My Elbow Is Killing Me!

David,
I had "tennis elbow" a couple of years ago. Went through several doctors and lots of ideas, trying to figure out the root cause. I finally figured it out, and I suspect that you, as a writer, may have the same nefarious problem. It turned out that using the touchpad on my laptop was the culprit. While touching the touchpad with my index finger, I was simultaneously holding my other three fingers up in the air to keep them away from it. This strain transferred from my three fingers directly to the tendons in my elbow. I didn't realize this at first, but I was running out of ideas, and had heard of "carpal tunnel" etc, and I use my laptop all day long, every day. So I got a USB mouse and tried it out. ONE DAY after I stopped using the touchpad, I began to feel relief from months of sharp, intense pain. Within a few days, it was gone completely. And, by the way, if I use the touchpad for a couple of days now, it comes back!

I hope this helps you -- whether it's the real cause, or maybe points you to something similar. Good luck!

David,
I looked through all the replies to your elbow article and found only one mention of the only thing that ever helped my "electricians elbow", I got it by using hand tools for the past 40 plus years. The BAND-IT elbow device works great.
I wear one at work every day all day, and even have a clean one I wear the rest of the time. Do yourself a favor and Google BAND-IT, buy one and kiss your elbow pain goodby.
Gary Sparks

David,

I enjoyed your article, and was particularly interested in your description of how alluring the media often finds the newest, sexiest, most technically exciting elements of modern medicine. All while many people suffer with some level of the ???garden-variety aches and pains???, that go relatively unexplored by the media. I am an acupuncturist, and have noticed a parallel trend in how people approach my branch of medicine.
I am shocked by how much interest there is, from the media, other medical providers and the public in general, in some of the applications of acupuncture that are very much outside the mainstream practice of our medicine. Acupuncture anesthesia (in which surgery is performed using only acupuncture as anesthesia), its ability to flip breech babies, as well as its use for weight loss and smoking cessation are all areas of our medicine which may hold some clinical value, but they are all far outside acupuncture???s mainstream bread and butter applications.
Acupuncture???s ability to effectively treat the common every day discomforts which, as you ably point out, afflict a shockingly large percentage of our society (who doesn???t have a family member who suffers regularly with back pain, knee pain, hip pain, painful periods, or even yes, elbow pain), has been known for literally thousands of years. Its efficacy to do so has recently been demonstrated repeatedly in a steady stream of well designed, large scale randomized controlled trials. It is a constant source of mild frustration to me though, that more people seem more interested in its ability to help people quit smoking and make them look 10 years younger, rather than the more traditional uses where it has excelled for millennia.

Adam Learner, Licensed Acupuncturist
alearner@acufamily.com
www.acufamily.com

David,
I could not relate more to your article. I am a chronic do-it-yourselfer of the home and automobile. I have suffered with tennis elbow for years. I have tried PT, multiple Cortisone injections, rest, anti-inflam pills, and daily ice massage, only to have the problem reoccur. As I write this I am in a cast after having surgery done last week to (hopefully) cure me once and fore all. The pain interrupts every aspect of your life. I finally reached the breaking point when I realized it was limiting the activities I could do with my kids. Feel free to email me about my progress after surgery.
Good luck!

Physical therapists are movement specialists. The elbow is a complex structure consisting of the humerus, radius and ulna. All bones have inherent movement built into them. This means they can glide, slide, roll and twist where they come together. This also means they can get stuck just slightly out of place, for example when a load is placed on them in awkward positions, i.e. shoveling in mid December. Here you have a scenario of a long lever arm, multiple twisting motions and a significant weight at the end. For you, this ended up with symptoms of epicondylitis or even a tendonitis. The bones are not moving correctly but you are still using your arm. This makes the muscles and ligaments work harder (like a door off its track). These muscles and ligaments become pinched, swollen and inflamed. This is why you were instructed to take an anti-inflammatory medication or consider a possible injection. That would help with the swelling which contributes to increased pain as less room becomes available for the muscles and tendons, as they swell, to move. The cycle can continue. This is why the pain comes and goes. However, the problem is that the bones are out of alignment and until they get back on track the problem will continue. A very effective treatment by a PT would include soft tissue, joint and functional mobilization. Meaning, a PT would evaluate what movement dysfunction was occurring in your elbow and help the ligaments, muscles and bones back on track. Because you are not in my office I cannot tell you exactly what developed but I am sure you can find a good physical therapist in your area to help you with this pain.

