What To Do When Weightlifting Gives You Tennis Elbow

Working out with weights is a great way to tone and strengthen your muscles. But for some, these activities can bring on the dreaded diagnosis of tennis elbow, or lateral epicondylitis. Whether you are a novice or a diehard, here are a few suggestions that can help prevent the condition from getting worse so you get back to your routine sooner.

1. Recognize the Signs of Tennis Elbow:  Tennis elbow is an injury to the tendon that attaches your wrist muscles to the elbow. Pain occurs on the outside of the elbow, with point tenderness over the small bony protrusion, called the lateral epicondyle. Often, pain radiates down into the forearm muscles. Numbness and tingling do not occur with tennis elbow.
2. Respect the Pain: Because tennis elbow is an overuse injury, you should NOT work through the pain. The condition is caused by small tears in the tendon. Ignoring the pain and continuing your routine can make the condition worse, resulting in longer healing times. It's best to rest your elbow for a few days. You can still head to the gym, just focus on cardio and your lower body.
3. Use Cold Packs: If you notice the signs of tennis elbow during or after your workout, place a gel cold pack in a pillowcase and put it on your elbow for about
   10 minutes. Repeat this several times a day over the next three days and then intermittently as needed to decrease pain.
4. Stretch the Forearm Muscles: Gentle stretching is important in any exercise routine but many people don't think of stretching their forearm muscles. These muscles are active whenever you use your hand, so make sure to incorporate the following stretch into your daily life. Start with your right arm in front of you, with the shoulder at a 90 degree angle and your palm facing down. Place your left hand on top of your right hand and gently stretch your right wrist down towards the floor. If you don't feel a stretch in your forearm, try making a light fist. If you still don't feel a stretch, rotate your arm so that the palm is away from you and bring your arm down across your body (towards your left knee). Do two to three repetitions, holding for 20-30 seconds. Repeat on the left arm. To learn more specific exercises to treat tennis elbow, check out Treat Yourself Therapy for a four-phased program at www.TreatYourselfTherapy.com/tennis-elbow.

If you try these steps as soon as the symptoms start, you should be able to slowly return to your workout within a couple of weeks. You'll know you're ready if you are pain-free at rest and with light activity. Stay tuned for Hitting the Gym with Tennis Elbow, which provides specific tips to decrease the strain on your elbow during your gym workout.

Treat Yourself Therapy, LLC provides innovative and inexpensive do-it-yourself videos for people unable to attend hand therapy. These videos were developed by Jessica Karge, OTR, CHT and Kathleen Papi-Baker, OTR,CHT, both certified hand therapists who have over 40 years of combined clinical experience. To learn more, visit www.TreatYourselfTherapy.com.

What types of arthritis affect the hands?

You may think that “arthritis is arthritis,” and that it all affects the joints in the same way.  The truth is, there are several types of arthritis and how they present themselves in the hand is very different. 

The most common type of arthritis is osteoarthritis.  It results from wearing of the cartilage on the joint surfaces.  It is usually slow in its progression, with the first signs being soreness at the joint.  As it progresses, it can become more painful.  Over time, the cartilage can wear down, eventually leading to a joint with bone rubbing on bone.  The joints in the hand most prone to osteoarthritis are the base of the thumb and the small joints in the fingers.  Nodules at these small joints, called Heberden’s nodes, are the result of osteoarthritis. Treat Yourself Therapy’s video for Thumb Arthritis is a treatment program designed for osteoarthritis of the thumb. It contains specific exercises and education to decrease pain and improve flexibility while saving you time and money.

Rheumatoid arthritis (RA) is another type of arthritis that affects the hands. RA is a systemic condition involving many organs in the body.  It usually affects both hands symmetrically, and the joints most involved are the large knuckles.  An overproduction of the lubricating fluid around the joints, called synovial fluid, is the mechanism that affects the joints.  When the condition is in its active state, the joints feel warm and become swollen, stiff, and painful. 

Gouty arthritis can also affect the hands, although it is more commonly seen in the feet.  Gout is caused by too much uric acid in the blood, which can develop into hard crystals in the joints.  It usually has a sudden onset, resulting in burning pain, swelling, and stiffness.

