Nonoperative Treatment

Almost all cases of epicondylitis initially should be managed nonoperatively. Exceptions may be made for elite or upper-level athletes who have acute ruptures. With appropriate nonoperative treatment, a success rate of more than 90% can be expected. A combination of patient education, anti-inflammatory agents, orthoses, and physical therapy exercises and modalities can be used. Most importantly, the patient must avoid provocative activities. The patient should be counseled regarding the expected course and duration of the disorder. Primarily, the goal of treatment is relief of pain. For mild or moderate symptoms, treatment includes rest, ice, and anti-inflammatory medications. A counterforce brace or wrist extension splint may be added at the physician's discretion. If pain is severe or symptoms persist after 3 months of appropriate treatment, then a corticosteroid injection is recommended. Subcutaneous deposition of the injection must be avoided to prevent hypopigmentation (Fig. 6.1) and fat atrophy. An increase in pain is expected after the injection, but should resolve by 8 to 12 hours. The patient should be counseled appropriately.

Improved throwing mechanics and endurance exercises are stressed for throwers. The importance of a proper warm-up and stretching cannot be overemphasized. For tennis players, alterations in grip size, racquet weight, and string tension are significant for the treatment and prevention of lateral epicondylitis.

Once pain and tenderness have been reduced, a regimented physical therapy program is initiated. As part of the program, the patient begins muscle stretching and gradual strengthening exercises. Counterforce bracing (Fig. 6.2) is employed during rehabilitation. A combination of isotonic and isometric exercises is used. Initially, the patient's opposite hand should provide resistance. As strength increases, a program involving dumbbell weights in 1-lb increments can be implemented. Repetitions are increased as the patient can tolerate them. If pain returns at any time, a return to a lower level of exercise is indicated. If pain persists despite the decreased activity level,

FIGURE 6.1. After an injection of the elbow for tendinopa-thy, subcutaneous deposition of the steroid can cause hypopigmentation of the skin in the area.
FIGURE 6.2. Counterforce bracing is used as an adjunct to rest and rehabilitation in treating tendinosis of the elbow.

the physician should consider administering another cor-ticosteroid injection. Therapeutic modalities are added at the physician's discretion.

Cure Tennis Elbow Without Surgery

Cure Tennis Elbow Without Surgery

Everything you wanted to know about. How To Cure Tennis Elbow. Are you an athlete who suffers from tennis elbow? Contrary to popular opinion, most people who suffer from tennis elbow do not even play tennis. They get this condition, which is a torn tendon in the elbow, from the strain of using the same motions with the arm, repeatedly. If you have tennis elbow, you understand how the pain can disrupt your day.

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