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Non-specific treatments include:
- Non-steroidal anti-inflammatory drugs (NSAIDs): ibuprofen, naproxen or aspirin
- Heat or ice
- A counter-force brace or "elbow strap" to reduce strain at the elbow epicondyle, to limit pain provocation and to protect against further damage.
Before anesthetics and steroids are used, conservative treatment with an occupational therapist may be attempted. Before therapy can commence, treatment such as the common rest, ice, compression and elevation (R.I.C.E.) will typically be used. This will help to decrease the pain and inflammation; rest will alleviate discomfort because golfer's elbow is an overuse injury. The patient can use a tennis elbow splint for compression. A pad can be placed anteromedially on the proximal forearm. The splint is made in 30–45 degrees of elbow flexion. A daytime elbow pad also may be useful, by limiting additional trauma to the nerve.
Therapy will include a variety of exercises for muscle/tendon reconditioning, starting with stretching and gradual strengthening of the flexor-pronator muscles. Strengthening will slowly begin with isometrics and progresses to eccentric exercises helping to extend the range of motion back to where it once was. After the strengthening exercises, it is common for the patient to ice the area.
Simple analgesic medication has a place, as does more specific treatment with oral anti-inflammatory medications (NSAIDs). These will help control pain and any inflammation. A more invasive treatment is the injection into and around the inflamed and tender area of a long-acting glucocorticoid (steroid) agent. After causing an initial exacerbation of symptoms lasting 24 to 48 hours, this may produce an improvement of the condition in some five to seven days.
The ulnar nerve runs in the groove between the medial humeral epicondyle and the olecranon process of the ulna. It is most important that this nerve should not be damaged accidentally in the process of injecting a golfer's elbow.
If all else fails, epicondylar debridement (a surgery) may be effective. The ulnar nerve may also be decompressed surgically.
If the appropriate remediation steps are taken - rest, ice, and rehabilitative exercise and stretching - recovery may follow. Few patients will need to progress to steroid injection, and less than 10% will require surgical intervention.
Although anti-inflammatories are a commonly prescribed treatment for tennis elbow, the evidence for their effect is usually anecdotal with only limited studies showing a benefit. A systematic review found that topical non-steroidal anti-inflammatory drugs (NSAIDs) may improve pain in the short term (up to 4 weeks) but was unable to draw firm conclusions due to methodological issues. Evidence for oral NSAIDs is mixed.
Evidence is poor for long term improvement from injections of any type, whether corticosteroids, botulinum toxin, prolotherapy or other substances. Corticosteroid injection may be effective in the short term however are of little benefit after a year, compared to a wait-and-see approach. A recent randomized control trial comparing the effect of corticosteroid injection, physiotherapy, or a combination of corticosteroid injection and physiotherapy found that patients treated with corticosteroid injection versus placebo had lower complete recovery or improvement at 1 year (Relative risk 0.86). Patients that received corticosteroid injection also had a higher recurrence rate at 1 year versus placebo (54% versus 12%, relative risk 0.23).
Complications from repeated steroid injections include skin problems such as hypopigmentation and fat atrophy leading to indentation of the skin around the injection site. Botulinum toxin type A to paralyze the forearm extensor muscles in those with chronic tennis elbow that has not improved with conservative measures may be viable.
Evidence for the treatment of lateral epicondylitis before 2010 was poor. There were clinical trials addressing many proposed treatments, but the trials were of poor quality.
In some cases, severity of tennis elbow symptoms mend without any treatment, within six to 24 months. Tennis elbow left untreated can lead to chronic pain that degrades quality of daily living.
Steroid injections are helpful in the short term (first approximately 4 weeks) however, their long term effectiveness is not known, and quality of evidence for its use remains poor and controversial.
