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Pain in the elbow

May 26. 2014
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By Cholawish Chanlalit, MD

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A painful condition often found in those who enjoy racquet sports or are constantly making repetitive movements, tennis elbow -or lateral epicondylitis as it is medically known - is a common injury causing pain on the outside of the elbow.
 Lateral epicondylitis tends to affect people who are around 40 years old and affects more women than men. Pain often occurs when undertaking such activities as using a hand screw driver, wringing out wet clothes, opening doors, or tilting the wrist when sweeping the floor. The pain or tenderness occurs on the outside of the elbow extending down the forearm. The doctor will check if the area around the elbow is sore by pressing on it. The resisted wrist extension test (Cozen’s test) may be performed and is considered positive if a resisted wrist extension causes pain. Other tests may be recommended to rule out other causes of the problem.
As other pain can occur in the elbow area, caused by among others. posterior interosseous nerve irritation, cartilage degeneration and impingement of the lateral plica, the doctor will make his diagnosis through a physical examination and also ask questions about the patient’s medical history. Additional tests, such as an x-ray or MRI to examine tissue conditions such as tendons, muscles, fascia, ligaments and bones may be ordered and an electrodiagnosis is used to evaluate nerve entrapment or compression. A CT scan is used to see misshapen bones or mal-alignment. The need for these special tests is determined by the doctor though fortunately, given the cost and time involved, many will be unnecessary. 
When the cause of elbow pain is known, it can be used to determine the prognosis, treatment plan and method of treatment for the patient. 
Eighty per cent of people recover by themselves. Treatment is provided when the symptoms interfere with daily life, work or sleep. A combination of treatments includes medicine to relieve pain and reduce inflammation, physical therapy, compression, and modification of activities. In some cases, if the symptoms are particularly painful, a steroid injection may be recommended on the sore area. Only 1-2 injections are required and the time interval between injections should be longer than a month. One study found that the injection relieves pain in the short term, but does little for long-term improvement (over 6 months). However, the injection helps reduce pain and can help patients to continue their physical therapy. These increase the chance of rehabilitation. 
There may also be some side-effects from the repeatedly injections, such as a loss of pigment in the skin or fat atrophy around the injection site. It also increases the possibility to tendinopathy causing tear and elbow instability which requires surgery. 
Surgical treatment includes open surgery and arthroscopy (a kind of minimally invasive surgery) and is indicated when conservative treatment fails after 6-9 months of treatment. In some cases, when a tendon tear is caused by an accident, the surgical treatment will be considered as a primary option. 
Dr Cholawish Chanlalit is an Orthopaedic Surgeon at Samitivej Srinakarin Hospital.
For further information, contact the Spine and Joint Centre at (02) 378 9000.

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