Monthly Archives: November 2013
Tennis elbow and golfer’s elbow (lateral and medial epicondylitis) are common afflictions of middle age adults. While associated with various sports activities, these conditions can result from any repetitive activity including those in the workplace. They are less commonly the result of traumatic injury.
While patients many times believe that their symptoms arise from problems of the elbow bones or the elbow joint itself, tennis and golfer’s elbow actually result from problems at the level of the musculo-tendinous attachment of the forearm muscles to the distal humeral (arm) bone. Microscopic tearing of these tendon attachments many times produce the patient’s symptoms
Many physicians believe that both tennis and golfer’s elbow are attritional afflictions, and part of the normal aging process in adults. In this regard, symptoms can resolve on their own over time. However, symptoms in many cases are pronounced and can restrict and impede activities of daily living.
Numerous treatment options are available. Many patients have loss of motion of the elbow and decreased strength, particularly wrist muscle and grip strength. Exercises and/or physical therapy can dramatically improve symptoms. Because epicondylitis is associated with tendon inflammation, oral and topical non steroidal anti-inflammatory agents may be beneficial. Cortisone injections can dramatically improve symptoms, but should not be used repetitively as they may impede the tendon healing process. Bracing supports the inflamed musculature of the forearm and is useful during activities.
Newer therapies include the injection of platelet rich plasma. The goal is to promote healing of the microscopic tendinous tears. These treatments are still being studied and evaluated. Early results are promising but there are at least 5 different variants of injections that are being utilized and none of these therapies is covered by insurance.
Surgery is rarely necessary but generally quite effective, with a recovery period of 2-3 months.
Go Time Ministries is a nonprofit, nondenominational ministry located in the Mon Valley. They operate a community outreach program that administers to youth and adults both locally and abroad. A considerable portion of their activities are designed to meet individuals and community needs.
Go Time has been active in a number of countries including Russia, Haiti and Peru. A recent mission trip to Peru provided portable water filtration systems to an underserved municipality in the capital city of Lima (June 2013).
Three weeks ago Go Time completely its first ever medical mission trip to Lima, Peru. I was proud to be a part of that trip. 21 individuals from the South Hills, including 5 physicians from Jefferson Regional Medical Center participated. We spent 5 days treating patients primarily in the San Martin district of Lima (population approximately 10 million). San Martin has a population of 700,000, one of the largest of Lima’s 43 districts. Many, if not most of these people, especially on the outskirts of the district have never had contact with a physician. We treated and evaluated between 2500-3000 people. Orthopedically, many of these patients were treated for arthritis (medicines, injections), infections and other acquired congenital abnormalities. Referrals were made as appropriate.
Significant support was provided by the mayor of San Marin, Freddy Teimo and numerous municipal employees. We had the benefit of interpreters, as well as local primary care and dentists on site.
Certainly, many of these patients would benefit from orthopedic surgical procedures, but their primary needs are far more basic. In the United States we take for granted our access to health care. Even without health insurance, an emergency room is never that far away. In the Santa Cruz region of San Martin, an emergency room is a minimum of 90 minutes away. Many of these people live as squatters on isolated mountains within the city limits, some as high as 2000 feet. The socialist government provides minimal services for them. Medical consultation/treatment is typically not an option.
That may change. A goal of Go Time Ministries is to secure land and construct a clinic facility in San Martin to better serve the population. This truly was a humbling experience for me.