Harlan Selesnick, M.D
 
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JOCK Doc's Lower Arm Questions

Question
I am a 45 year old tennis player (4.5 level) I am having problem with my right TFCC on my wrist. I visited a hand MD specialist last week and told me after reviewing my hand arthogram that I have a tear in my TFCC (Triangular fibrocartilage complex). Is this a ligament of cartilage? I don't have any pain after resting it for 3 weeks, I am have afraid to play again. But what is the correct procedure for this type of injuries. Roberto

Answer
Many athletes may have tears of their wrist cartilage (TFCC) and it does not effect performance. However, sometimes the tears are large or symptomatic enough that require arthroscopic surgery of the wrist to fix. Also, not all TFCC tears are isolated injuries and wrist ligaments tears can occur concommitently. Once you are symptom free you could return to tennis and see if your symptoms recur. If the symptoms do return you should see your orthopedic surgeon or hand specialist for evaluation and treatment.The Jock Doc


Question
In May 1999, I had surgery on my right elbow, what is called an epicondylectomy. I was under the impression that I would be back to normal activities after 3 months. I play softball year round and am getting very frustrated with not being able to throw and being stuck playing first base. I usually play 3rd and have always had a very strong arm. I was told that it was either the surgery or live with the pain and it get worse. This was after 5 years of pain, 5 cortisone shots, and numbness in my fingers. Two weeks after the surgery, I reinjured my arm, extending it farther than it was suppose to be. My whole arm was swollen and bruised for weeks. According to my surgeon, everything is fine. I received no physical therapy after the surgery. My question is, am I ever going to be able to use my arm again like I'm use to? I've asked if there is anything that I can do to regain the strength, and was told just to lift weights. I can do very few curls with little weight and my elbow is sore and gives out on me. Ariann

Answer
Surgery for chronic epicondilitis "tennis and golfers elbows" is usually reserved for patients that fail a period of non surgical treatment. Most patients get better without surgery. The rate of success of surgery is about 90% better. Unfortunately, most people are never 100%. I do believe that rehab post op can help decrease the swelling, improve the range of motion, and help to strengthen the elbow and forearm safely. Since you are not yet doing well I recommend you discuss a possible rehab program with your surgeon or get a second opinion. Occasionally, compression for a nerve can cause a lesser result and this to must be considered if you do not get better after rehab. The Jock Doc


Question
I have a sore elbow, probably from hand spraying chemicals at work. Any treatment? Scott

Answer
There are many causes for a sore elbow. Most elbow injuries are the result of overuse. The most common overuse elbow injury is lateral epicondylitis "tennis elbow." The pain is localized to the outside part of the elbow and activities such as shaking hands, lifting luggage, or screwing in a light bulb cause pain. Other possible overuse injuries include triceps tendonitis (pain with elbow extension), biceps tendonitis (pain with elbow flexion or forearm rotation to a palm upwards position) and medial epicondylitis (pain on the inner part of the elbow). Most overuse injuries can be treated with modification of the offending activity, anti-inflammatory medication (i.e. Advil, aspirin, etc), and a pain-free strengthening program. If your symptoms persist I recommend you see your orthopedic surgeon. The Jock Doc


Question
I have been getting a sour pain in my elbow on my right side. It started in my shoulder as a sour muscle, i would guess it was sour from throwing the softball all summer, after not throwing it at all for a few years. Now the pain has moved to my elbow and is shooting up my wrist. Very sharp pains in my wrist. Is it just tendonitis? What else can it be? Rob

Answer
Pain that starts in the shoulder then radiates to the elbow and then wrist could be a form of tendonitis (biceps and wrist extensors). However, there can be other causes of your pain such nerve problem coming from your neck or the arm. Since the symptoms have persisted I recommend you see an orthopedic surgeon to help establish an accurate diagnosis and begin treatment to get you back playing tennis quickly. The Jock Doc


Question
I had surgery for tendonitis ("tennis elbow") in March 1999. I spent 6-8 wks. rehabbing and began driving race horses during the summer. My elbow seemed to get sore for a day or so, but then the pain went away. Now, (November 1999) I'm experiencing pain in the elbow again. I'd played tennis about 4 times in a 6 week period and quit playing about 3-4 weeks ago. The pain is still persisting. Before surgery, my elbow bothered me for 3 1/2 years and I was treated with exercises and had four (4) cortisone shots in the joint. (which helped less and less, hence the surgery. What else could I do? Do you have any suggestions? Michelle

Answer
Tennis elbow, lateral epicondylitis, is the result of chronic inflammation and micro-tears at the origin of the extensor tendon. Most patients heal without surgery. Unfortunately, you required surgery 3 1/2 years ago that initially was successful. Occasionally symptoms can recur. I recommend you see an orthopedic surgeon to evaluate why your symptoms returned (such as new tears, entrapment of the posterior interreous nerve, or other causes). Treatment options besides repeat surgery include anti inflammatory medications, physical therapy, or massage. Recently, a new device "the ossatron" has been successfully used to cure about 75% of patients with tennis elbow that failed to respond to conservative treatment. The ossatron is a device that uses high energy shock wave therapy to aid in healing the epicondylitis. It usually requires just one treatment for effective results. The device is currently in phase 2 of an FDA trial and so far has been shown to be very safe and effective. There are 5 centers in the US testing the device including HealthSouth Doctors Hospital in Miami. The Jock Doc


Question
Thank you very much for sending me a reply. I am 25. My family has no history of any disorder concerning my finger . I am a chef and one day while working I felt some pain in my finger . It was not much . I went for an X ray but the bone was normal. Months went and the swelling was constant . The pain makes me very uneasy and I have observed that the swelling is on the sides of the joint . I also have a locking sensation. The anti-inflammatory does not work. I work on the ship and I need some help as it is becoming a problem in my profession. Manoj

Answer
Finger pain and triggering can be caused form a form of tendonitis known as a trigger finger. You can also have finger pain and swelling from a form of arthritis or an infection. I recommend you see a doctor to help establish the diagnosis and treat you. If a trigger finger is caused by tendonitis an injection of cortisone at the source of the triggering may help. The Jock Doc


Question
I have a problem in my right hand ring finger. the pip joint is swollen since the last one year and the bone is normal. The x-ray is normal and all the anti-inflammatories have not worked .The pain comes and goes and it does not feel like muscular pain but is deep inside. Please advise. I'm really worried. Manoj

Answer
It is difficult to explain exactly what is wrong with your finger without knowing certain facts. Did you injure the finger? How old are you? Is there a history of rheumatologic diseases in your family? What have you done to treat this problem during the last year? etc. I recommend you see a rheumatologist who may obtain blood tests and further work up to help you with your problem. The Jock Doc


Question
I routinely lift heavy objects in the course of my work. For the last six weeks I have had pain in my left elbow,; slight when I either bend or extend it, great when I try to lift something. It also seems to extend up my triceps. Stephen

Answer
Pain from repetitive lifting or working out may result in an overuse injury. The most common overuse injuries are epicondylitis (lateral on the outside of the elbow-tennis elbow and medial on the inner part of the elbow-golfer's elbow). Also a triceps tendonitis can result in pain at the triceps insertion on the posterior (back) part of the elbow. Most overuse injuries can be treated with a physical therapy program to rehab the elbow. Also anti-inflammatory medication and workout modification can also help. Since you did not describe the location or type of pain you are experiencing it is hard to be more specific. I recommend you see an orthopedic surgeon to correctly diagnosis your injury so you can get better quickly. The Jock Doc

 
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