Other, more conservative and non-surgical, treatment options available for the management and treatment of tendinopathy include: rest, ice, massage therapy, eccentric exercise, NSAIDs, ultrasound therapy, LIPUS, electrotherapy, taping, sclerosing injections, blood injection, glyceryl trinitrate patches, and (ESWT) extracorporeal shockwave therapy. Studies with a rat model of fatigue-damaged tendons suggested that delaying exercise until after the initial inflammatory stage of repair could promote remodelling more rapidly. There is insufficient evidence on the routine use of injection therapies (Autologous blood, Platelet-rich plasma, Deproteinised haemodialysate, Aprotinin, Polysulphated glycosaminoglycan, Corticosteroid, Skin derived fibroblasts etc.) for treating Achilles tendinopathy. As of 2014 there was insufficient evidence to support the use of platelet-rich therapies for treating musculoskeletal soft tissue injuries such as ligament, muscle and tendon tears and tendinopathies.
Both eccentric loading and extracorporeal shockwave therapy are currently being researched as possible treatments for tendinosis. One study found both modalities to be equally effective in treating tendinosis of the Achilles tendon and more effective than a 'wait and see' approach. Other treatments for which research is on-going includes vitamin E, vitamin B6, nitric oxide, Platelet Rich Plasma (PRP), and stem cell injections.
One study found increased achilles tendon healing in rats supplemented with high doses of vitamin C, which is needed for collagen synthesis.
The most-often prescribed treatments for early-stage RSIs include analgesics, myofeedback, biofeedback, physical therapy, relaxation, and ultrasound therapy. Low-grade RSIs can sometimes resolve themselves if treatments begin shortly after the onset of symptoms. However, some RSIs may require more aggressive intervention including surgery and can persist for years.
General exercise has been shown to decrease the risk of developing RSI. Doctors sometimes recommend that RSI sufferers engage in specific strengthening exercises, for example to improve sitting posture, reduce excessive kyphosis, and potentially thoracic outlet syndrome. Modifications of posture and arm use (human factors and ergonomics) are often recommended.
Depending on the severity of the lesion, physicians may recommend either conservative treatment or surgery. The first step is simply to rest and modify daily activities that aggravate the symptoms. Patients may be prescribed anti-inflammatory drugs, Physical or Occupational therapy, splints for the elbow and wrists, and corticosteroid injections as well. This is the most common treatment for CTS. Especially involving compression at the wrist, such as in CTS, it is possible to recover without treatment. Physical therapy can help build muscle strength and braces or splints help recover. In pronator teres syndrome, specifically, immobilization of the elbow and mobility exercise within a pain-free range are initially prescribed. However, if the patient is not relieved of symptoms after a usual 2 to 3 month refractory period, then decompression surgery may be required. Surgery involves excising the tissue or removing parts of the bone compressing the nerve.
Many tendon transfers have been shown to restore opposition to the thumb and provide thumb and finger flexion. In order to have optimal results the individual needs to follow the following principles of tendon transfer: normal tissue equilibrium, movable joints, and a scar-free bed. If these requirements are met then certain factors need to be considered such as matching up the lost muscle mass, fiber length, and cross-sectional area and then pick out muscle-tendon units of similar size, strength, and potential excursion.
For patients with low median nerve palsy, it has been shown that the flexor digitorum superficialis of the long and ring fingers or the wrist extensors best approximate the force and motion that is required to restore full thumb opposition and strength. This type of transfer is the preferred method for median nerve palsy when both strength and motion are required. In situations when only thumb mobility is desired, the extensor indicis proprius is an ideal transfer.
For high median nerve palsy, the brachioradialis or the extensor carpi radialis longus transfer is more appropriate to restore lost thumb flexion and side-to-side transfer of the flexor digitorum profundus of the index finger are generally sufficient. To restore independent flexion of the index finger could be performed by using the pronator teres or extensor carpi radialis ulnaris tendon muscle units. All of the mentioned transfers are generally quite successful because they combine a proper direction of action, pulley location, and tendon insertion.
One way to prevent this injury from occurring is to be informed and educated about the risks involved in hurting your wrist and hand. If patients do suffer from median nerve palsy, occupational therapy or wearing a splint can help reduce the pain and further damage. Wearing a dynamic splint, which pulls the thumb into opposition, will help prevent an excess in deformity. This splint can also assist in function and help the fingers flex towards the thumb. Stretching and the use of C-splints can also assist in prevention of further damage and deformity. These two methods can help in the degree of movement the thumb can have. While it is impossible to prevent trauma to your arms and wrist, patients can reduce the amount of compression by maintaining proper form during repetitive activities. Furthermore, strengthening and increasing flexibility reduces the risk of nerve compression.
