So hello and welcome to Orthopaedics Made Simple....Making No Bones About It and this is Naveen , Your Bone and Joint Guy.
So today it is Lateral Epicondylitis of the Elbow. Ouch I nearly forgot that the aim of this blog is to keep it as simple as possible and non medical as far as possible. This painful condition around the outer aspect (palm facing upwards) of the elbow is commonly called Tennis elbow.
 |
| The Site of Pain |
Despite its name, athletes and tennis players aren't the only people who develop tennis elbow. People whose jobs feature the types of motions that can lead to tennis elbow include plumbers, painters, carpenters and even parotta (paratha) cooks who have to repeatedly use the muscles of the forearm and wrist to mix the dough.
Now this happens because the muscles that help in forearm and wrist movement originate from the prominent bump on the outer aspect of the elbow. And with these muscles being repeatedly used they can cause stress to the tendons and over a period of time can cause little tears in the tendon at the point of attachment to that prominent bone. Tendons ,by the way ,are wire like structures that attach a muscle to the bone.
 |
| The Problem |
What does the patient experience? Usually the only complaint is pain around the elbow that sometimes may radiate upwards or downwards. This pain is usually caused when the person uses the forearm and wrist. Everyday activities like turning a door knob , holding a glass of water and drinking from it and even shaking hands. And the other symptom is the prominence around the outer aspect of the elbow hurts when touched.
If it isn't too alarming some Rest and a few over the counter drugs like Paracetamol should settle the issue. But if it is too troublesome and does not respond to this , please visit the doctor. The doctor will ask you a few basic questions to get the history and more or less would have confirmed the diagnosis even before touching you.
The doctor then would perform a few basic clinical tests like Touching the prominence which would hurt . He will ask you to bend your elbow and raise your wrist and fingers against resistance which again would cause pain around the prominence.
Sometimes an X Ray will be ordered to rule out other conditions that might mimic Tennis elbow or to see if there are any bone changes in the point of insertion of the tendons.
The treatment is straightforward , but recovery can take quite some time and the patient is advised to be patient. If the patient is in a hurry , the physician will be forced to go to the next level of treatment which can be avoided if we give it some time. Let me explain.
First it is Restriction of activities that caused or would aggravate the condition. The legendary Sachin Tendulkar himself had to be off cricket for nearly six months because of this. I hope you understand the importance of this aspect of treatment now. Restriction and Rest are key elements.
Wearing a Tennis Elbow Splint can help. This is a band around the forearm muscles which is tight and it helps the muscles to start acting from that point instead of the usual spot giving the affected area some rest. Studies and clinical experience have shown that it is not 100% effective but some patients do find some relief.
Pain killers and Medicines that help reduce swelling and fluid collection , commonly called NSAIDs too are helpful if used for a brief period of time. But do not self medicate over a long period of time. Even though they help control the pain , they are harmful for your stomach and kidney.
Physiotherapy in the form of a therapy called Ultrasound Therapy is also helpful. A 15 minute procedure where the physiotherapist massages that area with a small ultrasound probe.
A great percentage of patients get away with these modalties which are completely non invasive and have no side effects. But a few patients do not respond to them and may need other minimally invasive or invasive procedures. I repeat , this is only for a very few patients.
The first of the invasive procedures is injecting into that area. Two types of injections are available. One is the Steroid-Local Anaesthetic combination. This helps to reduce pain and inflammation and patients symptoms are reduced. The other is the injection where the patient's blood is drawn , processed and the part of the blood which has platelets is taken and injected into the area. This platelet rich blood is supposed to have healing properties that help to heal the damaged area. But I would like to point out it may not be 100% effective.
Then for a very very miniscule percentage , surgery is an option. The scar tissue is removed and the patient's elbow is splinted and rested for 4 to 6 weeks for recovery. There are two ways of doing it. An Open Surgery or by Key hole surgery which is called Arthroscopy. Very few centres in the world perform arthroscopic repair and the results of the two modalties are more or less similar. But again , the need for surgery in Tennis elbow is very very rare.
