Patient Guide to Understanding Tennis Elbow

This is the first among our series of articles on patient guides on treatments and understanding a particular medical condition written by one of our Doctors from Wockhardt Hospitals. We start with one of the most common Sports Injuries"Tennis Elbow"

What is tennis elbow?'

Tennis elbow is an inflammation around the bony knob on the outer side of the elbow. It occurs when the tissue that attaches muscle to the bone becomes irritated. The bony knob is called the lateral epicondyle, and tennis elbow is also called lateral epicondylitis (ep-ih-kondah- LY- its).

Causes

Playing a racket sport can cause tennis elbow. So can doing any thing that involves extending your wrist or rotating your forearm- such as twisting a screwdriver or lifting heavy objects with your palm down. With age, the tissue may become inflamed more easily.

Symptoms

The most common symptom of tennis elbow is pain on the outer side of the elbow and down the forearm. You may have pain all the time or only when you lift things. The elbow may also swell, get red, or feel warm to the touch. And it may hurt to grip things, turn your hand, or swing your arm.

Understanding your elbow problem

The muscle that allows you to straighten your fingers and rotate your lower arm and wrist are called the extensor muscles. These miles extend from the outer side of your elbow to your wrist and finger. A cordlike fiber called a tendon attaches the extensor muscles to the elbow. Overuse or an accident can cause tissue in the tendon to become inflamed or injured.

When the tendon is in flamed

When the tendon is inflamed, the nerves around the tendon become irritated. Then moving your elbow is painful. Turning your hand or grasping objects can also be painful.

Diagnosing tennis elbow

Your doctor can usually diagnose tennis elbow from your symptoms and from the look and feel of your elbow. He or she may order an x-ray to be sure the bone is not diseased or fractured. In some cases, other tests may be needed.

Treating tennis elbow

Your treatment will depend on how inflamed your tendon is. The goal is to relieve your symptoms and help you regain full use of your elbow.

Rest and medication

Wearing a tennis elbow splint allows the inflamed tendon to rest, so it can heal. Using your other hand or changing your grip also helps take stress off the tendon. And oral anti inflammatory medications and heat or ice can relieve
pain and reduce swelling.

Exercise and therapy

Your doctor may give you an exercise program, or refer you to a therapist, to gently stretch and then straitened the muscles around your elbow.

Anti-inflammatory Injections

Your doctor may give you injections of an anti inflammatory, such as cortisone, to help reduce the swelling .You may have more pain at first, but in a few days your elbow should feel better.

Surgery

If your symptoms persist for a long time, or other treatments don't relieve them, your doctor may Recommend surgery to repair the inflamed tendon.

Preventing flare-up

To prevent flare-up after treatment , you may need to change the way you do some things. Gripping with the palm up, lifting heavy objects with both hands ,or vary activities through out the day will help reduce stress on the tendon. When you play racket sports or golf ,be sure to condition your muscles ,do warm-up and cool-down exercises, and use the correct strokes.

About Wockhardt Hospital, Bone and Joint care :The Wockhardt Hospitals Bone and Joint care is one of our super specialties and is a center of excellence with highly skilled clinical expertise.

The Wockhardt Bone and Joint Care is equipped to treat all types of musculo-skeletal problems ranging from Trauma Surgery to Minimally Invasive Arthroscopy Surgery. The hospital also specializes in surgery for joint replacements, sports medicine, ligament repair, knee surgery, spine surgery and physical therapy for rehabilitation.

Wockhardt Bone & Joint Care has complete technology and advanced skills to perform Microscopic Lumber & Cervical Discectomy, Endo-scopic Spine Surgery and Arthroscopic surgeries such as Ligament Reconstruction in the knee, Subacromial Decompression in the shoulder.For online appointments write into enquiries@wockhardthospitals.net or logon to our website at wockhardthospitals

Rotator Cuff Injuries:Causes and Treatements

Doctor Ashish Anand, consultant, sports medicine and orthopedic surgeon, Wockhardt Hospitals, Talks to us about "Rotator Cuff Injuries" causes , treatments and preventing them

Dr Ashis Anand is a highly qualified Orthopedic Surgeon who has worked in India and US. His areas of interest include Arthroscopy and Joint Replacement (Hip, Knee and Shoulder). With more than 450 replacements (Primary and Revision). He has also excelled in Unicompartmental Knee Replacement which is done by very few centers in India.

Cardio workouts on the treadmill, elliptical trainers and stairclimbers or weight training with bench press, leg extensions, leg curls and hip adductor and abductor - they could all make you fit, but could also injure you if done improperly.

