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Treatment options for tennis elbow

Tennis elbow is a painful condition that usually comes from overuse or repetitive use of the muscles and tendons of the forearm and the elbow joint.

Several layers of treatment can be implemented at home or after consulting a physician.

First, rest is important. The rest allows the tiny tears in the tendon attachment to heal. Tennis players treat more serious cases with ice, anti-inflammatory drugs, soft tissue massage, stretching exercises, and ultrasound therapy.

[man with tennis elbow]
Racquet sports and other activities that put strain on the forearm can cause tennis elbow.

Stretches and progressive strengthening exercises involving use of weights or elastic bands to increase pain-free grip strength and forearm strength can be helpful.

Physiotherapists commonly advise racquet sports players to strengthen their shoulder rotator cuff, scapulothoracic, and abdominal muscles. This can help to reduce overcompensation in the wrist extensors during gross shoulder and arm movements.

Soft tissue release or massage can help to reduce muscular tightness and decrease the tension on the tendons. Strapping the forearm can help realign the muscle fibers and redistribute the load. A physician may recommend immobilizing the forearm and elbow by using a splint for 2 to 3 weeks.

If symptoms are very painful, and the condition is making movement difficult, a steroid injection may be recommended.

Cortisone is a steroid that can help to reduce inflammation. After a steroid injection, the person should rest the arm and avoid putting too much strain on it too quickly.

Ice massage and muscle stimulating techniques can help the muscles to heal.

Other treatments include injections of botulinum toxin, also known as Botox and extra-corporeal shock wave therapy, a technique that is thought to trigger healing by sending sound waves to the elbow. Heat therapy, low level laser therapy, occupational therapy, and trigger point therapy are other options.

A new type of therapy is an injection of platelet-rich plasma (PRP), prepared from the patient’s own blood. PRP contains proteins that encourage healing. The American Academy of Orthopaedic Surgeons (AAOS) describe this treatment as promising but still under investigation.

Between 80 percent and 95 percent of patients recover without surgery, but in the rare cases where nonsurgical treatment does not solve the problem in 6 to 12 months, surgery may be needed to remove the damaged part of the tendon and relieve the pain.

In a discussion published in the Canadian Family Physician, Finestone and Rabinovitch, refer to a number of exercises using dumbbells that have helped with muscle conditioning in patients with tennis elbow. They point out that the patient should “be compliant and have some tolerance for pain.”

Forearm Supports Reduce Upper Body Pain Linked To Computer Use

Providing forearm support is an effective intervention to prevent musculoskeletal disorders of the upper body and aids in reducing upper body pain associated with computer work, according to a study in The British Journal of Occupational and Environmental Medicine.

Reported in the April issue, the study shows that use of large arm boards significantly reduces neck and shoulder pain as well as hand, wrist and forearm pain. “Based on these outcomes, employers should consider providing employees who use computers with appropriate forearm support,” said lead author David Rempel, MD, MPH, director of the ergonomics program at San Francisco General Hospital and professor of medicine at the University of California, San Francisco.

Study findings also show arm boards and ergonomics training provide the most protective effect, with a statistically significant reduction in both neck and shoulder pain and right hand/wrist/forearm pain in comparison to the control group, who did not receive forearm support. The boards reduced the risk of incidence of neck and shoulder disorders by nearly half.

According to the authors, musculoskeletal disorders of the neck, shoulders and arms are a common occupational health problem for individuals involved in computer-based customer service work. Specific disorders include wrist tendonitis, elbow tendonitis and muscle strain of the neck and upper back. These health problems account for a majority of lost work time in call centers and other computer-based jobs. “Extended hours of mouse or keyboard use and sustained awkward postures, such as wrist extension, are the most consistently observed risk factors for musculoskeletal disorders,” Rempel added.

The one year, randomized study evaluated the effects of two workstation interventions on the musculoskeletal health of call center employees — a padded forearm support and a trackball. The forearm support is commonly called an arm board and attaches to the top front edge of the work surface. The trackball replaces a computer mouse and uses a large ball for cursor motion.

The researchers tested employees from two customer service center sites of a large health maintenance organization. Employees had to perform computer based customer service work for a minimum of 20 hours per week in order to qualify for the study. For one year, 182 participants filled out a weekly questionnaire to assess pain level in their hands, wrists, arms, upper backs and shoulders.

Participants were randomized into four groups, each receiving a different intervention: ergonomics training, training plus a trackball, training plus forearm support, or training with both a trackball and forearm support. Outcome measures included weekly pain severity scores and diagnosis of a new musculoskeletal disorder in the upper extremities or the neck-shoulder region based on physical examination performed by a physician.

The trackball intervention had no effect on right upper extremity disorders. “The trackball was difficult for some participants to use,” said Rempel. “Employees with hand pain may want to try them, but they should stop if it is difficult to use.”

The researchers also performed a return-on-investment calculation for the study to estimate the effects of ergonomic interventions on productivity and costs. Their calculations predicted a full return of armboard costs for employers within 10.6 months of purchase.

“Based on this study, it is in the best interest of the company and the employees to provide forearm supports and training,” Rempel concluded.

In the study, the authors also outline other ergonomic-specific tasks that employees who use computers can do to relieve pain on their own. They suggest employees take scheduled breaks, maintain an erect posture, adjust chair height so thighs are parallel to the floor, adjust arm support and work surface height so the forearms are parallel to the floor, adjust the mouse and keyboard location to minimize the reach, and adjust monitor height so that the center of the monitor is approximately 15 degrees below the visual horizon.


Co-authors of the study include Niklas Krause, MD, PhD; Robert Goldberg, MD; Mark Hudes, PhD; and Gary Urbiel Goldner, MS, from the division of occupational and environmental medicine, UCSF; and Douglas Benner, MD, occupational health, Kaiser Permanente of Northern California.