Dr. Miller: Tennis elbow, do you only get that when you play tennis? We're going to talk about that next on Scope Radio.
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Dr. Miller: I'm Dr. Tom Miller and I'm here with Dr. Angela Wang, she's a professor of orthopedic surgery and she's a specialist in hand care and hand surgery. So what is tennis elbow, and why do they call it tennis elbow, and can you only get it by playing tennis?
Dr. Wang: All right. I'll take the last part of that first. Actually, most people who have tennis elbow do not play tennis. I think it probably got the name because it was common for tennis players in their backhand stroke to get pain in this side of your elbow, the outside or lateral part of your elbow.
Dr. Miller: How do you get tennis elbow? I mean, what is the way that people typically develop this? Is it because they're doing something repetitively? Incorrectly? Or just because of the type of work that they're doing?
Dr. Wang: So it can happen, I'd say, most of the time we see it with no particular reason causing it. Sometimes we'll see it, someone was working on a deck, or doing some big home project that will set it off. So that definitely can be a possibility, but the vast majority of the people just say, "It started hurting. The pain on the side of the elbow, it hurts me when I try to pick up anything." And it's pretty common that it's been going on, even for sometimes months, before they get in and see us.
Dr. Miller: What is it that causes the inflammation that gives you the pain of tennis elbow?
Dr. Wang: So tennis elbow's actually not an inflammatory condition. It's caused by a degeneration of the muscle's origin so the muscles where they come off of the bone in the elbow. And then they run down your forearm, and they lift your wrist and they lift your fingers. So that's why it hurts when you lift the wrist and the fingers, and the pain is up at the elbow area because that's where the muscles actually come from. And it's a degenerative type of condition. The tissue becomes torn, we think there are micro-tears and then that what's causes the pain.
Dr. Miller: But not necessarily inflammation?
Dr. Wang: Correct.
Dr. Miller: Would it follow that non-steroidal anti-inflammatories like Ibuprofen or Aspirin might not help them?
Dr. Wang: That's correct. I usually tell patients, "It's worth trying, but don't be surprised if it doesn't help you a whole lot."
Dr. Miller: How about simple things like heat or ice? Hot or cold?
Dr. Wang: Right. Again, since it's not inflammation, ice may or may not help. But I tell patients if there's something that makes it feel better, go ahead and try it. It's not going to hurt.
Dr. Miller: One of the things that tips me off when I see patients that believe that they may have tennis elbows, when they have difficulty turning a doorknob, or carrying a pot of water across a room to put on a stove, carrying luggage, where they have pain in the elbow, all of those things kind of indicate to me that they could potentially have what we call tennis elbow.
Dr. Wang: Right. It becomes really pretty debilitating to a point where even almost any type of reaching, even lightweight objects become painful. I'd say most of the patients come in claiming pain on a pain scale of even 7-8.
Dr. Miller: And what is the most common way to treat that?
Dr. Wang: Well, over the years, we've tried lots and lots of things, and unfortunately, none of them have proven consistently successful for treating it. Rest definitely would help. It's not an inflammatory condition so usually, anti-inflammatory medications are not really helpful. We do sometimes give people a wrist brace so that they are not moving the wrist up and down and aggravating those muscles that actually come from the elbow. That's why it hurts at the elbow.
Dr. Miller: Now is that wrist brace that little band that wraps, the elastic band that wraps around the arm and has a little bubble on the middle of it?
Dr. Wang: No, so that's a forearm strap. We also do use that in combination with the wrist brace. And the forearm strap is just sort of aimed at . . . I liken it to dampening the guitar strings, so you stop the vibration before it gets to that area, the elbow that kind of hurts.
Dr. Miller: So you like to use both braces sometimes?
Dr. Wang: I do. I combine them or tell the patients to figure out, play with them and use them in combination or separately.
Dr. Miller: Physical therapy, stretching, does that seem to help some?
Dr. Wang: Stretching does help. We oftentimes send the patients to a therapist who have a program where they gradually do stretching, and then add back exercises with strengthening. Also, I think activity modification is a big thing that we don't always talk about, but patients should change the way they're lifting. So instead of lifting with your palm down and using those forearm muscles, you want to try to turn your palm up and use more of your biceps and that lets the area heal.
Dr. Miller: I imagine you treated a few athletes in your practice and what do you say to them? I mean, obviously, they want to keep doing what they're doing, one is a tennis player. Can they modify the way they hit the ball? Or are there things that they can do with their trainer that might lessen the severity of this?
Dr. Wang: Yes. Usually, I leave those specifics up to physical therapy or we actually have an athletic trainer that can help. I think rackets have been changed so they have a bigger sweet spot and that helps less vibration to the elbow.
Dr. Miller: Last one thing I'd like to point out about the University of Utah Orthopedic Center is that you have a full panoply of care, physical therapists and trainers that can help an athlete with that particular problem, and you would assign them into a physical therapist, I guess, right?
Dr. Wang: Yes, sometimes we refer them to therapy. We actually do have an athletic trainer right with us in clinic that can offer advice as well.
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