FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

YOU DON'T HAVE TO BE A PRO TO GET TENNIS ELBOW

Question: My arm has been hurting for a few weeks. I don't remember doing anything particular that hurt it. Since the discomfort wasn't getting any better, I went to my doctor. He said I have tennis elbow. I understand that one doesn't have to play tennis to get tennis elbow, but what did I do to get it? And what causes the pain in tennis elbow?

Answer: Tennis elbow is a common condition; each year, 59 out of every 10,000 workers in the United States are afflicted with it. Although it is more common in white males between 30 and 60 years of age, people of all races, genders and ages can develop tennis elbow. In most younger individuals, tennis elbow is a result of injury from sports such as tennis, hence its name. But, when all ages are considered, 95 percent of cases are caused by repeated minor injuries what we doctors call "repeated micro-trauma" as a consequence of work or hobbies, not from playing tennis.

It is quite common to have no recollection of a specific injury that brought on elbow pain. This is so because the damage is typically the result of micro-trauma from repeated activities such as hammering, sawing, or working at a keyboard. These activities require repeated action of the muscles in the lower arm that are used to bend back the hand. The muscle most prominently involved in this condition has a whopper of a name the "extensor carpi radialis brevis" for those anatomy students among my readers.

When there is constant or repeated tension in this muscle, it produces inflammation in the tendon where it attaches the muscle to the upper arm bone. As you've probably guessed, this attachment site called the lateral epicondyle is at the elbow. The more formal "doctor name" for tennis elbow is derived from the name of this location with the addition of "-itis" to indicate the involved parts are inflamed. That's why we doctors call it lateral epicondylitis.

Tennis elbow produces pain in the elbow area when the inflamed muscle is used. This makes it uncomfortable to do common things like picking up a full cup of coffee or picking up a heavy book while the palm of the hand is pointed down. However, picking up the book with the palm of the hand pointing up is not painful because the sore extensor carpi radialis brevis muscle isn't used. In fact, pain from this type of hand and arm use is one of the features your doctor used to determine that you have tennis elbow instead of several other conditions that cause pain at the elbow area.

Question: My doctor gave me some medication and told me to come back if my elbow wasn't better in a few weeks. Are there other things I should be doing?

Answer: Your doctor probably gave you a non-steroidal anti-inflammatory (NSAID) medication such as ibuprofen or aspirin. These medications are often quite effective at relieving the pain of tennis elbow and getting your arm back into full use. In addition to medication, I often prescribe a brief period of rest to allow the inflammation to subside. Then, I rely on the physical therapist to instruct and supervise my patients in the performance of specific exercises to strengthen and stretch the muscles of the forearm.

In some cases, injection of a corticosteroid may be needed when physical therapy and NSAID medications have failed to give adequate relief. In the most severe cases, which thankfully are uncommon, surgery may be required.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.