ASK THE DOCTOR:
Temporary brace may help ease pain of golf, tennis elbow

By DR. JIM MITTERANDO

Q - I was diagnosed with tennis elbow. My doctor told me to take ibuprofen but my elbow pain persists. What do you recommend?

A - Tennis elbow - also known as lateral epicondylitis - is a common overuse injury of the elbow.

The pain of tennis elbow occurs where the tendons of your forearm muscles attach to the bony prominence on the outside of your elbow. Pain also can radiate into your forearm and wrist. You also may have a painful or weak grip.

The pain of golfer's elbow occurs at the bony prominence on the inside of your elbow. Elbow tendinitis occurs with overuse from repetitive motion activities, including gardening, painting, using a screwdriver, knitting, typing or weightlifting, or improper use such as a poor tennis or golf swing. Tendinitis of the elbow can last months to years. Treatment for both tennis elbow and golfer's elbow is essentially the same.

Initial treatment includes rest, ice and anti-inflammatory medications such as ibuprofen (Advil, Motrin) or naproxen (Aleve). At this point, you should reevaluate the actions causing the injury to assess whether you may need to change your form, posture or position to prevent further elbow injury.

If you do not improve after several weeks, buy a tennis elbow brace, which consists of a Velcro strap that you tighten around your forearm about two inches from your elbow. This takes the forces of the forearm muscles off the injured tendon and places it further down the arm, allowing the tendon to heal.

Wear this brace 24 hours a day for a month and only remove it for bathing. It is important to sleep with the brace, since sleep position often affects this injury. You will need to tighten and readjust the brace throughout the day.

If you do not improve after one month, add a Velcro wrist splint that will prevent twisting or bending of the wrist. Wear both the wrist splint and tennis elbow brace for the next month. If you do not improve, the next step is physical therapy for massage and strengthening. At this point most people will see some improvement.

If you are not improving, you can consider a cortisone injection. Cortisone injections seem to help, at least for the short term. Medical studies reveal that cortisone injections do not have many long-term benefits. In fact, cortisone injections can potentially weaken tendons that may, rarely, lead to future tendon ruptures.

Surgery is considered as a last resort treatment for those with persistent pain and disability resistant to all other treatments.

These steps may help you prevent elbow tendinitis:

• In tennis or golf, have a professional review your technique to see if you're using the proper motion. Swing with your whole arm and get your entire body involved in the swing, not just your wrist.
• Prepare for any sport season with appropriate pre-season conditioning. Do strengthening exercises with a hand weight by flexing and extending your wrists.
• Letting the weight down slowly after extending your wrist is one way to build strength.
• Keep your wrist straight and rigid during any lifting activity - including weight training - or during tennis or golf. Let the bigger, more powerful muscles of your upper arm do more of the work than your smaller forearm muscles.
• Warm up properly. Gently stretch the forearm muscles at your wrist before and after use.
• Consider wearing the tennis elbow brace when you perform activities that irritate it.

Dr. Jim Mitterando is a family doctor at Cohasset Family Practice and a staff member at South Shore Hospital in Weymouth.Readers should send questions to: Ask the Doctor, The Patriot Ledger, P.O. Box 699159, Quincy, MA 02269-9159, or by E-mail to his attention at features@ledger.com.

Questions of general interest will be answered in this column. The information in this column is not intended to diagnose individual conditions, and individual replies are not possible. Readers should see their own doctors about specific problems.

Copyright 2004 The Patriot Ledger
Transmitted Tuesday, April 13, 2004