What is it? Epicondylitis is inflammation of the bony parts on either side of the elbow where some tendons of muscles attach. The lateral epicondyle is where the wrist extensor muscles attach, and inflammation here is called lateral epicondylitis or “tennis elbow”. The medial epicondyle is where the wrist flexor muscles attach, and inflammation here is called medial epicondylitis, or “golfer’s elbow”.
How did I get it? You don’t have to play one of these sports to experience an injury that causes inflammation at the elbow. Epicondylitis can happen due to repetitive forceful wrist motion, or from trying to keep the wrist stable against an external force, or due to a traumatic injury.
How do I know if I have it? You can tell you have “tennis elbow” if it hurts to touch the lateral epicondyle, and the pain increases when you extend your wrist against resistance. You can tell you have “golfer’s elbow” if it hurts to touch the medial epicondyle, and the pain increases when you flex your wrist against resistance. Your physician can check these maneuvers for you if you are not sure.
How do I treat it? The first and most conservative treatment is rest – take a break from the activity that caused the epicondylitis. You can use ice or heat for 10 minutes three times a day. A counterforce brace to the forearm can be used to decrease the tug of the muscles on the elbow. A counterforce brace is the strap that you sometimes see on athletes encircling their forearm just below the elbow, which you can typically get at your local pharmacy. There are some over-the-counter remedies you can try such as topical Arnica gel, Traumeel ointment, or a Salonpas patch to help decrease pain and swelling.
What if I still have pain? Then, it is time to see your physician. Your physician will perform a physical exam to rule out other diagnoses and to confirm lateral or medial epicondylitis. Your physician may want to order an x-ray to rule out an avulsion of the epicondyle, which is when a little piece of bone gets pulled away with the tendon during a forceful movement. An injection at the location where the wrist muscle tendons attach to the elbow can help decrease the pain. I recommend not injecting steroids because they can weaken the tendon making it more likely to rupture. I prefer to inject natural pain-inhibiting substances like Sarapin and local anesthetics. I also like to use Kinesio tape over the forearm and elbow in a pattern that inhibits the wrist extensor or flexor muscles while the area is healing.
What if it has been more than 2 months, and I still have elbow pain? Then, your body has not fully healed the injury and might need some assistance to do so. Prolotherapy is a series of injections of a safe, proliferative solution to the spots where the muscles and ligaments attach to bones. Prolotherapy stimulates your body to lay down more collagen, strengthening the tendons and ligaments of the elbow, fixing the problem.
My elbow is all better. Can I go back to my activities? How do I prevent myself from getting epicondylitis again? The best thing to prevent future bouts of lateral or medial epicondylitis is a stretching and strengthening program for your wrist flexor and extensor muscles. Start with isometric strengthening, which is when you flex or extend your wrist against resistance without moving it. You should be able to see the muscles in your forearm contracting. You can stretch the wrist flexors and extensors by using your opposite hand to gently push your hand into further flexion or extension than you can achieve on your own and hold for a count of ten. Your physician can teach you these maneuvers or refer you to a physical therapist. Once your elbow is pain-free, strong, and limber, then you can return to your activities.
Contact Dr. Boston at the Akasha Center for Integrative Medicine if you are interested in being evaluated and treated for elbow pain. The Akasha Center is located at 520 Arizona Ave, Santa Monica, CA 90401. (310)-451-8880