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Treating that tricky tennis elbow

After playing tennis for more than two decades, Barney Chadwick never experienced tennis elbow.
Then one day, Chadwick, director of tennis for River Hills Club in Jackson, overexercised his arm with — of all things — a leaf blower.

“We were in the process of selling our house and I could feel my arm getting tired, but I thought I was building muscle,” he recalled, with a chuckle. “When I went to hit a backhand the next day, I thought my arm was going to fall off. I learned that many times, a person gets tennis elbow from doing other activities, but it’s the tennis stroke where you feel the aggravation.”

Tennis elbow is also known as lateral epicondylitis, a degenerative condition of the muscle on the outside of the elbow. The condition is the result of small fiber tears of the muscle tendons where it connects to the bone on the outside of the elbow. It causes pain and inflammation and can lead to significant limitations and use of the elbow.

“Almost anything that we use a hand for requires that we use that muscle because that muscle cocks up the wrist and extends the fingers,” explained Dr. Larry Field, an orthopaedic surgeon at the Mississippi Sports Medicine and Orthopaedic Center who primarily handles cases involving shoulder and elbow injuries. “People with this condition classically say they can’t even pick up a glass of tea or a gallon of milk without localized pain.”

Field debunked the myth that tennis elbow is the result of muscle weakness.

“You get tennis elbow one of two ways, and these ways overlap,” he said. “One way is that you overuse the muscles on the outside of the elbow. When you play tennis, obviously you’re gripping something. You’ve got your wrist cocked up and it’s the ‘perfect storm’ to generate symptoms. You could also be predisposed to this condition based on genetics.

Most importantly, tennis elbow is based on age because it’s rare to have somebody in their 20s come into the office with those symptoms. It’s extremely common to have somebody 40 or 50 come to the office with tennis elbow. It’s as much a degenerative process as it is some type of overuse process. That said, it’s more likely in people who do a lot of repetitive work.”

To decrease stress on the outside of the elbow, tennis players can take certain precautions, said Field.

“Using new tennis balls, for example, requires less force,” he explained. “Having strings strung less tightly makes it easier to hit with less power. There’s controversy concerning the best size of racket grip. Some specialists promote really big racket handles while others recommend small ones. Probably using a middle-of-the-road handle is best because all of today’s rackets have a wide throat design. Those are the best because they help control rotational forces when players hit the ball off center.”

Field said there’s no scientific evidence to support using wrist support straps as a preventative measure.

“If you get tennis elbow, decrease the level of the offending activity,” he recommended. “It’s also important to do some very simple home exercises that involve stretching and strengthening the muscle. Also, an occasional cortisone injection can be really effective in helping to make the symptoms go away.”

Other techniques include a platelet infusion, where platelets, a component of the blood, are separated and injected into any localized area of tendonitis, such as the elbow. “One medical article suggests it’s valuable, but there’s very little science to support it at this time,” said Field. “It’s a new intervention.”

Surgery is required for only 10% of tennis elbow sufferers. Field advocates an arthroscopic technique that requires a very small nick on the outside of the elbow to repair and release the tendon from the inside of the elbow.

“Cosmetically, it’s more desirable because there’s no incision or a minimal incision,” he said. “There’s also a quicker recovery time. The technique has proven itself very valuable and effective, and is certainly the way I usually do the operation.”

Even though tennis elbow may seem like a small malady, it can have a significant impact on people who suffer with it. “If people love playing tennis, it can make them unhappy,” he remarked, “but for scholarship athletes or assembly workers or the 45-year-old construction worker who has a wife, three kids and a mortgage and suddenly has trouble swinging a hammer, it could greatly affect their livelihood.”

Even though the tendons heal to some extent, tennis elbow marks a permanent change. “On a microscopic level, it will never look the same and probably never function quite the same as it did,” said Field.

Chadwick said he was fortunate that his tennis elbow eased after a year “and gave me a great excuse to get out of yard work.”

Contact MBJ contributing writer Lynne W. Jeter at Lynne.Jeter@gmail.com.


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