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

PAINTERS AND CARPENTERS CAN SUFFER FROM "TENNIS ELBOW," TOO

Question: I'm a painter and I've had trouble recently on the job because of pain in my elbow. When I went to the doctor last week, he said that I have tennis elbow. Does this sound like the right diagnosis to you? Can you recommend any exercises to help my elbow pain?

Answer: The elbow is a complicated structure involving the upper arm bone (humerus), two lower arm bones (radius and ulna), ligaments that support the joint, muscles and their tendons that move it, blood vessels that nourish it and nerves that coordinate all this activity. Disorders of any of these elbow components can cause pain. Therefore, a correct diagnosis is essential.

Tennis elbow is a specific condition with inflammation -- at the attachment point to the humerus -- of the muscles that are used to flex the wrist and turn the palm upward. This is on the outside (lateral surface) of the elbow joint. This point is called the lateral epicondyle, and therefore, the medical term for tennis elbow is lateral epicondylitis. And to be complete, I need to mention that there is another similar condition called "golfer's elbow" that involves the area where muscles attach on the medial (next to the body) side of the elbow.

As in your situation, most individuals who have tennis elbow do not play tennis. Painting with a paintbrush is actually a more common cause of "tennis elbow" than is playing tennis. Carpenters and others who use hammers also commonly suffer from this disorder.

As you might imagine, the name "tennis elbow" came about because the condition was first described in tennis players. Regardless of the activity, the inflammation of tennis elbow results from repeated strain injuries. In tennis players it comes about because of forceful gripping of the racket while using a backhand swing. It is more common in players who use a racket whose handle is too small in diameter for their hand and, thereby, makes them grip harder. It is also more common among those who use a racket with very high string tension.

Non-tennis players who develop tennis elbow do so because they have repeatedly performed a similar arm and wrist movement while forcefully gripping. In your case, this is the nearly constant back and forth motion you make while gripping the paintbrush handle.

The treatment for epicondylitis is predominately the avoidance of additional injury. The body will heal the injury in due course. It is important to maintain sufficient activity to keep good muscle strength and joint flexibility while avoiding additional injury. Exercises can be helpful for this, but they don't actually shorten the time for healing.

Many treatments are used for epicondylitis. Anti-inflammatory medicines such as aspirin or ibuprofen are often prescribed, but my experience is that they don't help a great deal. A non-elastic band worn around the muscles of the lower arm is frequently tried. This largely serves to remind the person to be mindful of the things they do rather than promoting healing.

Acupuncture, ultrasound, injection of cortisone, exercises and other physical therapy treatments are often used as well. Surgery is occasionally used for those with the most debilitating cases of epicondylitis. This should only be considered as a treatment of last resort. Unfortunately, none of these treatments consistently works better than time itself. Most people suffer with this for up to nine months despite the treatment they receive.

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.