As of Thursday, December 26, 2013
DEAR DOCTOR K: I’ve been playing tennis for years, but lately I’ve been sidelined by elbow pain. What can I do?
DEAR READER: Elbow pain is the bane of tennis players. It has kept me off the courts for several months at a time. Let’s talk about how to get you back on the court — and prevent a repeat injury.
Elbow pain associated with racquet sports is a form of tendonitis called epicondylitis. It affects anchor points on either side of the elbow joint (the epicondyles). Hold your arm out straight, with the palm up. Then, starting at the wrist of your outstretched arm, run your thumb up the inner side of the arm and your middle finger up the outer side. When you get to the elbow, you’ll feel two hard bumps on either side of it. Those are the epicondyles.
Muscles in the forearm that flex the wrist attach to the epicondyles with a fibrous tendon. Over time, repeating the same body motion damages the tendon. Hitting a tennis ball requires a firm grip on the racquet, and when you strike the ball the tendon tugs at the epicondyles. That’s particularly true of the one on the outer side of your elbow when you hold the arm out with the palm up.
When trouble develops in the tendon that attaches on the outer side of the elbow, it’s called lateral epicondylitis. It’s more commonly known as “tennis elbow.” (I’ve put an illustration on my website, AskDoctorK.com.)
Right after injury, focus on relieving pain and inflammation and resting the affected area:
— Rest: Stop playing for a few weeks or months to give the tendon time to heal.
— Ice: Ice the joint for up to 20 minutes several times a day.
— Compression: A counterforce brace wraps snugly around the forearm, reducing tension on the tendon. Relieves symptoms.
— Anti-inflammatory medications: These drugs (such as ibuprofen and naproxen) can help relieve pain and inflammation.
— Corticosteroid injection: Your doctor may consider a limited number of corticosteroid injections to provide symptom relief.
In my experience, these measures almost always do the trick, but it takes time to heal. If you have severe, unrelenting pain that does not respond to the above treatments, you and your doctor may consider:
— Platelet-rich plasma therapy (PRPT): Platelets and other substances from your own blood are injected into the injury site. PRPT may help stimulate a healing response in the damaged tissues, although this treatment is unproven and controversial.
— Surgery removes damaged, non-healing tissues and may stimulate healing.
Once you’re back on the court, do the following to prevent further injury:
— After you play, ice your elbow, even if it doesn’t hurt.
— Make sure the size, weight and grip of your racquet are right for you.
— Warm up before playing. Stretch, put your joints through their full range of motion and increase activity gradually.
Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.