Hello and welcome. My name is Doctor J. Michael
Bennett. I’m an Orthopedic Sports Medicine Physician. I specialize in
injuries of the shoulder, elbow, and knee. Welcome to the Whiteboard Series.
Today, we’re going to talk a little bit about lateral and medial epicondylitis,
also known as tennis elbow and golfer’s elbow. I just want to go
over what exactly it is and the appropriate way to use a counter-force brace
or the type of brace that you would need for any of those tendinitis. So, basically tennis elbow and golfer’s elbow
occurs from repetitive use of the wrist or the elbow. If you’re looking
at an elbow, right here, the bony anatomy, the lateral side, which is the outside
area; this is where the common extensors that lift the wrist insert
right here at the bone. So the muscles come up and insert right here to the
lateral epicondyle. The medial side, which is the inside of the elbow; the
flexors which allow you to flex the wrist insert right here at the medial
bone. So what happens is with repetitive, forceful
activities you irritate both of those insertion sites. Depending on your
swing and what type of sport you’re playing is going to determine whether
or not you’re going to have a medial epicondylitis on the inside or lateral
epicondylitis on the outside. It’s usually due to repetitive, forceful flexing
or repetitive forceful extension. I’ve seen medial epicondylitis or golfer’s
elbow in tennis players as well usually if they’re going through with a fore-hand.
We’ll see more tennis elbow when they’re going through with the
back-hands. So, that’s using more extensors and when they’re going with the
fore-hand that’s using more flexors. Golfers, typically in their swing,
when they’re coming through they’re flexing their wrists sometimes and
that irritates this inside aspect of the elbow. When it does become irritated,
you get an inflammation. If it’s a long period of time,
if it’s chronic, sometimes you can even get partial tears of this tendon. Many people have partial tears of this tendon
and nine times out of ten this can be treated conservatively with conservative
measures and non- operative measures. One of those measures
is to use appropriate bracing and the brace that we typically would recommend
for these type of tendonitis’s is a counter-force brace. This is a counter-force brace. All that this
is, is a circumferential brace made of neoprene that actually gives you a
little bit of tension across the irritated area. The way you use a counter-force
brace is you find the area that’s painful, if it’s the outside of the
elbow or the inside of the elbow. Approximately one thumbs breadth below
where it hurts you’re going to slide the brace. You’re going to slide
it all the way up one finger breadth or one thumbs’ breadth below where
it’s irritated and then you’re going to wear it snuggly. You use this throughout the day, during your
regular activities. Use it for a couple of weeks to see if you have an improvement
in your symptoms. If it does help then that may be all you need to
do; in addition to maybe taking an anti-inflammatory. Now one thing that’s key is make sure you
don’t have this too tight. If you have it too tight where you actually feel
numbness or tingling in your hands or you see some discoloration that means
it’s too tight and you want to loosen it up a little bit. This is supposed
to be comfortable. Just be aware of what you’re doing repetitively during
the day; make sure you’re not repetitively using that wrist, or lifting
that wrist, or flexing that wrist. Occasionally, you may want to pick up a wrist
splint as well. That also helps immobilize the wrist and keeps you from
using that wrist over and over again and irritating either side of those
tendons. If you fail conservative measures, then definitely, I
would highly recommend that you be evaluated by an orthopedic specialist;
preferably someone who specializes in shoulders, elbows, and knees
and has experience in dealing with this type of problem. The good news is that this is a very common
problem and most general orthopedists are familiar with treating this
type of pathology. So, if you have any further questions, feel free to visit
my web site at orthopedicsportsdoctor.com or jmichaelbennett.com
as well. Thank you very much for this session of the white board series.

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Dennis Veasley

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