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Ask Dr. Rick – April 2011

April 6, 2011

Lateral Tennis Elbow

Lateral tennis elbow, or lateral epicondylitis as it is medically known, is a process that is one of the most common causes of elbow pain. It is believed to be caused by overuse, and most commonly, it is the dominant arm that is affected. One can develop tennis elbow and have pain with the extension or lifting at the wrist and rotation of the forearm. Normally, people who have tennis elbow are not tennis players, and it can be seen in cases where repetitive stress is used to the arm or forearm. Tennis elbow is commonly found in people who frequently use heavy tools, who often use hand-held tools or who initiate rotational stress to the forearm from repetitive actions such as opening a jar. The pain is normally over the outside part of the elbow where there is a large bump called the lateral epicondyle, and when the elbow is used, it is extremely painful.

Lateral tennis elbow is a degenerative process in the lateral epicondyle, and normally occurs in patients who are 40 to 60 years old. It can occur at any age, and it can occur at any time; it commonly occurs with activities not associated with any type of sports including carrying a briefcase, lifting, pushing, pulling or rotating the forearm. It is frequently caused by stress to the wrist and forearm than to the elbow itself.

Treatment for classic lateral epicondylitis includes physical therapy. This is the first order of business, along with rest and the use of anti-inflammatories. Early stretching, strengthening and ice, as well as decreasing the stress to the elbow, will minimize the inflammation of the lateral epicondyle. Once the inflammation is decreased, decentric muscle strength, mainly strengthening the forearms and wrist extensors, decreases stress on the insertion of these structures into the lateral elbow. A tennis elbow brace or a resistance brace can be used to decrease the stress on the structures that insert into the outside part of the elbow.

If stretching and strengthening are not effective, the next line of treatment in the past might have been a cortisone injection. My recommendation at this time is to avoid all cortisone injections, and my recommendation would be to instead inject one platelet-rich plasma injection, which can decrease and stop the inflammation in the lateral aspect of the elbow. Another conservative treatment is extracorporeal shock wave therapy, which has been used to treat tendinopathy or inflammation in the Achilles tendon and the lateral or outside aspect of the elbow.

If these treatments fail, surgery is generally recommended, as it is with about five-percent of tennis elbow cases with most patients being treated conservatively with resolution of the pain. Arthroscopic tennis elbow release is very effective with postoperative rehabilitation.

Ask Dr. Rick

“Dear Dr. Rick, I have a young daughter who is a gymnast and who has been having pain in her foot, which started about a month ago. The pain is in the top part of her foot near her second toe. Do you have any thoughts?”
– Allison S., Clayton, MO.


Allison, foot pain in gymnasts is extremely common and considerations would include a stress fracture in the toe or a loss of blood supply in the area of the growth plate near the second toe. Normally, these areas need to be x-rayed, and the general treatment is decreasing stress on the toe in terms of her gymnastics.She can strengthen and condition, but actual loading of the forefoot and midfoot should be limited. Thank you very much for your question.

“Dear Dr. Rick, I have been told that Acai-berry supplements acting as antioxidants can help me decrease body fat. This seems somewhat odd. Can you please straighten me out?”
– Karen M., Wentzville, MO.


Karen, there are many claims made on supplements and other modalities to help lose weight, improving conditioning, etc. Although the Acai berry is a strong antioxidant, it has no benefit in weight loss and no benefit in decreasing abdominal fat. As with most of the claims made in these supplements, medically, you need to be very careful and try to research these claims to see if they are true. Most of the claims that are made seem to be a stretch and are not clinically-based. I thank you for your question. I believe we all need to be more careful in believing everything we hear.

Pearl for the Month of April: Before you head outside for your spring yard work, limber up. Yard chores may seem easy, but they involve muscles you probably haven’t used in a while.

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