Non-surgical treatment of radial tunnel syndrome includes rest, NSAID, therapy with modalities, work modification, ergonomic modification, injection if associated with lateral epicondylitis.
Patients whose conditions are more adapted to surgical intervention are those who do not respond to prolonged conservative treatment. The patient must have pain with resisted supination, positive middle finger test, positive electrodiagnostic findings, and pain relief after anesthetic injection into the radial tunnel. Based on 2002 data, surgical decompression leads to 60-70% good or excellent results.
The condition is called "Golfer's Elbow" because in making a golf swing this tendon is stressed, especially if a non-overlapping (baseball style) grip is used; many people, however, who develop the condition have never handled a golf club. It is also sometimes called "Pitcher's Elbow" due to the same tendon being stressed by the throwing of objects such as a baseball, but this usage is much less frequent. Other names are "Climber's Elbow" and "Little League Elbow": all of the flexors of the fingers and the pronators of the forearm insert at the medial epicondyle of the humerus to include: pronator teres, flexor carpi radialis, flexor carpi ulnaris, flexor digitorum superficialis, and palmaris longus; making this the most common elbow injury for rock climbers, whose sport is very grip intensive. The pain is normally caused due to stress on the tendon as a result of the large amount of grip exerted by the digits and torsion of the wrist which is caused by the use and action of the cluster of muscles on the condyle of the ulna.
Epicondylitis is much more common on the lateral side of the elbow (tennis elbow), rather than the medial side. In most cases, its onset is gradual and symptoms often persist for weeks before patients seek care. In golfer's elbow, pain at the medial epicondyle is aggravated by resisted wrist flexion and pronation, which is used to aid diagnosis. On the other hand, tennis elbow is indicated by the presence of lateral epicondylar pain precipitated by resisted wrist extension. Although the condition is poorly understood at a cellular and molecular level, there are hypotheses that point to apoptosis and autophagic cell death as causes of chronic lateral epicondylitis. The cell death may decrease the muscle density and cause a snowball effect in muscle weakness - this susceptibility can compromise a muscle's ability to maintain its integrity. So athletes, like pitchers, must work on preventing this cell death via flexibility training and other preventive measures.
Climbers often develop calluses on their fingers from regular contact with the rock and the rope. When calluses split open they expose a raw layer of skin that can be very painful. This type of injury is commonly referred to as a flapper.
The use of magnesium carbonate (chalk) for better grip dries out the skin and can often lead to cracked and damaged hands
There are a number of skincare products available for climbers that help to treat calluses, moisturise dry hands and reduce recovery time.
Radial Tunnel Syndrome is caused by increased pressure on the radial nerve as it travels from the upper arm (the brachial plexus) to the hand and wrist.
Injuries in rock climbing may occur due to falls, or due to overuse (see Sports injury). Injuries due to falls are relatively uncommon; the vast majority of injuries result from overuse, most often occurring in the fingers, elbows, and shoulders. Such injuries are often no worse than torn calluses, cuts, burns and bruises. However, overuse symptoms, if ignored, may lead to permanent damage (esp. to tendons, tendon sheaths, ligaments, and joint capsules).
Encouraging the use of proper ergonomics not only includes matching the physical ability of the worker with the correct job, but it deals with designing equipment that is correct for the task. Limiting heavy lifting, training, and reporting early signs of injury are examples that can prevent MSD. Employers can provide support for employees in order to prevent MSD in the workplace by involving the employees in planning, assessing, and developing standards of procedures that will support proper ergonomics and prevent injury.
