BY ALAN GJEDSTED MD

So, you have "
Tennis Elbow". "But", you say, "I don't even play tennis. How could I have Tennis Elbow?"

Good question, but easily explainable: you have Lateral Epicondylitis, or what used to be referred to as "Tennis Elbow". It is an inflammation over the bony prominence on the outside of your elbow, where a large flat tendon sits. This tendon (the fibrous structure that attaches mus
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cle to bone) is the one that controls your wrist and, to some degree your fingers, when you bend them up, or back (extend). Go ahead, give it a try - put your other hand over the outside of your elbow, near where
the pain is, over the outer forearm muscles; now wiggle the fingers of your effected side's hand; feel the movement under there? This is the source of your problem; not bursitis or arthritis in your elbow, but overuse of your fingers and wrist. In athletes,
it usually is a condition brought on by either poor backhand form in a racquet sport, or from having to repetitively use the hands to grip or hold, during the sport (windsurfing, weight training, etc.). In the non-athlete, it is almost always from repetitive use of the hands and fingers, typically from using a keyboard or having to do any repetitive hand motions, especially gripping something. It is fast becoming one of the most frequent job-related maladies we encounter these days. In a small percentage of people, it is related to a prior injury to the bone in the elbow, over which the tendon courses.
The most common misperception with this ailment is that it is from a problem in the elbow. It is not, as you can see; it is from use of the hand and wrist, in whatever activity you are doing.



What Can Be Done About it?
There are a number of possible therapies for this problem, depending on the
severity of the problem itself.

1. Rest: The first thing to attempt will be to give some rest to the injured arm This, of course, is a bit more difficult than it may seem at first glance "How", you might ask, "am I supposed to quit using my hand(s)?!" Of course, you can’t So, we must find other ways 'to "Rest" the effected arm/hand The first would be to decrease, or stop, the amount of keyboard work you are doing, if this is an option.
If you find that you are doing a lot of gripping and lifting as part of your daily routine, you may try to modify this aspect. If you cannot stop your keyboard/typewriter use, then be sure to make it as "Ergonomically-correct" as possible. This would entail proper seating height (forearms parallel with the floor while typing), elevation of the wrists (with a wrist bar) to the level where the wrists are straight while typing, not bent back and, perhaps, even a more Ergonomic keyboard, that are now being developed just for this problem.

2.)
Splinting: This is essentially another form of Rest, as above. What is entailed here is the application of some outside, or external, support for the wrist and elbow. The most famous of these "splints" is a narrow strap that is placed over the muscular part of the forearm and "cinched down", providing some compression of the forearm muscles. Also available is an elbow slip-on "sleeve" with the strap
elbow-strap

incorporated into it (right). It is not well understood just how these "Tennis Elbow Straps" work; some feel they "fool" the tendon into 'thinking it attaches in a spot under the strap, instead of in the elbow. Another form of splinting that I find quite useful is the Wrist Splint, a sort of fingerless glove that slips on over the hand and wrist leaving the fingers free, but immobilizing the wrist itself. Remember: going back to the actual cause of this problem in the hand and wrist that it is here where the source of the problem really originates, so why not immobilize the wrist to give it some rest? And that is what we do. It is important to use the Wrist Splint and the Tennis Elbow Strap whenever engaged in any activity that causes the problem; you know, all that stuff mentioned above.

3. Anti-Inflammatory Maneuvers: These include such things as
medications (Ibuprofen [Advil, Motrin], Naprosyn [Alleve], Aspirin) and ice. Ice massages over the most tender, painful area can be a real relief, especially at times of greatest discomfort. A good way to do this is: take a small paper cup, fill it with water, freeze it, then peel away the top l/2"-l" of the cup and, "voila", you have a
small, convenient ice massager, with a paper bottom to hold on to. Massage for 15-20 minutes, or until you feel the area getting "numb". Do this 3-6 times a day, if needed. Note: do not take anti-inflammatory medicines if you have had an ulcer or are allergic to aspirin.

4.
Exercises:
Included with this information sheet are some exercises for both strengthening and stretching the forearm muscles and tendons. You can expect to
relapse if you do all the other maneuvers listed, but forget these exercises.
One very good exercise is wringing out a bathtowel, twisting first one way, then the other. You can use low weights (2lbs or less) instead of the Theraband shown.

5.Physical Therapy: Some people, who are not making any headway on their own, require specialized Physical Therapy for the elbow. They have a number of different "modalities" of therapy, along with instruction on home exercises to be done. Ask your doctor if you feel you need a referral to Physical Therapy.

6.Injections: Some people, no matter how much of the above routine they try, still do not improve. Then, There are others, who may improve, but still are limited by the pain. In these people, it is often worthwhile to give a trial of injected Cortisone (or Cortisone-like medications) into the most inflamed area. Although there is a small "failure rate" with this technique, it often provides lasting relief of the problem and allows one to continue with the other rehabilitative maneuvers in a more painfree state. Although the risks of injection are rather low; you should discuss these with your doctor if you have questions concerning this therapy.

7.Surgery: In a small percentage of people, none of the other modalities
seem to provide relief. In these, surgery may be the only option left. This is an uncommon therapeutic technique, however, as the vast majority of people improve using the above modes of therapy

FOR THE ATHLETE:
We have already discussed some of the Work-related, or Non-athletic adjustments one can make to decrease the incidence of Tennis Elbow. How about the things one can change in his/her sport to help?
For Tennis or Racqu
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et-sport enthusiasts: it is very important to WARM UP before starting any game in earnest: USE THE LIGHTEST RACQUET you can use and still be proficient in your game; be sure to LOCK YOUR WRIST, or decrease any wrist motion to a minimum, on both forehand and backhand. The shoulder, and the whole body, should take part in every shot. Also, it has been found that the TWO-HANDED BACKHAND is much easier on the elbow than the single-handed type. The looser strung the racquet and the larger the "sweet spot", the easier on the elbow
It is very important to have a PROPER FITTING handle, as well; refer to the diagram.