David,
I simply could not pass up the opportunity to pass on some information that helped me tremendously. I too suffered from tennis elbow and can certainly relate to the pain. I went to several doctors, physical therapy, and was still in incredible pain a year later. I received a referral for a doctor named Durlan Castro that practices Active Releae Therapy and reluctantly set up an appointment. After a few months of treatment, I no longer felt any pain! I was so grateful to have received the referral and felt obligated to pass it on! His website i www.nyactiverelease.com and his office is in Commack, NY @ 631-462-0005 or at least was a few years ago when I went. He trains doctors & therapists nationwide in this technique so may be able to refer someone in your area. I can't believe that in our 40's (as I am) or our 50's or 60's for that matter, that we should settle for chronic pain if we don't need to! I certainly hope you find the relief that I feel so fortunate to have received.

David,
I can completely relate to your elbow pain, having suffered from tenni elbow myself. I had to suggest another option - as I went to several doctors, physical therapists, etc and was in terrible pain a year later. I received a referral for a doctor that was practicing Active Release Therapy. Dr. Durlan Castro has trained many doctors in this technique. I was treated by him, and my elbow is completely fine now and hos not given me any problems for years. He has an office in Commack NY but trains chiropractors & therapists nationwide in this technique. I would certainly recommend trying this before settling for such pain in a "57 year old elbow:!!!! I wilsh you all the best & hopefully a full recovery as well. I couldn't pass up the opportunity to pass on advice that I was so grateful to have received - I don't miss those nights of pain, ice & complaining - and yes, I certainly felt your pain!

I'm 65 and still in reasonable shape - for example, if I need a 55-gallon drum of something moved at work, I could go get somebody else to do that, but I could also go get the 2-wheeled cart and move it myself, as long as it's not over 700 pounds (only the chlorinated solvent is that heavy). I hurt in various places, but at least I can be thankful that it's not as bad as yours. For whatever it's worth, I suspect that your ice treatment is only numbing the nerves temporarily (not to minimize the value of that) and it's interesting to read about the lady who immobilized the joint for 6 weeks and had good results. Maybe you (or I) could try that just part of the time. I think it helps my elbow if I remember to take my hands off the keyboard when I am not actually typing. And, even if cold does some good some of the time, does anyone out there have any comment about steam rooms or saunas or hot tubs? They might be good for more than just fun. As a chemist, I am inclined to think that if we want our elbows to heal, we should be trying heat, as lots of chemical reactions go faster with increased temperature. And, good luck to you.

I am suffering (6 months+) from pain in my glutes, hip and leg that might be bursitis of the hip... or pelvic misalignment ... or knock knees ... all aggravated by starting to do sprint triathlons in my 50's. Several people mentioned your article to me ... wonder if they are getting tired of hearing every fascinating detail about today's pains and theories about how to fix them?!? I totally sympathize, feel equally frustrated by the plethora of conflicting advice, and just encourage you to stay optimistic. I am doing chiro, acupuncture, Rx, etc and feel that a good physical therapist can be your best ally -- someone who looks at the entire system, not just the symptoms, and figures out how to help you get stronger. Good luck!

Mr. Noonan, I can emphathize with your recent elbow problem. I developed the same problem after throwing a ball for a friend's dog. Initially I ignored the problem (for about 2 months) and then went to see a physical therapist. The stretching exercises were only minimally helpful and I was not interested in cortisone injections. Finally, I followed the advice that I knew to be correct (as a Nurse Practitioner) and put on a temporary splint (one of those splints that hardens as a cast might- note, the arm should be bent 90 degrees at the elbow with the palm facing up toward the sky and the splint should run from the back nuckles to above the elbow ) and wore it and a sling for 6 weeks. Needless to say, as a busy mom of 2 and a medical professional, this was a bit inconvenient! However, 6 weeks later...problem solved. The pain was gone and other than a bit of stiffness and an ache that comes when the weather changes my elbow is no longer killing me. I hope you have success in your healing as well. Elizabeth Griffin,FNP

David,
To quote a fellow 50+ year old baseball teammate on the North Sydney Bears, when I complained of a sore throwing arm: "At our age mate, if it doesn't ache, it's probably fallen off!"
If I were you, I'd give acupuncture a go. It worked wonders for a pinched nerve in my neck.
Bob (ragarm) Morley

During the initial treatment for elbow pain;strech and strengthen therapy should be avioded.Such initial therapy wil only cause greater pain and damage by the act of pulling apart muscle and tendon that are in severe contraction(spazm)..Effective treatment would involve a resetting of the supinator,tricep,and extensor muscles.melvinmapp.com

Pain and weakness may be reported in the biceps as well as the olecranon process of the ulna near a triceps tendon.Treatment is hyperextension of elbow with fine tuning of adduction or abduction.There are other other rare elbow problems.Since movements are gross,it is relatively easy to fumble your way to a succesful treatment.melvinmapp.com

How funny that I'm sitting reading my Newsweek with ice on my golfer's elbow when I turn the page to see your article. I had to laugh. It's amazing how much of my day, and apparently your's too, is consumed with trying to figure out how NOT to use my right arm. An impossible task. Gotta quit typing now.