One focus of ergonomic principles is maintaining neutral postures, which are postures in which muscles are at their normal length and able to generate the most force, while reducing stress and possible injury to muscles, tendons, nerves, and bones- therefore, in the workplace or in everyday life, it is ideal for muscles and joints to maintain neutral positions. Additionally, to prevent hand, wrist, and finger injuries, understanding when to use pinch grips (best for fine motor control and precise movements with low force) and power grips (best for high-force movements done repeatedly) is important for employees and general tasks outside the workplace. The choice of tools should match that of the proper grip and be conducive to neutral postures, which is important for employers to consider when purchasing equipment. In order to reduce injuries to the low back and spine, it is recommended to reduce weight and frequency of lifting cycles as well as decreasing the distance between the body and the load to reduce the torque force on the back for workers and individuals doing repeated lifting to avoid fatigue failure of the spine. The shape of objects being lifted should also be considered, especially by employers, because objects which are easier to grip, lift, and access present less stress on the spine and back muscles than objects which are awkwardly shaped and difficult to access.
The National Institute of Occupational Safety and Health (NIOSH) has published ergonomic recommendations for several industries, including construction, mining, agriculture, healthcare, and retail, among others.
The exact etiology of tendinopathy has not been fully elucidated and different stresses may induce varying responses in different tendons. There are multifactorial theories that could include: tensile overload, tenocyte related collagen synthesis disruption, load-induced ischemia, neural sprouting, thermal damage, and adaptive compressive responses. The intratendinous sliding motion of fascicles and shear force at interfaces of fascicles could be an important mechanical factor for the development of tendinopathy and predispose tendons to rupture. Obesity, or more specifically, adiposity or fatness, has also been linked to an increasing incidence of tendinopathy.
The most commonly accepted cause for this condition however is seen to be an overuse syndrome in combination with intrinsic and extrinsic factors leading to what may be seen as a progressive interference or the failing of the innate healing response. Tendinopathy involves cellular apoptosis, matrix disorganization and neovascularization.
Tendinopathy can be induced in animal models by a surgical injury to the tendon. In both sheep shoulder (infraspinatus) and horse forelimb (superficial digitor flexor) tendons, a mid-tendon transection caused pathology in the entire tendon after four and six weeks respectively.
Quinolone antibiotics are associated with increased risk of tendinitis and tendon rupture. A 2013 review found the incidence of tendon injury among those taking fluoroquinolones to be between 0.08 and 0.2%. Fluoroquinolones most frequently affect large load-bearing tendons in the lower limb, especially the Achilles tendon which ruptures in approximately 30 to 40% of cases.
A repetitive strain injury (RSI) is an "injury to the musculoskeletal and nervous systems that may be caused by repetitive tasks, forceful exertions, vibrations, mechanical compression, or sustained or awkward positions".
Groups who are at particular risk can be identified, and modifications to the physical and psychosocial environment can be made. Approaches to prevention in workplace settings include matching the person's physical abilities to the tasks, increasing the person's capabilities, changing how tasks are performed, or changing the tasks. Employers can also utilize engineering controls and administrative controls to prevent injury happening on the job. Implementation of engineering controls is the process of designing or redesigning the workplace to account for strengths, weaknesses, and needs of the working population- examples would be workstation layout changes to be more efficient or reducing bending over, or moving necessary tools within shorter reach of the worker's station. Employers may also utilize administrative controls like reducing number of hours in a certain position, limiting overtime, or including more breaks during shifts in order to reduce amount of time at risk for each worker.
Nintendo thumb, also known as gamer's grip, Nintendonitis and similar names, is a video game-related health problem classified as a form of repetitive strain injury (RSI). The symptoms are the blistering, paraesthesia and swelling of the thumbs, mainly through use of the D-pad, though any finger can be affected. This can lead to stress on tendons, nerves and ligaments in the hands, and further onto lateral epicondylitis ("tennis elbow"), tendinitis, bursitis and carpal tunnel syndrome (CTS).
Some of the symptoms are described under trigger finger.
Originally known in a video gaming context as "Leather Thumb", this condition was known to occur frequently among users of 2nd generation video game consoles such as the Intellivision or the Atari 2600 in the late 1970s and early 1980s. The condition was first highlighted when the Nintendo games consoles were released, leading to reported cases of RSI, primarily in children (being one of the primary audiences of early-generation videogames). Later, the controllers for the Sony PlayStation and PlayStation 2 were noted as causing the condition. However, due to the shape, size and extended use of game controllers it is not limited to just those specific ones and can occur in users of any gamepad or joystick. Similar problems have also been observed with the use of mobile phones, and text messaging in particular (see Blackberry thumb).