Wrist & Elbow Pain

The most common elbow condition is called tennis elbow or lateral epicondylitis.  In tennis elbow, the point in the elbow area where the outer part of the shoulder bone is attached to the tendons becomes irritated. A group of muscles that flex the wrist toward the top of the hand is attached to this area.

The tendons in the elbow develop degeneration as we age,  in the same way as other tendons. Continuous repetitions and overuse, such as hitting tennis balls or excessive computer mouse usage can lead to tiny tears in the forearm tendon attachment at the elbow. Over half of these injuries are caused by direct trauma,  blows to the epicondyle, a sudden forceful pull, or forceful extension.

The pain may begin if an untrained person has repeatedly performed motions that require a lot of strength or in connection with overexertion. Typically this pain feels on the outside of the elbow, initially during exertion but later continuously and even at night. If the stress causing the irritation continues, the problem becomes worse.

There may be pain when lifting or extending arm. There is usually also pain during heavier exercises like lifting weights or throwing. Other symptoms include stiffness and a weak and painful grip.

Diagnosis is made by typical clinical signs, symptoms and findings. Often no further tests or imaging are needed, and treatment can be started immediately, though x-rays, ultrasound, MRI or ENMG may be used to exclude other possible causes for the pain.

To reduce pain, anti-inflammatory drugs and ointments and cold compresses are often used as treatment. The following stretching exercise after cold compresses is recommended: bend your elbow and hold the wrist bent towards the top of the hand with your other hand. Straighten the elbow while holding the wrist bent with the other hand, which helps stretch the muscles that attach to the elbow. Hold the hand in this position for 20-30 seconds. Repeat the exercise several times a day.

A wrist splint can be used at the time of acute pain to prevent repeated wrist motion. This reduces the irritation at the point where the muscles attach to the elbow. A tennis elbow support may be useful later in an attempt to reduce stress at the muscle attachment site.

Work or hobbies that require repeated squeezing of the hand should be avoided. If you have been using a mouse with the sore arm, learn to use it with the other one.

Those working at computers should take short breaks several times a day. The sore arm can be lifted up, all muscles contracted and then relaxed. Shake the arm after the exercise. Make sure that there is enough space in front of your keyboard to place your hands. Try a wrist support and learn to rest your hands on it while you type.

A cortisone injection given by a doctor or physical therapy may be necessary if medication and other treatments do not alleviate the situation.

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