Carpal Tunnel Syndrome – Tennis Elbow

Discussions from our Radio Show:

CALLER: I had a question, I wanted to know how the doctor felt about repetitive stress injury as the result of computer use.

Dr. Darrow: That is a great question, we have found an epidemic of people who are having repetitive use syndromes of their fingers, wrist and elbows, shoulders, sometimes all of that from computer use. We talk about the proper ergonomics about the proper hand placement around different equipment, the proper distance of the chair to the equipment, the type of chair, etc.

In the office, there are people who are on the computer all day long, they do not have a chance. Doing anything repetitively, they are going to get an overuse syndrome. I see people come into the office sometimes with their arm tucked around their abdomen. They are afraid to touch anything with it because they hurt so bad.

One of the greatest things to watch is to do some Prolotherapy into the area and seeing the tissue that has been worn down, regrow,

The thing that is so unique about this is people are always coming in and telling me, I am already inflamed, why do you want to inflame me anymore and make it worse? And Prolotherapy actually does this, it actually re-inflames the area, brings up more inflammation in a very short period of time, usually 24 hours, which will bring more blood supply to the area, and these fibroblasts and chondroblasts that actually help regrow tissue. It is the chronic low level inflammation that hurts and to get over it we have to increase the inflammation a little bit. The body’s natural healing response is inflammation. Prolotherapy has helped so many people with computer overuse syndromes, not just computer over use, we have musicians and athletes who also get overuse syndrome.

Tennis Elbow for the most part is an overuse syndrome, it occurs usually because the backhand is not performed correctly. Which is to keep the elbow more in an extended position, those beginners or players who do not have proper technique down, will bend the elbow when they are ready to hit the ball and then they will straighten it out. This causes quite a bit of overuse strain.

What we do is inject around the elbow and we are actually thickening up the tendon that attaches to the bone. There was a study done before and after Prolotherapy in the ligaments of the low back which showed a 50% growth of the ligament itself and a 200-400% strength growth. So that is what we are doing, growing more tissue, strengthening the area.

My way of thinking is that it is a very invasive technique, even though it is much less evasive than cutting the area open with a knife, but at the same time, you are typically poking two or three holes the size of a pencil into the tissue, and creating an awful lot of destruction by just entering the area. And I was one of the poor unfortunate souls that had arthroscopic surgery on my shoulder when I was in medical school because my boss at the time did it. And my arm blew up like a balloon and it took about a year for that shoulder to calm down enough to get back the level of pain it was at before the surgery. I later learned about Prolotherapy, injected myself in the shoulder and it healed right up.

Now for the pain the caller has the “lateral epicondylitis” or tennis elbow, pain around the outside of the elbow, typically Prolotherapy will take 4-5 sessions to clean that up. Now if you use the computer a lot, and this action caused the pain in the first place, it will cause it again if you are not careful. Find equipment that is ergonomically suited for you.

Please watch Prolotherapy treatments to the elbow performed by Dr. Darrow.

What Causes Golf Injuries?

Researchers writing in the American Journal of Sports Medicine examined what causes golf injuries.

McHardy A, Pollard H, Luo K. One-Year Follow-up Study on Golf Injuries in Australian Amateur Golfers. Am J Sports Med. 2007 Mar 28;

 

BACKGROUND: Considering its popularity, little epidemiologic literature exists on golf injuries.

HYPOTHESIS: The low back is the most common injury location for golf-related injury. Most golf injuries occur as a result of the golf swing, and occur mostly at impact. The variables age, handicap, practice habits, and warm-up habits are associated with injury.

METHODS: A prospective survey over 1 year was used to study golf injuries among 588 golfers at 8 Australian golf clubs. Information collected included golfers’ injuries sustained during the year, location of injury, onset, mechanism of injury, and whether injury occurred during the golf swing or at another time. Additional information was sought on the type of treatment received after injury. Logistic regression was used to examine the epidemiologic patterns of golf-related injury and any possible risk factors for the injury.

RESULTS:
The overall 1-year incidence rate of golf injury was 15.8 injuries per 100 golfers, which equates to a range of 0.36 to 0.60 injuries/1000 hours/person.

Recurrent injuries were most common, while injuries were more likely to occur over time as opposed to an acute onset. The lower back was the most common injury site (18.3%), closely followed by the elbow/forearm (17.2%), foot/ankle (12.9%), and shoulder/upper arm (11.8%).

A total of 46.2% of all injuries were reportedly sustained during the golf swing, and injury was most likely to occur at the point of ball impact (23.7%), followed by the follow-through (21.5%). Multivariate analysis revealed that the amount of game play (odds ratio [OR] =3.73, 95% confidence interval [CI] 1.29-10.75) and the last time clubs were changed (OR =0.32, 95% CI 0.12-0.86) were significantly associated with the risk of golf injury (P <.05). Other factors such as age, gender, handicap, practice habits, and warm-up habits were not significantly associated with golf injury.

