Tennis Elbow, What's the Reason?

Courtesy of Dr. Ueli, Chiropractor,
Nation Doctor Clinic, Chiangmai

These two conditions got their names from the sports that most often elicit the problem. On the other hand, many people suffer from these conditions without ever having played golf or tennis.

The proper medical terms for pain at the lateral elbow, and at the medial elbow, are epicondylitis humeri lateralis and epicondylitis humeri medialis. No wonder laypeople prefer the terms "tennis elbow" and "golf elbow!"

The pain is caused by inflammation at the insertion points of the tendons of the forearm muscles, and into the bone of the upper arm (periost of the humerus). The cause is overuse of the forearm in general (e.g. excessive typewriting or other handwork, or simple household duties). Of course, many times it's caused by strain when playing tennis or golf too strenuously, or with a false technique.

The intensity of the symptoms can vary from a slight discomfort when lifting something by hand, to agonizing pain associated with any activity, including rest. Some people hardly dare to shake hands anymore.

The diagnosis should be made through a physical exam although X-rays and ultrasounds are rarely necessary. Treatments include:

• Local antiphlogistic applications such as antirheumatic gels or creams or ice-packs
• Local cortison injections
• Chiropractic treatments including manipulation of the spine and the elbow combined by laser application or ultrasound or electrotherapy
• The last resort is always surgery

If the epicondylitis persists after 1 to 3 local cortison injections, the patient should be more thoroughly examined by a specialist such as a chiropractor, rheumatologist or orthopedist. The possibility of any problems with the cervical or thoracic spine that may be causing the recurrence needs to be ruled out. There are definitive connections between spinal functional disturbances and the development of epicondylitis. Unless the spinal condition has been taken care of, the tennis/golfer elbow may come back every so often, sometimes over months and years.

All treatments should be accompanied by not using the involved arm/hand too much and wearing a special tennis golfer elbow brace. The prognosis is good, but convalescence may take from a few days to months or even years if the proper treatment is not applied.

Nation Doctor Clinic: 10/2 Huay Kaew Road, opposite Central Kad Suan Kaew Shopping Center. Tel. 66 53 217762.