Elbow Woes

A gentleman who has been under care for a lower back issue for a couple of weeks asked me one day last week if I would take a look at his elbow.  He has been having pain in his elbow and his wife told him she thought chiropractors worked on all joints and that he should ask me about it.  After I examined his elbow and performed some simple orthopedic tests I told him he had tennis elbow.  “But I have never held a tennis racket in my life,” he said.  Tennis elbow is what he has and it never dawned on him that you can have tennis elbow without playing tennis.  He is a weekend carpenter, though, and spends a lot of time using screwdrivers and hammers on the weekends and in his spare time helping his son-in-law build things.  His is a classic case of overuse syndrome and it happens to fall into the category of injuries called tennis elbow.

Tennis elbow and golfer’s elbow are both injuries to the muscles and tendons in the elbow that result from repetitive stress, or overuse, syndrome.  Anytime a particular motion is performed over and over again repetitive stress injuries can occur.  In the case of the elbow, the bony prominences, or epicondyles, are insertion points for tendons and become inflamed from repetitive stress or strain.  There are two epicondyles in the elbow that are the points of pain for sufferers of tennis and golfer’s elbow.  The one on the thumb side of your elbow is the lateral epicondyle and the one on the pinky side of your elbow is the medial epicondyle.  If the lateral one is inflamed you have tennis elbow, or lateral epicondylitis and if the medial one is inflamed you have golfer’s elbow, or medial epicondylitis.

Tennis elbow is the most common injury to the elbow.  It is a painful condition that can cause localized pain on and around the bony area where the extensor muscles merge into tendons and insert onto the bones of the forearm.  The pain can also radiate down the forearm into the hand.  Motions that involve gripping anything or extending the wrist can make the pain more intense.  Sometimes the muscle bellies can become so tight from overuse that they put pressure on the nerves that go into the hand and the pain can mimic that of carpal tunnel syndrome.  Many times people come into our office with the misdiagnosis of carpal tunnel syndrome when in reality their extensor muscles are too tight and pain in the hand results.  As soon as the muscles are treated and the bones of the forearm and wrist are properly aligned the pain goes away and no surgery is needed.  Tennis elbow is treated similarly.  It is an inflammatory condition and usually goes away when the inflammation is reduced and the muscles are re-educated.

Golfer’s elbow is much less common but no less painful.  This condition results from overuse of the flexor tendons in the forearm.  Improper golf techniques or any period of excessive golf swing practice are the most common causes of flare-ups of this type.  The pain is as intense as it is for tennis elbow, but begins on the medial or pinky side of the elbow.

Treatment for both of these conditions is similar.  At home you want to decrease inflammation first.  The R.I.C.E. formula works best to accomplish it.  Rest the body part that hurts.  Don’t continue doing the motion that caused the problem in the first place.  It has been said that insanity is doing the same thing you have always done but expecting different results.  Don’t continue to cause the injury you are trying to treat.  Ice is always the best local anti-inflammatory for an injury.  Ice shrinks tissue and in the case of elbow epicondylitis there is tissue swelling, so ice will help.  Compression of the muscle bellies and the area over the bony epicondyles will aid in pressing inflammation out of the injured spot.  Elevation helps to aid in removal of fluid in an inflamed area, and since excessive fluid is commonly present it is a good idea.  After the inflammation has decreased, it is important to increase flexibility and strength in the muscles of the forearm again.  There are many good exercises available online for this or your healthcare team can provide some for you.

If your elbow hurts following any repetitive stress or overuse, don’t just ignore it.  Hammering, screwdriver use, key turning, computer work or, believe it or not, excessive hand-shaking can cause tennis or golfer’s elbow.  The longer you let the pain stay around without treating it, the longer it will take for the injury to heal.  Do not hesitate to ask your chiropractor about helping your elbows or other non-spinal joints in your body.  We sometimes get into a “zone” when we are treating the spine and don’t always talk about the other areas of the body that we can help.  It never hurts to ask.  Treat your body well.

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