Question
I have developed tendonitis in my right elbow over the last few weeks. At times it is not too bad, and at other times it can be quite painful.
The location of the tenderness is - if I were to put my arm straight out, with the back of my hand facing up(hurts when I do this, by the way), it is the first "bump" as I feel down from the top of my arm, at the elbow location . Hope that makes sense.
I am a golfer, but I have been playing for 25 years with no problems whatsoever up until now. Could I have just injured it somehow? What can I do to rehabilitate it? Should I use ice or heat on it?
The funny thing is - it doesn't really hurt when I swing a golf club.
Any recommendations, etc. will be greatly appreciated.
Thanks,
Dave


Answer
Hi Dave-

Based on what you're telling me, it appears you may have a case of lateral epicondylitis, better known as tennis elbow (no tennis playing required!).  Simply put, this condition - along with it's "sister" condition golfer's elbow, which is found on the inside of your elbow, opposite where YOUR pain is - is an irritation/inflammation of the attachment of certain forearm muscles at or near the bone they attach to.  This happens for a number of different reasons, including tennis of course, but also any other activity that involves forceful or repeated muscle contraction against an external force.
Let me give you an example of what I'm talking about: If you were playing tennis as a right-handed player, and you struck a backhand shot, in order to keep the racquet (and your wrist) from just giving out from the force of the ball striking the racquet the muscles in your forearm (running from the back of your hand to the elbow) have to contract.  While this happens (the muscle contraction) the ball and racquet are trying to stretch those same muscles because of the force involved in the backhand - exactly the opposite direction the contracted muscles are trying to achieve.  This "tug of war", whether it's a one time occurence or several hundred "mini-wars" creates significant amounts of abnormal tension at the attachment of the muscle to bone.  The bony attachment we are talking about in this case is called an epicondyle - add "itis" for the inflammation, and you have epicondylitis.

My guess is that you are a right-handed golfer, which would explain why the golf swing doesn't bother you too much.  The take-away (early parts of the backswing) may be uncomfortable, but you shouldn't have much difficulty with the downswing or follow through because that part of your forearm isn't involved much.

As far as treatment goes: ICE, not heat!  Heat feels good, but can recreate a form of inflammatory response in the area later, slowing down your healing.  Here's what I would try - apply ice (ice cubes in a bag, directly on the skin) 15-20 minutes at a time, several times per day to the area.  Only ice over the painful area - do not wrap your entire elbow in ice, as there is a superficial nerve running alonng the inside of your elbow (the "funny bone") and you could damage this nerve with repeated exposure to ice.  If you have an allergy to cold (develop hives or other painful area with cold?) ice is out - if not, no problem and you can ice as much as you are able as long as you allow one full hour between icings.  Give it a week and see how it feels.  Because this problem has been around for a few weeks, more treatment may be necessary to complete resolve the issue, and more importantly, keep it from returning.  Send me a message then and I will outine additional treatment for you, which can be done by any PT or most chiropractors.

Sorry for the lengthy response, but I believe it's important to let patients know exactly what is going on with their condition...good luck, and let me know how it goes.

Dr. Barry Wiese