CONCLUSIONS: Nearly 16% of Australian amateur golfers may expect to sustain a golf-related injury per year. The injuries in golf are most likely sustained in the lower back region as a result of the golf swing. Based on statistical analysis, only game play and a changing of clubs seem to be significantly associated with risk of injury after adjusting for other risk factors (P <.05). Other factors such as age, gender, handicap, practice habits, and warm-up habits were not significant.

When You Feel Below Par

While playing golf may not be as dangerous as Australian rules football, anyone who’s played the game for any length of time has woken up with aches, pains and strains. It’s a non-contact sport that beats the heck out of you. So, if you want to be able to walk fairways for the rest of your life, you should be aware of potential injuries and how you could prevent and treat them.

First of all, golf is not as sedate as you might think. Dr. Marc Darrow, a Physiatrist (a doctor of physical medicine rehabilitation) at the Darrow Sports & Wellness Institute in West L.A., says, “Surprisingly, golf probably causes more injuries than most sports. Swinging a club at a hundred miles an hour creates great torque (twisting) on your body.”.

This is particularly dangerous for the senior golfer because, as he notes, “collagen, the basic material for ligaments, cartilage and tendons, starts drying out as you get older. Stressing the joints causes strains and tears.”

Dr. James Fox, a senior partner at SCOI (Southern California Orthopedic Institute) in Van Nuys, agrees. “The tissues have lost elastic fibers,” he says, “and don’t stretch. Because they’ve lost some water content, they tend to fragment more easily.”

Okay, the fact that you’re more vulnerable to injury as you get older is not exactly a news bulletin. But, what are the golf injuries that occur most frequently and how can you avoid them?

Dr. Darrow ominously warns, “Golf can affect every joint in your body” while Dr. Fox says, in his experience, “the most common injuries affect the elbow, shoulder, back and knee.” Dr. Jeff Anthony, a sports medicine specialist at San Diego State University, sees “more lower back, elbow and shoulder injuries.” In other words, most of your body is at risk.

While each injury may present unique problems, Dr. Fox classifies injuries into two basic categories. “One, I call the “macro” injury,” he says. “This is the sudden injury, like when you fall into a sand trap. The other is the “micro” injury where repetitive actions add up. The muscle or tendon is constantly stressed, causing little tears. When someone says, `I only hit one drive and my back is killing me,’ it’s usually the result of long-term damage.”

“To prevent the macro injury,” Dr. Fox cautions, “use some planning and forethought. Look out for branches or walk out of the shallow side of the bunker. Sometimes we’re too competitive and take chances.”

To prevent the micro injuries, he says, “Warm up before the round. Stretch. Get in good shape, particularly cardiovascular shape.” And– where have we heard this before?– “Keep your weight down,” he warns. “Every extra pound is multiplied six times across the knee. If you’re ten pounds overweight, that’s an extra 60 pounds per square inch of pressure on the knee.”

Dr. Darrow agrees, “Work out, stay in shape. Don’t be a weekend warrior. That’s how you get hurt.”

If you’re at all not sure what to do, Dr. Anthony advises, “There are several good books available on exercises specific for golf. They show you how to stretch and warm up before playing.”

Stretching is probably the most important and the most overlooked exercise for golfers. Instead of getting to the course late, rushing to change your shoes, hacking away frantically at a bucket of balls, then-dashing-to-the-first-tee …sloooow down, get there 15 minutes earlier and stretch all the muscles. Your back will thank you in the morning.

Some work at home could help prevent one of the most common injuries, “golfer’s elbow.” To prevent this type of injury, strengthen your forearm. While you’re watching TV, just squeeze a tennis ball with your free (non-remote control) hand. Or, better yet, do wrist curls with a light dumbbell.

This strength development may be especially important for women, as Dr. Anthony claims, “Elbow injuries seem to occur more frequently with women golfers; men seem to have more problems with their backs.”

Lessons can have a double benefit– besides cutting strokes from your handicap, they can help you avoid serious injury. As Dr. Fox notes, “If you’re swinging the wrong way a hundred times in four hours, you’ll pay the price. You need good biomechanics.”

Speaking of lessons, if you do have an injury, however minor, however temporary, inform your instructor. Tom Barber, the head professional at Griffith Park Golf Courses, says, “I need to know what physical limitations you have, are there neck problems, back trouble? That goes for everyone, not just seniors.”

Besides giving you a chance to reach the green in regulation on long par-4’s, the new technology of golf clubs also helps limit the possibility for injury. Dr. Fox says, “The forgiveness of clubs today have helped seniors and the high handicapper (avoid injury). They probably have lowered the ratio of injuries to golfers today, although the absolute numbers may have increased because there are more golfers than ever out there.”

