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elbow pain
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albodary posted:
I've had pain in my elbow for the last two years or so. The doctor has told me its "tennis elbow"… and oddly enough I don't even play tennis. I've seen the the orthopedic doctor about it a few times over the last 2 years and he's given me cortisone shots in it on 3-4 occassions. The first 3 helped but the last and most recent one did not help at all. I've also tried an elbow brace that he recommended for me but I can't tell that it helps. The last time I saw him he mentioned surgery as an option. I really don't want to have surgery does anybody know of any of other ways to get rid of "tennis elbow"? Thanks

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lorigibs40734 responded:
Hi. The name can be misleading I suppose, as Tennis elbow is caused by repetition of the arm. They first diagnosed me with that back in 2006, when the pain first started. I worked as a data entry operator and was one of the fastest keyer's in my building. An EMG then confirmed carpal tunnel and a severely pinched ulnar nerve (cubital tunnel). And it all went downhill from there.

You might can try some stretching exercises for your arm. Has your MD suggested physical therapy? Also, heat or ice, which ever you prefer could also help. I use heat as anything cold makes my pain worse. I took an old tube sock and filled it with white rice, you can put it in the microwave for about a minute and wrap it around your arm. Works wonders.

Hope this helps you.

Lori
 
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mattzpt responded:
Hi Albodary,
The previous poster is correct that "tennis elbow" can be a misleading name. I'm a Doctor of Physical Therapy (candidate) and have seen numerous patients with this same diagnosis. About 80-90% of those patients do not play tennis and it did not cause their pain. Lateral epicondylitis or epicondylalgia is the medical term given to "tennis elbow" and it is simply an inflammatory process of the extensor tendons of the forearm or the sheath the tendons are encased in. One of the muscles typically involved in lateral epicondylalgia is the extensor carpi radialis brevis (ECRB). This muscle originates at the lateral epicondyle (bone on the outside of your elbow) and attaches at the base of your middle finger.
Through my experience, tennis elbow is most commonly found in adults age 35-55. As I have already mentioned and you've discovered, tennis is not usually the cause of this elbow pain. It is usually aggravated by repetitive activities of the wrist and forearm. I have found it most commonly in administrative/computer work, factory workers, and those completing household projects (I.E. painting, landscaping, etc). Your elbow pain needs to be examined on a macro-biological level, not just where the symptoms are but as an entire unit working together. In order to best treat your problem and abolish your symptoms the underlying cause needs to be established. This is where you need the skills of a physical therapist adept in diagnosing the underlying cause of your symptoms and then treating them with manual therapy, corrective exercise, and modalities.
A physical therapist will be able to examine, evaluate, and determine a differential diagnosis that will allow them to direct your treatment appropriately. The first differential diagnosis is a review of systems and medical screening to rule out any medical conditions that would require MD referral. Next a movement impairment diagnosis will be determined. This movement impairment diagnosis is unique to physical therapy and different than a general practitioner, who looks at patients on a micro-biological level, meaning they treat the symptoms and often not the cause. Taking this into consideration, until your cause is treated your symptoms may be prone to returning even if the symptoms are temporarily relieved. A physical therapist that is specifically trained to diagnose and treat movement disorders through careful biomechanical examination, observation, and then diagnosis would be beneficial. Once your examination is complete and diagnosis is determined your therapist will guide you on a path to recovery. Treatment strategies might include soft tissue releases, dry needling, LASER, and or ultrasound to help reduce pain and inflammation. In conjunction with these passive treatments, you will also be actively involved in your treatment with corrective exercises personalized to your particular movement impairment which will help prevent future flare-ups. While surgery is an option, I believe for someone with a non-acute injury like yourself, all other options should be explored before looking into surgery as a last resort. This is why I would advise you to seek out the help of an outpatient/orthopedic physical therapist in your area.
If you elect to pursue physical therapy treatment, know that 49 states have direct access, meaning you can be evaluated by a physical therapist without a physician referral. After the initial consult with the physical therapist, you may or may not need a physician to sign off on continued treatment depending on the state you live in and your insurance provider. I practice in North Carolina where we have direct access and can evaluate and treat most patients (except Medicare) without physician referral. I would recommend calling a physical therapy clinic in your area to determine your state's policies on direct access. Also, it is important to know that you, the patient, have the right to choose where you want to receive physical therapy.
Good luck with your recovery and I hope you can avoid surgery. If you have any other questions I'd be glad to try and answer them for you.
Matt Zwilling MPT, CSCS


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