tennis and weight lifting can aggravate the condition. If untreated, lateral epicondylitis can spontaneously resolve if the offending activity is stopped and the elbow is rested. More commonly the sufferer does not recognize the underlying cause and acts to further aggravate the condition.
Initial treatment includes anti-inflammatory medication, rest and activity modification. Your physician can also give you a brace to wear on the forearm called a "counterforce" brace that wraps around the forearm and reduces the stresses on the injured muscles.
If these first-line measures do not work, your physician can provide you with a cortisone (anti-inflammatory) shot in the elbow. This shot is usually combined with occupational therapy that focuses on teaching activity modification, correct lifting techniques and strengthening the good muscles at the elbow.
Some physicians are offering a new investigational treatment option in which one's own blood is injected into the affected area at the elbow. This is thought to help promote healing of the damaged tendons. If these non-operative measures fail, a surgical procedure is offered in which a small incision is made over the outer part of the elbow, and the damaged tendon is taken out. Surgery for lateral epicondylitis is rarely needed, because most patients find a livable baseline amount of discomfort with activities and learn to avoid those activities that aggravate the condition. Conservative therapy with the counterforce brace and anti-inflammatory medications usually reduce the discomfort and allow people to resume active lifestyles.
First Published December 12, 2011 12:00 am