One of the reason for this benefit, according to Dr. Darrow, is that “the looser (more flex) shaft takes some of the stress away from the body.”

Even with all these precautions, if you golf often and long enough, injuries are inevitable. What are the best treatments?

“I’m the King of Ice,” claims Dr. Fox. “Icing the damaged area will help with healing.”

To help control the pain and inflammation, Dr. Fox also recommends the use of anti-inflammatories, such as aspirin and ibuprofen.

Once you’ve suffered an injury, you must be concerned about a recurrence. For example, Dr. Anthony says, “I often recommend wearing an elbow sleeve for injuries to that joint. Elbow and shoulder injuries can be trickier than others.”

If injuries are chronic and never seem to disappear completely, there are additional steps you might want to consider. You might ask your physician for a referral for physical therapy. Don’t think that PT is only for the recovery from major traumas, like a broken hip. A lingering strained Achilles tendon or sore shoulder might respond to Ultrasound, specific prescribed exercise and massage. And the longer you wait, the more difficult it may be for a full recovery.

If you’ve never tried acupuncture, it may seem strange and a bit disconcerting, but it’s becoming an increasingly popular form of treatment. Talk to someone who’s tried it; they probably liked it. A tip: some physicians practice the Chinese art of body pin-cushioning which may make the treatment Medicare-eligible.

Dr. Darrow also practices Prolotherapy, which is the injection of a sugar solution into the area of inflammation around tendons and ligaments; this promotes the blood supply to the area and overall healing. In Dr. Darrow’s experience, some patients feel almost-immediate relief from pain.

Basically, there are as many remedies as there are ailments. Not everything works universally; you might have to look in more than one place for relief. But, the bottom line is: living with pain is not a given as you age. There are things you can and should do to prevent injuries and there are things you can do to heal quicker. Get in shape, stretch, ice and you can play golf forever. Not necessarily better, but forever. And that’s good enough for me.

Injury To The Elbow While Lifting Weights

Discussions from our Radio Show:

Question: I was lifting weights a number of months ago and felt a severe pain on the inside of my elbow. It’s getting worse, the pain is right on the bone.

Dr. Darrow: Pain on the medial or inner part (facing the body) of the elbow usually is called “Golfer’s Elbow” as opposed to “Tennis Elbow” which is pain on the outer side of the elbow. It’s called Golfer’s Elbow because golfers tend to flick their wrists a lot and the tendon that holds the muscles to the elbow joint gets worn out or stretched out.

When you do heavy weight lifting you are going to build up your muscles, but the tendons and ligaments that go along with those big muscles, that pull on the joints, don’t build up as quickly. So we have a huge muscle pulling on a “string,” that is these small ligaments and tendons and ripping them, we see this type of injury all the time.

What we do is use Prolotherapy around the elbow. We are trying to strengthen the tendon that attaches to the bone. There was a study done before and after Prolotherapy in the ligaments of the low back which showed a 50% growth of the ligament itself and a 200-400% strength growth. So that is what we are doing, growing more tissue, strengthening the area.

The Culprits of Chronic Elbow Pain

The Annular Ligament:
This ligament connects and stabilizes the two bones of the forearm, the ulna and the radius. Activities that involve rotation of the elbow, such as screwing in a light bulb, turning a screw driver, using a cork screw, puts a tremendous stress on this ligament. It especially includes those activities in sports where throwing is involved, or where an implement is used to drive a ball.

Sometimes the pain in the annular ligament can refer itself down into the thumb, wrist and index and middle fingers, mimicking and sometimes leading to an incorrect diagnosis of carpal tunnel syndrome.

While an acute injury, like a fall, can be responsible for annular ligament injury, it is usually repetitive motion that does it. This type of elbow injury can last for months and is usually diagnosed under the umbrella term “tennis elbow.”

“Golfer’s Elbow” is another umbrella term coined to describe elbow pain when flexing the wrist and hand are required as in activities such as grasping, clutching, and typing. It gets its name “Golfer’s Elbow” because the muscles and tendons required to hit a golf ball are the same ones used in the above named activity.

The ligament involved in Golfer’s elbow is the ulnar collateral ligament (UCL) which holds the ulnar bone of the foreram to the bottom of the the upper arm bone (the humerus.) When this ligament is injured or weakened its pain can be felt on the inside of the elbow.

Once determined that it is weakness or injury to the tendons or ligament that is causing elbow pain, Prolotherapy can be administered and the pain can be resolved.

