Common Problems of the Wrist, Hand, and Elbow


Tennis elbow
and its cousin, golfer’s elbow are common conditions that effect the elbows of active, middle-aged individuals. The technical names are lateral and medial epicondylitis. In lateral epicondylitis, there is activity related pain in the outer part of the elbow. In medial epicondylitis the pain is on the inner side of the elbow. Both conditions are brought on or flared up by repetitive gripping. In spite of the popular name, most cases occur in people who do not play either tennis or golf.

The main muscles that we use to flex and extend the fingers and wrist are divided into two groups. The flexors make the fingers and wrist bend while the extensors straighten them. Using short stretches of tendon, both groups of muscle are anchored to specific points on the end of the arm bone (humerus). The flexors attach to a bump on the inner side called the medial epicondyle and the extensors attach to a bump on the outer side called the lateral epicondyle. With epicondylitis, the tiny fibers (collagen) that make up the substance of the anchoring tendons start to break down or degenerate. When this occurs, it becomes painful to use the affected muscles because it pulls on the damaged tendon.

The most import thing to remember about epicondylitis is that the vast majority of cases go away on their own regardless of treatment. Although it can take an average of one to two years, gradual return to normal, painless function is the rule. Treatment is mostly directed at keeping individuals comfortable while waiting for the condition to run its course.

For mild cases of epicondylitis, simply cutting back on activities that require firm grip or heavy lifting may keep things under control. Therapy is often considered when activity modification is not working. It usually involves gentle stretching and strengthening exercises to encourage tendon healing. An elbow brace (sometimes called a counterforce brace) may make activity more comfortable by altering the direct pull on the affected tendon.

If the condition is not responding to the usual conservative measures, steroid (cortisone) injections are occasionally used to address the pain. Although studies have shown that steroids do not promote healing, they can temporarily reduce pain to make daily activity more manageable.

In a small minority of cases, when all the conservative measures have failed, surgery may be considered. Several techniques have been used, but most are directed at removal of the degenerated tissue to stimulate a healing response from the surrounding tissue.