I agree with Dr Sevier on this. This is a relatively easy condition to treat using the ASTYM treatment, as long as it's provided by a physical therapist who knows what they're doing. It's a shame Mr Noonan's physician didn't think of physical therapy first, but that's also very common in our culture: pills, injections, and surgery are all desired because the patient can be a passive recipient of treatment. Physical therapy might actually require the patient EXERCISE to treat something!

David, agree with earlier posts about immobilization and, then, stretching. The only success I've had treating your condition is persuading patients to wear a sling. If you don't do this you will continue to use your hand no matter how hard you try not to. Though it may have taken something significant to start this process in your more vulnerable older tendon, all it takes to keep it going is opening a door a few times a day. That is the part that most patients have trouble accepting. A sling is a huge inconvenience, but you can brush your teeth, albeit poorly, with your left hand; you can type with one hand; you can drive a stick shift with one hand. A sling has the added benefit of others accommodating your limitations, especially if this is doctor's orders. You might even get some sympathy from passers-by. You'll have to decide if the trade-off of serious inconvenience vs. your pain is worth it to you. I suspect this will depend on how convinced your are that this will work. I think we'd agree that you won't have this pain at this intensity 5 years from now -- because you will limit the use of your wrist/forearm until you fell better. I'm suggesting pursuing that inevitable route in an accelerated fashion. Hell, you'll probably get your best essay ever out of the experience. I don't see an advantage to stretching while you're still experiencing pain unless you're going to continue to use your wrist/forearm, so that when you do so, it won't put as much strain on the epicondyle. However, I suggest you pursue those methods once your pain is gone as part of a prevention program. Remember, anything you do that causes pain is prolonging your recovery. Also, if not already done, I would begin with prednisone 10 mg, 2 each am for 1 week, then 1 each am for 10 days. This is a perfectly safe and very potent anti-infalmmatory dose. 40 mg is much more likely to cause CNS side-effects and is not worth the limited additional effect. 10 mg is too low. Don't use pre-set dose pacs, just get 34 10 mg pills. You could repeat this a couple weeks later if necessary. This should be done along with the sling, not as a substitute. It's just jump-starting the process, as a doctor might agree to jump-start a wt. loss program with an anorexant if convinced the patient is embarking on a serious, structured dietary program. Good Luck!

This reminds me of my first Heberden's node. I was wimpering about it and showed a nurse friend the bump on my finger. Her TLC response was to thrust her hands at me, showing me the bumps on most of her fingers and say, "Live with it." There is a strange fascination in watching our bodies erode despite our best efforts to stay young forever.

I'm sorry your doctor did not recommend any complimentary care options; massage therapy, physical therapy, acupuncture, or countless other modalities many people use to find relief from their pain. Your office visit mirrors many people who are lost in the void when surgery isn't the answer. You don't have to live in pain. Here are some resources for you to find a qualified practitioner in your area. National Certification Board for Therapeutic Massage and Bodywork-www.ncbtmb.org, Associated Bodywork & Massage Professionals-www.massagetherapy.com, or American Massage Therapy Association-www.amtamassage.org

Tendinitis and other tendon disorders are persistent problems that have plagued countless people. Tendon disorders have caused considerable pain and functional limitation across the population. I am a research physician, and one of the topics I am often asked to speak upon is treatments for tendon disorders. Recent research has shown that chronic tendon disorders are probably not due to inflammation as originally thought, but are likely a result of tendon degeneration. Traditional remedies for tendon disorders are usually aimed at reducing inflammation. Perhaps that is why no reliable, consistent solution has been available in past years. However, as a result of scientific and clinical research, a physical therapy treatment is now available to effectively treat many tendonitis/tendonosis disorders by stimulating regeneration of degenerated tendons. The therapy is known as ASTYM treatment, and physical therapy providers may be located at astym.com under ???Locate a Provider???. I was fortunate to be involved in some of this research and now I am medical director of the institution that trains and certifies clinicians in ASTYM treatment. You should consider looking up a certified provider at astym.com, and getting this kind of therapy ??? it could really help your elbow.


Thomas L. Sevier, MD, FACSM