May 11, 2006

Q: This spring, for the first time in my life, I started playing tennis and find I cannot get enough of it. My problem is my elbow. It hurts. I guess it must be tennis elbow. Just what is that, and how do I fix it?

A: Let the hurting arm dangle to your side and reach around with your other hand to feel for the bony protuberance on the outside of the elbow. If that’s where you hurt, you most likely have tennis elbow. It’s the place of attachment of many tendons of the forearm muscles –– the ones that control wrist and hand movement and permit a person to grip a tennis racket firmly. Inflammation of those tendons is tennis elbow.

Almost always the inflammation comes from overuse. Tennis elbow is not the sole province of tennis players. It happens to all who constantly use their forearm muscles. Carpenters are prone to it. Even people who grasp a computer mouse for long periods can come down with it.

Rest is, of course, the most important aspect of treatment. Rest doesn’t mean immobilisation of the arm, wrist and hand. It means not making any painful movements. Initially icing the elbow minimises inflammation. You are at the stage when heat is appropriate. Warm, wet compresses applied for 10 to 15 minutes to the elbow three times a day will reduce swelling and pain. Anti-inflammatory medicines like ibuprofen are always suggested to those who can take them. If these conservative measures don’t bring relief, injection of steroids into the tissues surrounding the tendons helps. A newer treatment is application of sound waves –– extracorporeal shock-wave therapy. The waves increase blood flow to the injured tendons and hasten healing. They also break up any harmful scar tissue that has formed. The treatment is expensive, and not everyone shouts its praises.

Once the pain has gone, you have to begin a programme of strengthening the forearm muscles. A forearm counter-force brace, found in most sporting-goods stores, is a worthwhile investment as a measure to prevent a recurrence. Use a racket with a midsized head and made of lightweight material.

Q: I am right-handed and have developed pain in the outer part of my left wrist. I think it came from golfing. I find it impossible to swing a golf club because my wrist hurts so bad. It’s been three weeks since I have played, and the pain is the same. What could this be?

A: It could be a number of things, such as tendon inflammation or pressure on a nerve. I am going to suggest something to motivate you to see a doctor about this. Pain that doesn’t get better with three weeks of rest calls for serious investigation.

You might have a fracture of the hamate bone. The hamate is one of the eight wrist bones, and it’s located on the little-finger side of the wrist. It has a hooklike projection that can break away from the main body of the bone. Such an injury is not an uncommon golf injury. Right-handed golfers get it in the left hand, and vice versa for left-handed golfers.

This kind of fracture is often difficult to see on an ordinary X-ray, so special views of the wrist have to be taken when it is suspected.

Usually a cast is applied to assure healing.

In a few cases, the hook fails to unite with the main bone, and surgery becomes necessary. I don’t know if this is what you have. I want to get you moving, however. You shouldn’t let an injury hurt for so long without finding the cause.

Q: Eight years ago, when I was 63, I bought a strength training book that contains a table listing the goals of exercise that should be attained at particular ages. I have exceeded the uppermost category for my age. Should I continue with the same weight, or should I reduce the weight to correspond more to the table?

A: You can safely use any weight that you can lift eight to 12 times in a row without unduly straining.


Dr Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write to him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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