Ten to thirty percent of people with psoriasis, a skin condition, develop psoriatic arthritis.  It can affect many joints of the body and is characterized by pain, swelling, and morning stiffness. In the hand, the joints most frequently involved are the small end joints of the fingers.

There are treatments and medications for all types of arthritis that help make the condition more comfortable.  Consult your physician if you suffer from arthritis to ensure that you are properly diagnosed and receive the care appropriate for your specific condition.

Treat Yourself Therapy, LLC provides innovative and inexpensive do-it-yourself videos for people unable to attend hand therapy. These videos were developed by Jessica Karge, OTR, CHT and Kathleen Papi-Baker, OTR,CHT, both certified hand therapists who have over 40 years of combined clinical experience. To learn more, visit www.TreatYourselfTherapy.com.

What Tests Help with Diagnosing Carpal Tunnel Syndrome?

If you have pain, pins and needles, numbness, or muscle weakness in your arm, your doctor may refer you to a neurologist. Think of a neurologist as a nerve specialist. These physicians are trained to perform and interpret tests that look at individual nerves for signs of damage. Why are these tests important? With nerve injuries, the location of the symptoms may not be the location of the damage. For instance, the nerves in your arms emerge from your spinal cord at the level of your neck, called the cervical region. So if you experience symptoms in your hand or forearm, the damage could be in your hand or forearm but it also could be coming from your neck. These tests are invaluable in determining where the damage is occurring to make sure you receive the correct diagnosis. This is especially important if surgery is being considered.

Dr. S.M. Zimmerman, a private practice neurologist in the state of Utah, suggests thinking of nerves like electrical wires. The wire is the axon and the outer covering, is the myelin sheath. If only the outer covering is damaged, it can be expected to heal easily. But if the axon itself is damaged, healing can be slower and less certain.
A nerve conduction study helps to determine the pattern of a nerve injury. "The severity of the symptoms a person is experiencing usually correlates with the severity of damage shown on a nerve conduction study and EMG, but not always. Occasionally a person has classic symptoms but normal nerve conduction studies."

A nerve conduction study looks at both the nerves that make your muscles work and the nerves that provide sensation. The test measures how fast the nerve sends a signal from one point to another, called the conduction velocity. This determines if there's damage in the myelin sheath, or outer covering of the nerve. It also measures how big the response is, which tests the axon of the nerve. If the axon is damaged, it can still heal but it won't do as well as if only the sheath was damaged, explains Dr. Zimmerman.

Dr. Zimmerman explains that  during an electromyogram, or EMG, an acupuncture-like needle is placed in a muscle to act like an amplifier. The neurologist is trained to recognize subtle differences in the sound, as well as in the amplitude of the muscle response to determine if the damage is still occurring. If the damage is no longer occurring, the test indicates how recently it had occurred. The muscles are tested at rest and during an active contraction to look at recruitment. This information tells how much damage is going on in the specific muscle that is tested.

If you have numbness and tingling in your hand or forearm, be sure to see your doctor. Early detection of syndromes like carpal tunnel and cubital tunnel is important to prevent progression of symptoms. If your nerve conduction study and EMG suggest moderate to severe damage, you can expect a referral to a surgeon to further discuss your options. If, on the other hand, the injury is mild to moderate, conservative treatments like occupational therapy, splinting, or anti-inflammatory medications may be recommended. Treat Yourself Therapy has a self-treatment video on carpal tunnel syndrome that includes helpful hints to manage symptoms, how to find the right brace or splint, and appropriate exercises to manage the condition. To learn more, visit www.TreatYourselfTherapy.com/carpal-tunnel.

Treat Yourself Therapy, LLC provides innovative and inexpensive do-it-yourself videos for people unable to attend hand therapy. These videos were developed by Jessica Karge, OTR, CHT and Kathleen Papi-Baker, OTR,CHT, both certified hand therapists who have over 40 years of combined clinical experience. To learn more, visit www.TreatYourselfTherapy.com.

