Tennis elbow

[Cris]

I am a c6 complete 19 years post with tennis elbow. I didn't realize how much it hurt until I missed my pain control meds dosage. My flexor extensor mass is very painful.

When I do a transfer and I scooped up my legs under my knees to put them in bed and the spasms win, it only aggravates it. My spasms have taken me up and over the rails ion a hospital bed.

If in power chair, cocking wrist back to control joystick hurts more than pushing my manual chair. Pulling on a pair of jeans is excruciating even typing on keyboard hurts after awhile.

I have seen a GP 3 times, the last two for cortisone shots. The GP told me to do things like not use the wrist cocked back, therefore no tendonitis, and other normal ways to treat the pain. However I live by myself and work full time. I keep an air cast on, picking up a glass hurts, and I need relief!

What are the options? A wrist splint, stay on narcotics? What type of doctor should I see?

Thank you for your assistance.

[SCI-Nurse]

Cris - This is such an excruciating problem, as you know; unfortunately, quads, in particular, are at risk for this as your arms and shoulders are used for work for which they were not designed. I would suggest that you have an evaluation by a physiatrist (doctor of physical medicine) who has experience with SCI. (There are many good physiatrists whose practice involves sports injuris, recoveries from broken bones, etc., but not SCI.) For recommendations in your area either call the Florida SCI Resource Center at 1-800-995-8544 or go to: www.aapmr.org/pmaps/ (http://www.aapmr.org/pmaps/)

Following a physician's evaluation, hopefully, he will send you to a physical therapist for an assessment, treatment, and a management program. My experience with patients with this problem is that some times the problem originates from muscles in the shoulder that are being overworked, tight, and knotted as well as the condition of the muscles that surround and support the elbow and wrist. There are many P.T. modalities including deep myofascial release, ultrasound, heat/ice, and taping of the muscles that can provide some relief. Often the management program will include identifying muscles that may be being used incorrectly, that need strengthening or techniques that need modifying, i.e. wheeling your manual chair differently, altering your transfer technique. A physical therapist and/or an occupational therapist can observe the way in which you do some of your ADL's and determine if there is undue strain on the muscle; from this they will develop a program that will help overcome this problem. I have also seen a patient gain some relief from acupuncture and acupressure, when the above did not fully correct or alleviate the problem.

I urge you to be seen by someone who understands SCI. You should not let this persist as the longer it does it will be that much harder to correct, you are at risk of injuring yourself in transfers and your quality of life is so affected. CRF

[SCI-Nurse]

Cris - The Craig Hospital site, in its section on SCI Health and Wellness, has two articles on 'aching shoulders' and 'shoulder pain' that may be helpful to read. The content is similar to my earlier post, but may give you a few more incites. Go to: www.craighospital.org/C_Research/c2x_achingShoulders.html (http://www.craighospital.org/C_Research/c2x_achingShoulders.html) CRF

[SCI-Nurse]

I would recommend that you see a physiatrst (physician who specializes in physical medical) as they are experts in the management of joint problems, esp. those with associated sports injuries and over-use syndromes.

You may also benefit from seeing a PT or OT for a functional re-evaluation. This should help identify activities that you do that may aggravate this condition, and ways that you may change your activities to reduce this problem. (KLD)

[Cris]

This site, www.aapmr.org/pmaps (http://www.aapmr.org/pmaps) brought up a good doctor Stuart Miller. He is attached to a hospital that doesn't like my insurance though I told him I would see him Wednesday.

Thank all of you for insisting.

[Cris]

It now appears that doing data input requires the use of my whole arm. From my scapula to my wrist can hurt some days. Is 40 hours of data input a good idea, a realistic one? Will the soreness go away or compoound my future problems?

[SCI-Nurse]

Cris-- Since KLD has written back to you before suggesting a follow-up by a rehab doctor or PT or OT, my question would be, did any of these evaluations happen?

I too experienced elbow tendonitis from being on the computer for long periods. An environmental ERGONOMIC evaluation was done of my computer site. My key board was lowered and a few other padding items were added as well as the height of everything in front of me. I also took frequent breaks from it. After this occurred along with a 7 day course of ibuprofen and wearing of an arm band, it went away.