And the key takeaway for a patient is Patience is the key and it can take sometime to recover. And this comes from personal experience as Yours truly had to be off action for nearly three months to get back to full normal. We at SCOT always want to do as little as possible and with fewer side effects as possible.
There is a condition with similar symptoms and similar presentation needing near similar approach to treatment , but much fewer in number. It's called Medial Epicondylitis , commonly known as Golfer's elbow. This is on the inner prominence of the elbow when the palm is faced upwards.....caused by repetitive use of forearm muscles that help to lift the wrist and finger upwards or forwards , the exact opposite to Tennis Elbow.
So that is it friends , for this episode of Orthopaedics Made Simple ...Making No Bones About It for now from Naveen , the Bone and Joint Guy and catch you in the next one with yet another condition.
Keep Moving Always ...Without Pain...Bye
If it isn't too alarming some Rest and a few over the counter drugs like Paracetamol should settle the issue. But if it is too troublesome and does not respond to this , please visit the doctor. The doctor will ask you a few basic questions to get the history and more or less would have confirmed the diagnosis even before touching you.
The doctor then would perform a few basic clinical tests like Touching the prominence which would hurt . He will ask you to bend your elbow and raise your wrist and fingers against resistance which again would cause pain around the prominence.
 |
| Testing for Tennis Elbow |
Sometimes an X Ray will be ordered to rule out other conditions that might mimic Tennis elbow or to see if there are any bone changes in the point of insertion of the tendons.
The treatment is straightforward , but recovery can take quite some time and the patient is advised to be patient. If the patient is in a hurry , the physician will be forced to go to the next level of treatment which can be avoided if we give it some time. Let me explain.
First it is Restriction of activities that caused or would aggravate the condition. The legendary Sachin Tendulkar himself had to be off cricket for nearly six months because of this. I hope you understand the importance of this aspect of treatment now. Restriction and Rest are key elements.
Wearing a Tennis Elbow Splint can help. This is a band around the forearm muscles which is tight and it helps the muscles to start acting from that point instead of the usual spot giving the affected area some rest. Studies and clinical experience have shown that it is not 100% effective but some patients do find some relief.
 |
| Tennis Elbow Splint |
Physiotherapy in the form of a therapy called Ultrasound Therapy is also helpful. A 15 minute procedure where the physiotherapist massages that area with a small ultrasound probe.
 |
| Ultrasound Therapy |
A great percentage of patients get away with these modalties which are completely non invasive and have no side effects. But a few patients do not respond to them and may need other minimally invasive or invasive procedures. I repeat , this is only for a very few patients.
 |
| Platelet Rich Plasma |
Then for a very very miniscule percentage , surgery is an option. The scar tissue is removed and the patient's elbow is splinted and rested for 4 to 6 weeks for recovery. There are two ways of doing it. An Open Surgery or by Key hole surgery which is called Arthroscopy. Very few centres in the world perform arthroscopic repair and the results of the two modalties are more or less similar. But again , the need for surgery in Tennis elbow is very very rare.
 |
| Tennis Elbow Arthroscopy |
And the key takeaway for a patient is Patience is the key and it can take sometime to recover. And this comes from personal experience as Yours truly had to be off action for nearly three months to get back to full normal. We at SCOT always want to do as little as possible and with fewer side effects as possible.
There is a condition with similar symptoms and similar presentation needing near similar approach to treatment , but much fewer in number. It's called Medial Epicondylitis , commonly known as Golfer's elbow. This is on the inner prominence of the elbow when the palm is faced upwards.....caused by repetitive use of forearm muscles that help to lift the wrist and finger upwards or forwards , the exact opposite to Tennis Elbow.
So that is it friends , for this episode of Orthopaedics Made Simple ...Making No Bones About It for now from Naveen , the Bone and Joint Guy and catch you in the next one with yet another condition.
Keep Moving Always ...Without Pain...Bye
No comments:
Post a Comment