DEAR DR. GOTT: I have been suffering with tennis elbow for almost a year with little relief. I have tried physical therapy, used Aleve, heat, cold and had cortisone shots. Right now, I am trying deep-tissue massage that seems to help some. I continue to do stretching exercises.
I have an office job and spend a good portion of the day using a computer. My elbow started to bother me last winter after we had more than a foot of snow and I shoveled a lot. Are there activities I should avoid or take part in to help? I don’t want to have surgery to correct this, as I’ve heard there is no guarantee of results. Do you have any suggestions?
DEAR READER: Tennis elbow, technically known as lateral epicondylitis, can result from a number of causes but is common following repetitive motion of the arm and wrist — such as when executing a tennis or other racket-sport backhand improperly, shoveling snow, using a computer mouse, or swinging a hammer for a living.
Pain results from physical stress, overuse and inflammation that can radiate from the outer portion of the elbow to the wrist and hand. This may, in part, be the result of small tears in the tendons that attach the muscles of the forearm to the outside of the elbow.
Diagnosis can often be made by physical exam and verbal history of events that preceded the pain. Should questions remain, your physician might order an MRI or EMG to rule out nerve impingement. X-rays are not generally helpful because they don’t reveal tendon tears, but they can rule out other conditions.
Initial treatment is, as you attempted, with over-the-counter nonsteroidal anti-inflammatory pain relievers, followed by gentle stretching exercises, wearing a brace, or discontinuing the activity temporarily (two to three weeks) to allow the tendons to heal on their own. The use of an ice pack up to six times a day, an Ace bandage, acupuncture, massage or physical therapy, or a cortisone injection might provide relief. Devise methods to allow you to function throughout the day with reduced pain. Adjust the angle of your computer keyboard, play racket sports every other day instead of daily, use two hands when hitting a backhand, take lessons to determine what it is you did wrong to injure yourself, wear a wrist brace if your hand is on a computer mouse for hours at a time, take brief breaks to perform gradual hand-stretching exercises, use a lighter hammer, keep an ice pack handy to reduce inflammation, and use your opposite hand when possible to lessen the burden on the one that causes the pain.
When all else fails, speak with your physician regarding the pros and cons of surgery. He or she will likely want to know that you have attempted conservative measures for at least six months because invasive surgery involves trimming tendon sheaths or releasing a tendon from bone. Both may be performed on an outpatient basis, and your arm will either be placed in a sling or cast, depending on how extensive the procedure was. There is no guarantee surgery will improve your condition, and it will not be known for almost a month, so in my opinion, it’s not a choice to be made lightly.
To provide related information, I am sending you a copy of my Health Report “Managing Chronic Pain.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order made payable to Newsletter and mailed to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title.