I know you mentioned cortisone shots but did you also try any of the other things that worked for me? I think 40 hours a week at a computer for data entry is a lot but may be necessary for your job so you need to look at ways to modify what you are currently doing because it is obviously aggravating your tendonitis causing it to keep flaring up. PLG

[Cris]

Am seeing the 'hand' doctor again Wednesday. My data entry is not something you can take breaks from. I am entering tickets and solving problems for a hospital system solving s/w, h/w and connectivity issues. You can't take frequent break, someday your lucky to get lunch. there are patients whose care is impacted by the hospital network.

I was lying in bed last night and my whole arm had intense tingling, and now tying this message, its starting de is uncomfortable. If I'm on a regimen of class 2 narcotics and the pain in my elbow comes through, does mean it hurts a lot?

I promised them I would get them through the holidays at this osition, so I figure I need a more brain job (not as dumb a I look) rather than an intense one.

Stu miller will let me do anything I want; he makes it my 'call'. Usually I just call him for answers, whenever I'm in his office we BS about other things. 2 minutes what's wrong, 20 minutes of conversation.

Though this is more an attitude issue, can I a "lucky quad" give up a job just because it hurts

[antiquity]

Chris,

Definitely consider taking Glucosamine/Chondroitin with MSM. I had painful bursitis in my elbow from overuse which required two drainings and a cortisone shot. I started taking the suppliment soon after the cortisone and the swelling hasn't returned at all and the pain slowly disappeared after about two weeks of use. That was 6 months ago and I'm still Bursitis free. I take it now a couple of times a week just as a preventive.

[Wise Young]

Cris, you need to use common sense. The best treatment for tennis elbow is to rest it. While cortisone shots, anti-inflammatory drugs, and glucosamine help, the joint still needs time to heal. Analgesics merely mask the pain. The pain is a warning sign. You don't want this to become a chronic condition. I understand and envy your boss for your dedication to the job but you need to let your joint heal. In addition to the advice below, perhaps you should consider the following:
• See if you can get some help with transfers so that you eliminate at least that source of stress.
• If you do not have it already, install Dragon on your computer so that you can do more via voice command. Use a head mouse.
• Have your office get a temporary temp to help you through the most busy parts of the day, so that you can supervise and work more verbally.

Wise.

[Cris]

Dr. Young:

Thank you for your input. Regarding transfers, I transfer from chair to chair, chair to bed, chair to van seat. It's not realistic to get help with transfers. Dragon Speak is not really functional yet, at least for my uses. I have it with an array microphone.

Bringing in a temp for the'busy times' is not me doing the job,thats what I was hired for. I cover from 9-6, m-f. There are 3 others on staggered schedules.

I told them last week I would help them through the holidays, e.g. covering slots so others can take vacation time. Going back to specialist on Wed.

So I will not be able to do this particular job next year. Hopefully they will put me in a position, which requires more neural energy than muscle.

Thank you for your input.

BTW, Do you have any information on trouble metabolizing carbohydrates?


Cri

[Wise Young]

Cris, I don't understand what you mean by trouble metabolizing carbohydrates. Do any specific carbohydrates bother you? Are you having diarrhea when you eat bread, etc.? Are you referring to glucose levels when you eat?

A majority of people with spinal cord injury have trouble with their glucose levels for reasons that are poorly understood. For example, many people with spinal cord injury have abnormal glucose tolerance, i.e. their glucose levels remain elevated for a long time after they ingest carbohydrates or sugar. It is not dissimilar from diabete.

One theory is that some people with pituitary problems (which is common after spinal cord injury, particularly cervical spinal cord injury; see http://carecure.org/forum/showthread.php?t=3554 ) cannot respond rapidly with growth hormone (GH). The GH response is part of the way that the body handles sugar. In addition to insulin rising, GH levels also increase. In fact, it is one of the ways in which doctors diagnose GH deficiency. Have you had your GH levels checked out recently? You can take growth hormone supplements.

See
http://www.jdrf.org/kids/go/2000/02/hormones.html

[Cris]

Sorry Dr. Young on not following up on metabolizing carbohydrates will expound at a later time.

[This message was edited by Cris on Feb 24, 2002 at 08:46 AM.]