Seeing the Doctor for Tennis Elbow

Written by Kathleen Papi-Baker, OTR, CHT and Jessica Karge, OTR, CHT

First of all, you may wonder what kind of doctor you should see? Since tennis elbow is a fairly common condition, your family practice physician should be able to make the diagnosis. They will do a little poking and prodding to rule out a joint or nerve problem, and rule in tennis elbow. They will do some provocative testing, such as asking you to hold your wrist straight, while the doctor tries to flex your wrist. This typically produces pain at the outside of the elbow when you have tennis elbow.
Once the diagnosis is made, a variety of options may be presented to you. The following list is a options your doctor may suggest.
*Physical or hand therapy may be suggested if your symptoms are not chronic. You will learn about tennis elbow, and be taught specific stretches, and exercises. Of course Treat Yourself Therapy's Tennis Elbow video is an option here!
*Cortisone injection around the affected tendon. Cortisone is an anti-inflammatory hormone that relieves pain in the short run, typically yielding relief up to 4 – 6 weeks.
*Dry needling, or percutaneous needle tenotomy, which involves poking the tendon/bone unit with a needle to create an irritation, which creates an environment for healing to occur. This can be done in combination with a cortisone injection.
*Prolotherapy is similar to dry needling, however, in addition an irritant is injected into the tendon to create an inflammatory reaction, with the goal of stimulating a healing response.
The next two options are called biologics. These procedures, as explained by Dr. Joseph Albano, a musculoskeletal specialist in Salt Lake City, involve using the body's own tissues to aid in the healing process, and are appropriate for more chronic conditions. Dr. Albano first uses diagnostic musculoskeletal ultrasound to identify the extent of the damaged tissue. This ultrasound shows more detail in lateral epicondylitis than an MRI, being able to detect the thickening of the tendon, and they are less expensive. It is a dynamic diagnostic tool in that it can show the tendons and muscles while they are moving.
*Platelet Rich Plasma, referred to as PRP, is a procedure that involves spinning the patient's own drawn blood to obtain a higher concentration of platelets. These platelets contain tendon healing growth factors. Using ultrasound as a guide, the platelets are injected into the damaged area to facilitate healing.
*Augologous blood injections involve the patient's drawn blood being injected back into the damaged area without platelet separation.
*Focus aspiration of scar tissue, or FAST, is a procedure that uses ultrasonic energy to break up and remove damaged tissue after the tissue is first identified with diagnostic musculoskeletal ultrasound.
Surgery for lateral epicondylitis may be an option for some who do not respond to conservative treatment, and/or may show a tendon tear after diagnostic testing. In this surgery, the damaged part of the tendon is removed.
There are a lot of options available today for people with tennis elbow. Be an informed consumer, and be familiar with what is available before you make any decision regarding your care. Be sure to see a physician experienced in the procedures you are considering.

Treat Yourself Therapy, LLC provides innovative and inexpensive do-it-yourself videos for people unable to attend hand therapy. These videos were developed by Jessica Karge, OTR, CHT and Kathleen Papi-Baker, OTR,CHT, both certified hand therapists who have over 40 years of combined clinical experience. To learn more, visit www.TreatYourselfTherapy.com.

Pregnancy and Carpal Tunnel Syndrome

For many women, sporting a baby bump comes with an unexpected surprise—symptoms of carpal tunnel syndrome! A recent article has estimated that up to 60% of pregnant women get carpal tunnel syndrome, which is compression of a nerve where it lies in a small tunnel, at the level of the wrist. It's usually diagnosed in the third trimester.

So the first question is, "Why is this happening?" Well with pregnancy, hormonal changes may be a contributor but more likely it's due to an overall increase in fluid volume. Since the carpal tunnel is normally a tight space, the extra fluid constricts the contents of the tunnel even more, placing pressure on the median nerve. Gestational diabetes can also play a role by slowing the speed at which the nerve transmits signals. The symptoms that result are pain in the wrist or hand and pins and needles sensations, particularly in the thumb and first three fingers.

