Welcome to another Spinal Column.Thank you for the positive feed back on the new style.Some readers have commented that the case history outlining a real patient's problem made it all more real and brought it to life.I certainly agree that people can relate more to a real person's story.

This week we are going to focus on an annoying problem which can affect a tremendous number of people from a wide range of different causes.

Tennis elbow or lateral epicondylitis is the most common sport related elbow injury.However, many non-athletes also suffer.

Anyone who performs a repetitive action using their hands is vulnerable to epicondylitis. Carpet layers, electricians, typists and students can all suffer.

The epicondyles are the boney lumps that you can feel on the sides of your bent elbow.

The outer one is the lateral epicondyle (LE) affected by tennis elbow and the inner one is the medial epicondyle (ME) involved in golfer's elbow.

These protruberences are the sites of attachment for the muscles which flex and extend the wrist.

The extensors attach to the LE and are therefore under more strain during raquet sports.The flexors attach at the ME and are strained more by the actions used by golfers.I have seen one or two patients who have been unfortunate enough to present with pain in both sites on the same elbow.Debilitating but fortunately rare.

The main factor in this condition is repeated microtrauma from the traction created by the muscle.Repair of the tissue is made very difficult due to the repetitive nature of wrist movement.The pain is considered to come from microtearing of the attachment to the bone and the joint capsule and the muscle itself.

The most commonly affected muscle is the extensor carpi radialis brevis but extensor carpi ulnaris can also be involved.

If you suspect you have tennis elbow you can test yourself in the following way.

Completely straighten your arm out in front of you. Lift your palm up so you bend your wrist backwards and then close your fist.With your free hand press against your hand trying to bend it down whilst resisting. If this reproduces pain at the lateral epicondyle there may well be a problem.

Treatment of tennis elbow involves reducing the cause of the strain, reducing the swelling, facilitae the tear to heal and improving the wrist, elbow, shoulder and neck function which can be affected. This sounds quite straightforward but this condition can be very stubborn to treat as the following case will demonstrate.

Case History Mr B was a lovely gentleman who presented with a history of chronic elbow pain. He was a carpet fitter who was 52-years-old, and he was right handed. When he was a younger man he had been very sporty and had enjoyed playing tennis regularly.

He had never suffered from tennis elbow when he played but he did once fall trying to reach a ball and had fallen on to his right elbow. He was now self employed and was happy to be very busy, but he had been struggling to continue with his job due to severe right elbow pain.

The pain at the elbow was so bad he was unable to hold a full mug of tea in his right hand. The pain had developed gradually over the previous year.

His GP had given him anti-inflammatory tablets which had helped short term but he did not want to take them long term as they upset his stomach.

He took pain killers when he had a big job to finish but again he did not wish to rely on them. It had become so severe a few months ago, that his GP had given him a corticosteroid injection which did ease all the pain, but only for two months.

Mr B was hesitant to have another as was his GP, so it was decided to try some manual treatment.

Mr B was not in a position to stop working so the first action under taken was to measure his forearm and order a well fitting epicondylar clasp.

For some patients these can bring about great relief as they reduce the traction of the muscle on the attachment point at the epicondyle. Results vary.

At least this would reduce the continuing strain as much as possible whilst he was cutting the carpet.

If Mr.B had still been a keen tennis player I would also have recommended his raquet grip width was checked to be appropriate for him and that he sought instruction to rule out poor technique. Mr B was advised to use ice as regularly as possible on the elbow to reduce the inflammation. He also utilised an anti inflammatory gel as the painful structures are quite superficial the gel can be quite effective at this site.

Chiropractically, examination revealed severely restricted neck and shoulder movement. These were adjusted to optimise the nerve flow to the arm and elbow which would help the healing process.

The elbow and wrist were both quite restricted so these were also manipulated. Ultrasound and dry needling were used to improve blood supply and to reduce tension in the extensor muscles.

Following this treatment plan for a month Mr B reported a great improvement in his elbow pain. He was now drinking full mugs of tea again!

After the initial intensive treatment Mr B had a regular monthly session to reduce the problem becoming as severe again, and to keep him working as hard as he wishes.

In some cases, patients do not respond as well to treatment. Some patients have several injections and depending on the severity and chronicity, when all conservative measures have failed a surgical option is performed. This usually involves excision of the damaged portion of the muscle and repair of the defect, or release of the extensor tendon. This should always be a last resort as I have treated some patients who had already had this procedure performed and the n experienced a reaggravation at the elbow.

If you have experienced this problem and would like some advice, or have requests for future columns please contact Ilkley Chiropractic Clinic on 605060 or email ilkleychiro@tiscali.com.