The increasing number of gym-related injuries is certified by many of the city’s orthopedics and sports medicine specialists. They say that gym-related injuries now constitute anywhere between 40 to 90 per cent of their cases.

Rotator cuff is made up of the muscles and tendons which connect your upper arm bone with your shoulder blade. They along with the Deltoid also help hold the ball of r upper arm bone firmly in your shoulder socket. The combination results in the greatest range of motion of any joint in your body.

A rotator cuff injury includes any type of irritation or damage to your rotator cuff muscles or tendons. Causes of a rotator cuff injury may include falling, lifting and repetitive arm activities — especially those done overhead, such as throwing a cricketball or placing items on overhead shelves.

Most of the time, a rotator cuff injury heal on its own with self-care measures or exercise therapy.

Main Causes of Rotator Cuff Injuries

Four major muscles (subscapularis, supraspinatus, infraspinatus and teres minor) and their tendons constitute the Rotator Cuff and connect the upper arm bone (humerus) with the shoulder blade (scapula). A rotator cuff injury, which is fairly common, involves any type of irritation or damage to your rotator cuff muscles or tendons, including:

Tendinitis: Tendons in your rotator cuff can become inflamed and irritated due to overuse or overload, especially in athletes involved in overhead activities, such as in tennis or racquetball.

Bursitis:The fluid-filled sac (bursa) between your shoulder joint and rotator cuff tendons can become irritated and inflamed.

Strain or tear: Left untreated, tendinitis can weaken a tendon and lead to chronic tendon degeneration or to a tendon tear. Stress from overuse also can cause a shoulder tendon or muscle to tear.

Common causes of rotator cuff injuries include:

1. Normal wear and tear:This is commonly seen in people who are less than 40 years and most often occurs due to repetitive damage to the tendons.Age related wear and tear on your rotator cuff can cause a breakdown of fibrous protein (collagen) in the cuff's tendons and muscles. This makes them more prone to degeneration and injury. With age, one may also develop calcium deposits within the cuff or arthritic bone spurs that can pinch or irritate your rotator cuff.

2. Lifting or pulling: Lifting an object that's too heavy or doing so improperly — especially overhead — can strain or tear your tendons or muscles.

3. Repetitive stress: Repetitive overhead movement of your arms can stress your rotator cuff muscles and tendons, causing inflammation and eventually tearing. This occurs often in athletes such as swimmers and tennis players. It's also common in painters and carpenters.

4. Faulty posture: When you slouch your neck and shoulders forward, the space where the rotator cuff muscles reside can become smaller. This can allow a muscle or tendon to become pinched under your shoulder bones (including your collarbone), especially during overhead activities, such as throwing.

5. Falling:Using your arm to break a fall or falling on your arm can bruise or tear a rotator cuff tendon or muscle.

Symptoms of Rotator Cuff Injury
Rotator cuff injury symptoms may include:

• Pain and tenderness in your shoulder, especially when reaching overhead, reaching behind your back, lifting, pulling or sleeping on the affected side
• Shoulder weakness
• Loss of shoulder range of motion(stiffness)
• You avoid using your shoulder

The most common symptom is pain. You may experience it when you reach up to comb your hair, bend your arm back to put on a shirt or carry something heavy. Lying on the affected shoulder also can be painful. If you have a severe injury, such as a large tear, you may experience continuous pain and muscle weakness.

If you answer 3 of the 5 questions below you need to see a Shoulder Specialist

1. When did you first begin experiencing shoulder pain?
2. Have you experienced any symptoms in addition to shoulder pain?
3. How severe is your pain?
4. What movements and activities aggravate and relieve your shoulder pain?
5. Do you have any weakness or numbness in your arm?

Treatment

Self therapy
1.Rest
2.Local Ice Application.
3.Use medications such as Ibuproffen

Once you see the Shoulder Specialist and after a proper evaluation and investigations , you may be offered one or combination of treatments.

1.Use of pain killers with physiotherapy

2.Intrarticular injections of local anaesthetics

3.Surgery-Arthroscopic surgery to address the particular problem (Rotator cuff debridement,rotator Cuff repair,Labral repair, Acromioplasty)

4.Manipulation under Anaesthesia for frozen shoulder

Preventing Rotator Cuff Injuries

1. Do regular shoulder exercises to strengthen all muscles around the shoulder joint..
2. Take frequent breaks at work if your job requires repetitive arm and shoulder motions.
3.For sportspersons it is important to give adequate rest between games
4.At the first sign of pain apply ice packs.

Consult your Shoulder Specialist immediately.

To know more about Sports Injuries Centre at Wockhardt Hospitals,Please write to enquiries@wockhardthospitals.net