Left Lateral Epicondilitis

[firefighter ontheside]

Otherwise known as tennis elbow or just plain tendonitis.  I had surgery for it on my right arm about 10 years, but of course that was right lateral.  I've had it a little bit in my left elbow for years, but about 3 months ago it started coming on strong.  That kind of coincided with me getting back in the gym for some fitness.  Then about 6 weeks ago I did a bunch of sanding with my big orbital sander on some benches I was building.  Since then it's been terrible.  I've been stretching it.  I've been rubbing it.  I bought a brace for it at Walmart, but that was junk.  Yesterday I bought one at Walgreens like a coworker has been wearing and it is a lot better.  I will see if wearing this as much as I can causes any improvement.  I know rest is the best medicine, but who has time for that.  If it it doesn't start getting better I'll be making an appointment with the orthopedist.  Hopefully I can still get in to see the original guy I had.  If it goes like it did last time it will be him telling me to wear a band and perhaps physical therapy, then steroid shots in the elbow.  Those do great for a time, but it comes back.  Each time I got a shot in the right one, the relief was shorter lived than last time.  Finally came surgery which put me out of work for 7 weeks.  I hope to avoid that.  You guys have any experience with it?

 

[doctorb]

Yep.  That story you recounted could've been written by me.  Eventually had surgery, which cured it.  Most patients have it resolve with rest, straps, shots and strengthening exercises.  Studies show that it can take up to 2 years to get better, despite treatments.

Before we got married, my wife was a tennis player.  I was not, but I gave it a go.  Didn't take long to develop tennis elbow and put me on the same journey you went on.  Bothered me for quite some time.  Didn't seem to effect the relationship...we've been together for 32 years.

[firefighter ontheside]

Wish I could say that tennis had anything to do with either elbow, but it didn't.  I guess mine should be called woodworker elbow or maybe firefighter elbow.

[doc henderson]

when I was in med school I had a sail boating injury grabbing the tiller and trying to keep a blonde (now psychiatrist) from dumping the boat.  tore my labrum R shoulder.

[Old Greenhorn]

You guys are just SUCKING me into this conversation aren't you? ;D
 Bill sorry, I know that pain well, but right arm. Machinists have a habit of using their fists as mallets and I was no exception. It finally caught up with me in a real way for years. I tried several bands until I found one that worked well, used heat, ice, etc. The Firefighting days didn't help and some drills were just exercises in pain. But eventually, with lifestyle changes, the issue went away. It would still flare once in a while, but the band would keep it under control.
 Doc I had a similar injury in a small boat but there was no blonde involved  >:( I had the wife and kids out fishing in the St. Lawrence and we were anchored because the current was strong and we couldn't keep a line down. I happened to turn around and look upriver at the same moment the marine radio squawked up "pon-pon, pon-pon, pon-pon, all small craft...." with a severe storm warning of a squall coming down the river. They needn't have finished, I saw it, a BIG BLACK WALL of weather. I immediately and calmly told everyone to pull their lines in, we needed to go in. My son, about 10 at the time had recently earned the responsibility of handling the anchor, which he promptly started on. But it was hung. I coached and encouraged him as I watched the wall closing on us. Finally when he had done all he could, I had him pass me the line. It was hung... HARD.. and now the swells are picking up pretty good. As hard as I tried I could not get that anchor out of the rocks. It was getting bad, the rain started pelting down to the point that it was hard to see our dock 1/2 mile away.  I was not panicking, but frankly I was getting scared because I had the whole family in that boat. So I pulled us up to where the line was straight down and no matter how hard I pulled could not budge it. So I had an idea. When the wave went down and dropped the boat, I dropped my left hand as far down the line as I could reach and had my armpit right on the gunwale so there was no 'flex' in the system, well the next wave came, the boat went up, we went up, but my arm stayed with the anchor line and my grip did not slip. That was the plan. I didn't have time to consider what the weak point in that plan was. It was of course, my shoulder. The boat went up, my body with it, up to my shoulder, my arm stayed on that anchor line and I clearly felt it leaving my body until the point that the anchor broke free/ I pulled it up a few lengths then handed it back to my son to finish and I got the boat turned and underway upriver into the wind. By now we were steering into a crossing 30 mph wind and the waves were just breaking over the starboard side. My only option was to drive straight up into the wind, tack to the south for a bit, run up into the wind again and tack south some more. It was a very long 15 minutes, very long indeed, and all I could think about, beyond the task at hand, was my kids and wife living through it. I must note that my son and daughter, rather than panicking or freaking out focused in on what I was doing, asking good questions, and trying to assist in a solution. I was impressed (later). By the time we got back to the dock, there were 25 people there applauding, apparently word had spread, people gathered, and they watched the whole thing prepping a rescue with another small boat, but they were afraid to go out unless we went over because it was so bad. Maybe they were planning the recovery? I got out of the boat last and there was an older fella on the dock who reached out to lend me a hand up, turned that into a hearty handshake and wouldn't let let go. I looked at him and he said "man, I am retired from 40 years as a ship's captain and seaway pilot and I don't believe I have ever seen that level of seamanship from anybody that has been in my command. That was amazing, I would have put your chances at 10% or less making it in when you couldn't get the anchor up, then it got so bad I lost sight of you in the glasses."
 My shoulder took 4 years to repair from that (without treatment) until I managed to get mostly full range back.
 Yeah, you sucked me into this one. I have not re-lived that story in a long time. We got lucky that day.