Elbow Pain

THE QUESTION OF PROLOTHERAPY AND OVERUSE SYNDROME AMONG COMPUTER USERS

Doctor Darrow: That is a great question, we have found an epidemic of people who are having repetitive use syndromes of their fingers, wrist and elbows, shoulders, sometimes all of that from computer use. We always talk about the proper ergonomics about the proper hand placement around different equipment, the proper distance of the chair to the equipment, the type of chair, etc.

In the office, there are people who are on the computer all day long, they do not have a chance. Doing anything repetitively, they are going to get an overuse syndrome. I see patients come into our office (for Prolotherapy) sometimes with their arm tucked around their abdomen. They are afraid to touch anything with it because they hurt so bad.

One of the greatest things to watch is to do some prolotherapy into the area and seeing the tissue that has been worn down, regrow.

The thing that is so unique about this is people are always coming in and telling me, I am already inflamed, why do you want to inflame me anymore and make it worse? And Prolotherapy actually does this, it actually re-inflames the area, brings up more inflammation in a very short period of time, usually 24 hours, which will bring more blood supply to the area, and these fibroblasts and chondroblasts (immune system cells) that actually help regrow tissue. It is the chronic low level inflammation that hurts and to get over it we have to increase the inflammation a little bit. The body’s natural healing response is inflammation. Prolotherapy has helped so many people with computer overuse syndromes, not just computer over use, we have musicians and athletes who also get overuse syndrome.
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TENNIS ELBOW AS AN OVERUSE SYNDROME

Dr. Darrow: Tennis Elbow for the most part is an overuse syndrome, it occurs for the most part because of the backhand is not performed correctly. That is to keep the elbow more in an extended position, those beginners or players who do not have proper technique down, will bend the elbow when they are ready to hit the ball and then they will straighten it out. This causes quite a bit of overuse strain.

What we do is inject around the elbow and we are actually thickening up the tendon that attaches to the bone. There was a study done before and after Prolotherapy in the ligaments of the low back which showed a 50% growth of the ligament itself and a 200-400% strength growth. So that is what we are doing, growing more tissue, strengthening the area.

How would you compare this to Arthroscopic surgery?

Dr. Darrow: My way of thinking is that it is a very invasive technique, even though it is much less evasive than cutting the area open with a knife, but at the same time, you are typically poking two or three holes the size of a pencil into the tissue, and creating an awful lot of destruction by just entering the area. And I was one of the poor unfortunate souls that had arthroscopic surgery on my shoulder when I was in medical school. My arm blew up like a balloon and it took about a year for that shoulder to calm down enough to get back the level of pain it was at before the surgery. I later learned about Prolotherapy, injected myself in the shoulder and it healed right up.

HOW MANY PROLOTHERAPY TREATMENTS FOR COMPUTER OR TENNIS ELBOW OVERUSE?

Dr. Darrow: For the pain the caller has the “lateral epicondylitis” or tennis elbow, pain around the outside of the elbow, typically Prolotherapy will take 4-5 sessions to clean that up. Now if you use the computer a lot, and this action caused the pain in the first place, it will cause it again if you are not careful. Find equipment that is ergonomically suited for you.

Tennis Elbow

Tennis Elbow is a term for severe elbow tendonitis, or an inflammation, soreness, or pain on the outside (lateral) part of the upper arm near the elbow. It’s usually caused by a partial tear in the tendon fibers, which connect muscle to the bone. Symptoms include elbow pain that gradually worsens and radiates outside of the elbow to the forearm and to the back of the hand.

Although, termed “Tennis Elbow”, anyone can experience this painful condition that results from constant and overuse of the tendon.

The Problem with Tendons:Tendons are tricky. These tough bands of fibrous, but flexible tissue connect the muscle to the bone and allow movement in the joints, which enables you to walk, jump, lift, bend, and move in multiple ways. They are absolutely essential and thus become easily used and abused every single day.

However, unlike muscles, joints, tendons, and ligaments do not respond to physical therapy or exercise. Because of this, many physicians and patients resort to the temporary relief of anti-inflammatory drugs to cope with the pain caused from wear and tear or injury. In more severe cases, tendon surgery seems like the only option.

Patients with elbow tendonitis may not respond to the conventional treatments of wait, rest, and medicate for pain relief. For some patients still, this slow-track to healing is not in their schedule and they would much prefer getting on with their lives by fast forwarding the healing process. Consequently, they want and need a faster treatment.

I had a women come in years ago that had 16 cortisone shots for tennis elbow, she had no tendon just a few strands left. She could pick up her hand but it was very painful, we had to do Prolotherapy several times to grow back that tissue, and it was a long arduous process. I would hope that people not do that knee-jerk reaction of getting a steroid injection when they have pain, I think a better way to go is with Prolotherapy, which actually grows the tissue back and heals it up, rather than put a band-aid on it that makes you go out and feel like you can play tennis again.