Tennis Anyone?

Hey guys!  Hope you all are having an awesome St. Patrick’s Day.  Please be safe!

I just finished a REALLY rough week on call, too many middle-of-the-night calls and not nearly enough sleep.  I’ve been thinking about it but I have been coming up empty for blog post topics.  Then what happened?  A friend had surgery for tennis elbow.  Thanks Mrs. T!  Instant topic 😀

So what’s “tennis elbow?”  Its medical name is lateral epicondylitis.  First of all, I’d like to describe some of the anatomy of the elbow and forearm.

Look at your open palm.  Take the fingers of the other hand and trace from the thumb all the way up to just above the elbow.  There’s a bony bump there that is called the lateral epicondyle (the matching bump on the inner elbow is called the medial epicondyle).

Nearly all the muscles that move the joints of the wrist and fingers are actually located in the forearm.  They send long tendons like hydraulic cables into the hand to move the joints.  The human hand is really an amazing engineering miracle!  In med school we spent a ridiculous amount of time on the anatomy of the hand, but it was worth every minute because it’s so incredibly elegant.

All the muscles that open the hand and extend the wrist (put your hand palm-down on a table, then lift the fingers so the hand rolls up on the wrist – that’s extension of the wrist) attach at the lateral epicondyle in the elbow.  Conversely, all the muscles that close the hand and flex the wrist (opposite of extension) attach at the MEDIAL epicondyle.  These two places are very vulnerable to overuse and strain.

Overuse and strain of the lateral epicondyle is called tennis elbow.  It is called that because it is very common in competitive tennis players.  They tend to overwork the backhand (the weaker stroke) and extend the wrist over and over against the tension of the racket hitting the ball, creating an overuse injury of the lateral epicondyle.  (Interestingly, the corresponding overuse injury of the medial epicondyle is called golfer’s elbow, and it’s generally caused by the tension of the golf club head hitting the golf ball, and also by digging divots.)

So do you have to play tennis or golf to have one of these problems?  Absolutely not.  Anything that causes an injury of these two areas is notoriously difficult to heal.  Why?  When was the last day you didn’t use BOTH of your hands all day long?  Never.  It’s nearly impossible to rest the hands in any kind of meaningful way, and that’s what you need to do to heal one of these problems.

What symptoms do you get if you have tennis elbow or golfer’s elbow?  Pain and weakness, generally.  Both problems cause pain when you pick up objects.  I have seen them so severe that the sufferer can’t pick up a coffee cup, let alone the pot!  The weakness is initially due to self-limiting from pain (i.e. it hurts so bad I can’t do it) but can progress over time to true muscular weakness from disuse.

What do you do for tennis elbow?  Ice, rest and anti-inflammatory meds for the most part.  Have you ever seen those straps baseball players wear around their forearms?  Those are tennis elbow straps and are very effective.  You put one around the forearm muscles on the sore side, with the top edge about two fingers below the elbow crease.  Tighten it down and feel near-instant improvement in symptoms!  (The tightness is a little bit of a work in progress.  Tight enough that you feel the muscles pulling against the strap, not the sore elbow, but not so tight your fingers turn blue, LOL!)  It’s always very satisfying to put one of those straps on a patient, cinch it up and watch their face.  They open and close their hand a few times and break into a huge smile.  Makes me feel like a magician 🙂

If the strap isn’t effective, I will usually give a cortisone shot which generally gives good relief.  If that doesn’t work then I refer to orthopedics.  Sometimes the common attachment point is so badly damaged that it requires enforced rest (i.e. a long-arm cast) and if that doesn’t fix it it may need surgery.

Luckily not many patients with tennis (or golfer’s) elbow have cases extreme enough to require surgery.  Please say a prayer for Mrs. T that she recovers quickly and well!

I’d like to wish everybody a happy and safe St. Patrick’s Day!

Lucky stars above you, Sunshine on your way,
Many friends to love you, Joy in work and play
Laughter to outweigh each care, In your heart a song
And gladness waiting everywhere All your whole life long.
Gaelic blessing


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