So the second question is "What can be done about it?" Dr. S.M. Zimmerman, a private practice neurologist in Salt Lake City, Utah, says that most cases resolve between the fourth and sixth weeks after delivery, when most of the residual swelling has dissipated. In the meantime, she recommends splinting to her patients, especially while sleeping. The proper splint for carpal tunnel syndrome should keep the wrist in a straight position while allowing you to move your fingers and thumb. The splint or brace should extend approximately two-thirds up the length of your forearm. Using a flexible gel cold pack can also help to decrease the pain associated with carpal tunnel syndrome. Place the cold pack in a pillowcase to protect your skin. Wrap it around your wrist and hand for 8-10 minutes. This can be done several times a day.

"If it persists longer than one or two months after the baby is born," Dr. Zimmerman says "it may be because it has become a        mechanical problem." The hands and arms of new moms get quite a workout, from lifting the newborn to diaper and clothing changes. When combined with the pressure placed on the nerve from the increased swelling during pregnancy, the new heavier workload and awkward wrist positions when holding the baby can keep the cycle going. She suggests discussing your options with your doctor at this point. A nerve conduction study, which is highly sensitive in detecting carpal tunnel syndrome, and an electromyography test is the likely next step in evaluating the problem. Further treatment decisions can be made based on the results of these two tests. Since many cases of pregnancy related carpal tunnel syndrome respond to conservative treatment, Treat Yourself Therapy's video provides the education and exercises necessary to decrease symptoms and manage pain. It also includes suggestions to prevent progression of the condition. To learn more visit, www.TreatYourselfTherapy.com/carpal-tunnel.

Pregnancy photo courtesy of Delatte Photography.

Treat Yourself Therapy, LLC provides innovative and inexpensive do-it-yourself videos for people unable to attend hand therapy. These videos were developed by Jessica Karge, OTR, CHT and Kathleen Papi-Baker, OTR,CHT, both certified hand therapists who have over 40 years of combined clinical experience. To learn more, visit www.TreatYourselfTherapy.com/carpal-tunnel.

Healthy Gardening

Here is some special information for our customers who feel the call of the great outdoors when spring arrives!  No matter how green your thumb, gardening is a physically demanding activity that can take its toll on you if you're not prepared.  Think of it as a sport, you need to prepare and condition yourself.

First, some general tips.... Don't be a weekend warrior!  Pace yourself, and start  back slow.  You wouldn't start out running a 10 K if you haven't run all winter.  The same is true with gardening.  Vary the activities; raking, weeding, planting, and do them for short periods of time.  Take frequent rest breaks, and listen to your body.
Use good body mechanics when shoveling and raking. These activities are hard on the back because of their rotational characteristics.  Engage the core muscles,  by tightening your stomach, and keep a small bend in the knee.  Make a plan and only do a small area at a time.  If you have a lot of hand weeding, sit on a small stool.  It makes it easier to get up and down.  Weed after a rain storm, or watering.  The soil is softer, and the weeds will come out easier.
Wear gloves, they improve your grip, and prevent blisters.  Use the right tool for the job.  Clipper blades should be sharp, making each squeeze efficient.  If your gardening tools are old, think about investing in some new ones that have padded handles and are more ergonomically designed.

For our Tennis and Golfer's Elbow customers:
Keep your grip light when you're using hand tools.  Remember to keep your elbows bent when using hand tools to lessen the strain to your elbow.  When shoveling, use good body mechanics, distributing the weight into both hands.  Keep your elbows close to your body and generate more power from your legs than arms.  Avoid using hand clippers, their use causes too much resistive, repetitive hand motion, which can aggravate tennis elbow.

Do the Forearm Extensor Stretch and the Forearm Flexor Stretch from Phase 1  of the video before and after gardening.  Use a cold pack on your elbow after gardening if you are feeling any soreness in your elbow.

For our Carpal Tunnel Syndrome customers:
A very aggravating activity for carpal tunnel sufferers is cutting the lawn.  The gripping required coupled with vibration can be irritating for this condition.  The best option is to have someone else do it!  If that's not possible, break the task up into small sections, and take breaks.  Wear biking gloves with padded palms to decrease the vibration.  Use pipe insulation on the lawnmower handle to enlarge the grip and decrease the vibration even more. Keep your grip light on the lawnmower to decrease the force through the carpal tunnel.  If you have a wrist brace, wear it.  It's a good reminder to keep your wrist straight.

