FAMILY MEDICINE® COLUMN

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

CLEARING BRUSH AND PAINTING COMMON CAUSES OF "TENNIS ELBOW"

Question: My arm started hurting when I was clearing brush out of our woods, but that has been more than a month ago. The pain is worse at the elbow when I grasp the pruners or anything else, for that matter. I think I have tennis elbow because a tennis elbow support seems to help a little. I don't understand why my whole arm hurts, though. Also, how long will it take to get over this?

Answer: A simplified description of the elbow is that it is like a hinge between the upper and lower arm bones. But a simplified explanation won't do for this discussion because the elbow is a complicated structure. It involves the upper arm bone (humerus), two lower arm bones (radius and ulna) and supporting ligaments. Additional components are the muscles with their tendons that move the joint, 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. I'll make the assumption that your symptoms are actually caused by tennis elbow.

Tennis elbow is a specific condition with inflammation on the outside (lateral surface) of the elbow joint, where muscles that are used to flex the wrist and turn the palm upward attach to the humerus. This point is called the lateral epicondyle, and therefore, the medical term for tennis
elbow is "lateral epicondylitis."

Most individuals who have tennis elbow do not play tennis, although 50 percent of amateur tennis players do have some symptoms of the disorder. 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 do those who forcefully grasp implements and simultaneously extend their wrists -- like cutting brush!
Regardless of the activity that produces the symptoms, the inflammation of tennis elbow results from what is called a repeated strain injury. The current theory explains this as numerous small (actually microscopic) tears of muscle, tendon and bone tissue at the lateral epicondyle junction. When the area of injury is small, the symptoms are relatively minor; however, when the damage is more extensive, it can produce significant inflammation and result in persistent symptoms.

When tennis elbow strikes, the elbow hurts but the entire arm and shoulder often "complains" as you have noticed. This occurs because of the interesting and complex way our nervous system works. A simplified explanation is that the "crying" of the involved nerve "spills over" into nerves that supply other nearby areas, causing the arm and shoulder pain you experience.

The best treatment for epicondylitis is to avoid additional injury while allowing the body time to heal the injury. Impatient doctors and sufferers, however, often try other treatments. These include:

* Anti-inflammatory medicines such as aspirin or ibuprofen, but my experience is that they don't help a great deal;
* A non-elastic band worn around the muscles of the lower arm, like you're using, which largely serves as a reminder of the things you shouldn't do rather than to promote actual healing;
* Injections of cortisone, typically mixed with a local anesthetic, but this may improve symptoms without speeding the time for total recovery; and
* Acupuncture, ultrasound, exercises and other physical therapy treatments.

Surgery is sometimes used for the most debilitating cases. This is a last resort that should only be considered after all the other treatments have been tried. Unfortunately, none of these treatments consistently works better than time itself. And how much time, you asked? Well, 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., at Post Office Box 110, Athens, Ohio 45701.

Past columns are available online at http://www.FamilyMedicineNews.org.