Expert: Dr. J. Shawn Leatherman - 12/11/2006

Question
My arm has recently started hurting like it has never done before. It hurts in my wrist and elbow and the muscle going down from my elbow to the wrist.  But especially my wrist.  I can not pull or push things. It even hurts when I pick up a bottle of water to drink from and writing. What could this be and how do I make it stop being so painful? The most painful part is in the wrist by the thumb. I play tennis and my thumbs have hurt before from doing top spin. I was wondering if this sounded like tennis elbow or not.  

Answer
Dear Rachel,

Yes this does sound like a classic overuse injury from tennis, but "tennis elbow" is considered specific to the lateral aspect of the forearm, in contrast, "golfers elbow" is considered specific to the medial portion of the arm. I am not sure at which aspect you are having pain. In the anatomical position...palms facing forward, medial is next to the trunk, lateral is away from the trunk.

No matter in terminology though, the fix is the same, the bottom line is that overuse of the muscles of the forearm will irritate/inflame the tendon insertions at the elbow and can be responsible for significant pain.  Poor backhand technique or powerful forehand and serving can easily cause this.  

You need to stop playing tennis for awhile (couple of weeks)and let this area heal, initial use of ice is good for reduction of inflammation.  Concerning a wrist splint, this has been mentioned as beneficial in the clinical texts, but I rarely utilize it...for extension problems the splint should be in 30-40 degrees of extension to alleviate stress on the extensor tendons...for flexion the splint should be in approx 10 degrees of flexion.

Now for active treatment, myofascial release techniques are very effective.  Cross friction massage, ice massage, active release technique (ART) or Graston techniques will work the focal area of tension and inflammation, and help to realign any forming scar tissue. After the initial manual work on the muscle(2-4 treatments), I would recommend a brace at the elbow to shorten the tendon insertion called a chopat brace/tennis elbow brace.  This way you can return to sport and help to control the forces generated at the elbow.  This is a crutch, and you want to eliminate it when possible so that you can promote normal biomechanics of the joint and muscular activation and support, but remember this is an overuse injury...it will take some time.  These can be found at most pharmacies or sports stores and cost around $20.00.

Concerning the pain in the thumb/wrist area this is classic for a condition called de Quervain's Tenosynovitis.  This is due to traumatic chronic mico-trauma at the wrist in the tendon sheath.  INFLAMMATION is the reason for the pain.  Again you need to stop playing tennis, ice the area, over the counter ant-inflammatories are appropriate, and some doctors will use ultrasound over the tendons.  Improvement should be noted in 2-3 weeks, if not a thumb splint may be needed to immobilize the area or a steroid injection around the tendons to reduce the inflammation.  Surgery is rare.

Both of the above conditions should be able to be managed effectively with ice, myofascial release techniques, and rest from the sport.

Rachel, Feel free to write back if you need any further help.

Respectfully,
Dr. J. Shawn Leatherman