For our Thumb Arthritis customers:
I can give you personal, as well as professional advice since I have CMC arthritis in my left thumb.  I love to garden, and this is what I have found helpful.  If you have a soft neoprene brace, wear it when you garden.  I like the Comfort Cool CMC Restriction Splint.  It helps take some of the stress from the base of the thumb by providing light support.

Weeding can be very painful since it requires a strong pinch force.  Try to weed when the ground is soft, after a rain.  Use a hand weeder or shovel to loosen the weeds first, requiring less pinch strength to pull the weed out.  Pace yourself, and only weed for short periods of time, then take a break.

As I mentioned earlier, there are several gardening hand tools on the market that are ergonomically designed to reduce the force on the hand.   The larger, padded handle options feel better on my thumb.   If you're not in the market for new tools, you can pad your own with foam pipe insulation, available at hardware stores.

Happy Gardening!

Treat Yourself Therapy, LLC provides innovative and inexpensive do-it-yourself videos for people unable to attend hand therapy. These videos were developed by Jessica Karge, OTR, CHT and Kathleen Papi-Baker, OTR,CHT, both certified hand therapists who have over 40 years of combined clinical experience. To learn more, visit www.TreatYourselfTherapy.com.

Golfer's Elbow--Or Is It?

A baseball pitcher throws a fastball. After the game, he notices his elbow is sore. He grabs an ice pack, placing it on the inside of his elbow and heads out the door.
A phone salesman wins an award for the most sales in his department. He gets in his car to drive to his favorite restaurant to celebrate, shrugging off the pins and needles sensations in his ring and small fingers and the sharp pain at his inner elbow.
When a golfer makes contact with the ball, he winces from pain in his elbow, causing him to drop the club. He grabs his arm, wondering what could be wrong.
What do all of these situations have in common? They all have pain at their inner elbow. So they all have the same diagnosis, right?
Wrong! Like the rest of your arm, the anatomy in this region is complex and intricate, so many structures can cause pain at the inner elbow. Bend your elbows to a 90 degree angle and place them next to your body. The part touching your sides is the inner, or medial elbow. This article discusses three of the most common causes of elbow pain at this location.
The baseball pitcher is suffering from a medial collateral ligament (MCL) strain, a result of repetitive torque and stress to the elbow during pitching. Small tears and overstretching of the ligament occurs, leading to laxity and instability at the elbow over time. See a physician if you suspect you have this condition. Early treatment should include a throwing analysis by an experienced occupational or physical therapist. They can pinpoint biomechanical problems and offer suggestions to correct technique. If ignored, MCL strains can progress to the point that surgery may be required.

Cubital tunnel syndrome is the likely culprit causing the salesman's symptoms. It occurs when pressure is placed on the ulnar nerve, which is located behind the bony knob on the inner elbow. Remember the last time you hit your funny bone? Well, that pain was the result of you hitting your ulnar nerve, which feels anything but funny! In the early stages, you will feel soreness at the inner elbow and may notice pins and needles in you ring and small fingers. This condition can also progress if ignored, so it's important to make an appointment with your doctor if you have these symptoms. Treatment includes splinting and stretching but focuses on modifying the activities that are aggravating the nerve. Again, ignoring these symptoms for long periods can require a surgery to remove pressure from the nerve.

The golfer does indeed have the characteristic "golfer's elbow," which is caused by inflammation of a tendon at the medial elbow. This tendon attaches the muscles that bend your wrist and fingers to the bony knob at the inner elbow. Seeking treatment in the early stages of this condition is also best because healing times are slower when any tendonitis becomes chronic. Identifying the aggravating activities and learning how to modify them can help to decrease your pain and stop the symptoms from becoming worse. Treat Yourself Therapy has a comprehensive exercise video that includes the education you need to get through your day with less strain on your elbow. It also contains hints on returning to tennis and golf! Learn more at www.TreatYourselfTherapy.com/golfers-elbow. Surgery is rare for this condition, even in chronic stages, but can be a last resort option.
The above examples have shown you that inner elbow pain can be the result of damage to a ligament, a nerve, or a tendon. The take home message is to seek advice from your doctor in the early stages to prevent the condition from becoming worse!