One of the most common complaints we see here at SOFC is elbow pain. Often this follows a busy weekend of activity, especially working with the hands, pulling, gripping, building, painting, chopping or carrying. When the pain is on the outer side of the elbow we call this “tennis elbow”. The more correct term is “Lateral Epicondylitis”, due to over use, caused by muscular contraction and tensile overload of the tendon attachment to the bone. This usually occurs between 35 and 50 years of age, may have been coming on for weeks and has suddenly gotten worse. The pathology appears to be small tears of the tendon attachment at the bone on the outer side of the elbow, resulting in formation of a painful scar area. Some patients may have calcium formation (20% of cases).

The diagnosis is usually made by patient history and a simple examination of the painful area. The doctor needs to think about other causes of pain in the outer elbow area such as nerve entrapment, neck problems and problems inside the elbow joint itself.

Treatment usually starts with pain relief. This includes rest, avoiding any activity which aggravates the pain, and cold therapy (ice) to the local area. Over the counter nonsteroidal anti-inflammatory medicines (aspirin, ibuprofen, naproxen) are useful and usually help. DMSO has not been demonstrated to be more effective than a placebo. A tight wrap around the area just below the elbow (a tennis elbow brace) often helps. If these treatments do not help, stronger prescription medicines, including nonsteroidals and narcotics may be necessary. Physical therapy modalities often are useful. We usually order ultrasound, high-voltage electrical stimulation, ice, stretching and strengthening exercises. Most people recover over a period of 6 to 10 weeks. If improvement does not occur, a cortisone shot into either the most tender area over the bony area of tendon attachment or just distal and in front of the tendon attachment is next. This almost always solves the problem. If the shots are repeated too often, more than 3 times per year, some skin atrophy and weakening of the tendon may occur.

Once the pain is relieved, the person must work to avoid the activity which caused the problem. Thus you must avoid abuse, alter your training technique, change your equipment and how it is used and use a tennis elbow brace (a counterforce brace). A graduated exercise program is necessary to strengthen the area.

If all this fails, surgery is often done. Tennis elbow surgery has been done since 1927. The principle is to either relieve the forces on the area by “sliding” the muscle attachment or removing scar tissue from the muscle attachment area. Surgery is done as an out patient. Anesthesia can be either a regional block or a general anesthesia. The pathology in most cases is scar formation and partial tears of the muscle and tendon. After surgery, some surgeons place the elbow in a cast for a week and then start rehabilitation. It usually takes 6 weeks before one can return to tennis. Heavy work may take longer. Full strength is not achieved for 5-6 months. Eighty-five percent of patients should be able to return to full activity after this operation. Twelve percent of patients have some pain with aggressive activity and about 3 percent have no relief. Reasons for failure are hard to understand but may be due to a nerve problem or other factors.

DR. LAURNEN RETIRES
Dr. Edwin L. Laurnen retired from active practice on July 1, 1998, after practicing orthopaedic surgery for the last 30 years. His colleagues and the staff will miss him, but are pleased that he has decided to continue part-time at the Clinic to assist with spine surgery.

Dr. Laurnen attended college at the University of Colorado, following which he graduated from the University of Colorado School of Medicine in 1958. He then served a one-year internship in Seattle at the University of Washington and Harborview Hospital. After his internship, he was called into the Service, where he was a medical officer for a fighter squadron support group in Northern Italy. Following completion of his military commitment, he completed his orthopaedic residency training at the Mayo Clinic in Rochester, Minnesota. He joined the Seattle Orthopaedic & Fracture Clinic on July 1,1968, where he has been practicing orthopaedic surgery with a special interest in spine surgery.

Dr. Laurnen is planning to pursue more actively his outdoor activities with he wife, Judy, including boating, hiking, fishing, skiing, elk and duck hunting, and flying his small plane.

Dr. Laurnen will miss seeing his patients, many of whom have become good friends, but he feels that after 30 years of practice, it is time to move on. Dr. Laurnen’s associates at Seattle Orthopaedic & Fracture Clinic will provide continuity of care for his patients.