Tennis Elbow-Lateral Epicondylitis

 

Tennis Elbow-Lateral Epicondylitis

Tendinitis is a common ailment, sometimes due to repetitive use/dysuse, sometimes due to trauma, and occasionally due to systemic illness.  Under most circumstances, the cause of the problem is fairly self-evident.

Repetitive use results in lateral epicondylitis, or ‘Tennis Elbow,’ whit activities that require the wrist to be gently dorsiflexed accompanied by flexion of the fingers.  Key-board use, as might be seen with prolonged computer keyboard or piano performance.  It will result from repetitive micro trauma as with ground stroke on a tennis raquet or non-dominant arm in the golf swing.  In any event, inflammation of the extensors of the wrist results in pain in the elbow, numbness and pain in the hand, and occasional pain in the shoulder.

Epicondylitis- kink ease The figure to the left demonstrates the anatomy of the lateral epicondyle, as well as anatomy of the flexors as they attach on the medial epicondyle.  Only rarely do inflammatory conditions occur on both sides, simultaneously, and when they do, it is usually due to violent trauma against an outstretched palm.

Symptoms of lateral epicondylitis include:

  1. Achiness in the elbow, often vague in nature, but most profound in the bone.
  2. Occasional numbness in the thumb, index and middle fingers.
  3. Subjective weakness when performing activities such as opening a door knob, lifting or holding a can of soda.
  4. Muscle spasm in the forearm.
  5. Subjective feelings of weakness of grip.

Prognosis:

Most cases of lateral epidcondylitis will resolve, over time.  80% or more require little more than rest and over the counter oral anti-inflammatory medicines, such as motrin, alleve or ketoprofen.


When the pain or weakness does not resolve in a week or two:

  1. Stronger anti-inflammatory medicines may be indicated, but the duration of therapy should be at least 6-8 weeks, otherwise the symptoms get better, briefly, and come right back.
  2. Some practitioners will inject cortisone or similar medicines at or near the muscular attachment at the elbow.  This is a reasonable approach, if it is done properly.
  3. Topical anti-inflammatory medicines may be a better approach.  Topical Voltarin is available by prescription, but, it, too, should be used for periods of 6-8 weeks (at least 4 weeks after the pain abates) or the problem will seem to re-appear.
  4. Use of oral anti-inflammatory medicines should be co-administered with injection therapy, for either to be most effective.

An alternative approach to the treatment of lateral epicondylitis (tennis elbow) involves the co-administration of topical MSM and oral MSM.  The regimen is outlined, below:

1.  Oral MSM 1000 mg taken by mouth, twice daily, for 6-8 weeks.
2.  Topical MSM (Kink-ease) is used 4 times daily for 4-6 weeks.
3. Oral Aleve or Motrin can be used, in addition to #1 and #2, above.

David S Klein, MD

David S. Klein, MD, FACA, FACPM was born in Washington, DC, and was raised in Chevy Chase, Maryland. He completed his undergraduate education at the University of Maryland with degrees in Chemistry and Psychology.

Medical School was completed at the University of Maryland at Baltimore, followed by Internship in General Surgery at the University of North Carolina and Residency in Anesthesiology at the Duke University, Durham, North Carolina. Dr Klein has been practicing medicine since 1983, concentrating in Pain Medicine, Minimally Invasive Medicine and Surgery, and Neuroendocrinology. Earning Board Certification in Anesthesiology, Dr. Klein was elected Fellow in the American College of Anesthesiology, and he was elected Fellow in the American College of Pain Medicine. He is currently an adjunct Associate Professor at the University of Central Florida, School of Medicine.

He has focused his private practice on treating patients with hormone imbalance issues, nutritional deficiency related medical problems as well as pain related issues and impairment. With a highly-complex, CLIA licensed laboratory in-house, he has been able to provide rapid-turn around analysis efficiently and cost-effectively.
Lecturing extensively nationally as well as internationally, Dr. Klein has authored many articles on topics relating to pain, injury and nutritionally modulated illness. His radio show, “Pain Free Living,” received top ratings during the 6 years it was on the air. Currently practicing in Longwood, Florida, Dr. Klein practices entirely in the office setting.

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