[firefighter ontheside]

Tom, I see so many lonely ropes floating up from the bottom only to be cut off right at the water line.  Poor lonely ropes whose owners couldnt get the anchor at the other end free from the bottom, but I know you...you werent going to abandon your anchor and cut it free, even if it meant tearing your arm loose from your shoulder.

[Old Greenhorn]

I hate those lonely ropes, seen lots of them. Hazard to navigation. Not only did I have a nice Danforth anchor down there on the bottom but it was connected with 75' of nice 3/4" sisal line. I even had a trip line on it, but that did no good. The bottom of the river has some monster rocks and usually running 'er up past the anchor will flip it and all is good. But not that one time when we needed it.
 In the St. Lawrence all the rental boats have home made concrete anchors (a clorox bottle filled with cement and an eye bolt.), but they don't bite until they get wedged in the rocks and that current can really set them tight. There are some divers that go down and find them and sell them back to the rental outfits. Also those small cast iron mushroom anchors are popular because they are cheap and everyone expects to loose them at some point.

[firefighter ontheside]

I've been waiting a few weeks to get in to see the orthopedist.  I had tried to see the doc who did surgery on my other elbow, but he only does knees now.  Go figure.  New doc was very nice and at the same clinic as old doc.  He knew I was familiar with tennis elbow and kind of let me decide whether to try some therapy or go straight to steroid shot.  I went for the shot as I've been doing stretches and my own therapy with ice and massaging it.  The shot wasn't comfortable, but should make elbow feel better in a few days.  I just hope the shot takes me through my trip to Croatia before the pain comes back.  I think there is a chance it won't come back, but I guess I'm a glass half empty guy, because I assume I will be having surgery later this year.

[Ljohnsaw]

I  blew out my elbows over the summer. I really don't know what I did at the time but when I was off my cabin project for 4 or 5 weeks due to smoke and heat, the both started hurting. I noticed on my drive to the airport that the weren't hurting anymore! Yay! 

Going to Croatia might be the cure.

[doc henderson]

take some topical NSAID cream with.

[firefighter ontheside]

i doubt i'll be able to take that on airplane.  cant take toothpaste.
two weeks of mostly rest will indeed be a good thing/

[Ljohnsaw]

cant take toothpaste.  😳 I have some mini dentist tubes in my carry on and made it through security twice so far.

[doc henderson]

I know you cannot carry on, but I assume you are taking more clothes for a two week deal.  I hope your wife is not going, if you cannot brush your teeth for two weeks! ;D 

[firefighter ontheside]

lol lol should have mentioned we are not checking luggage.  carry on only. we will have washers at almost every airbnb we are staying at.  cindy has a plan for toothpaste.

[doc henderson]

prob. can buy something there.  maybe even cheaper. 

[beenthere]

Yes, they sell toothpaste where you are going.  8)

[firefighter ontheside]

Beenthere, have you been there?

[beenthere]

Not specifically in Croatia. But other countries around that area. Hungary and Austria. 

Also somewhat virtually when watching a video channel of a woman trucker from Poland who travels all over Europe and records her travels. Lots of country to be seen along the way of her travels. Croatia was a place she went with a photographer to get photos for her annual calendar. 
Sesja zdjęciowa w Chorwacji do kalendarza, Calendar photo shooting in Croatia - Iwona Blecharczyk - YouTube

Not her typical video but does have views of the Croatia countryside and villages 

But the products they have are very similar to those that we have in out stores, is all I am saying. The toothpaste may be sold in a bucket and not in a tube. just sayin... 8)

[doc henderson]

but do they have aqua-fresh?   ;D ;D ;D

[firefighter ontheside]

I have scheduled surgery for my elbow in mid January.  I expect to be out of work for 6 weeks and then go back on light duty.  Technically the fire department doesn't allow light duty, because of the nature of our job.  Being a Battalion Chief is a lot less physically demanding than being a firefighter, so as long as I can do my job I get to go back to work.  I had my right elbow fixed about 14 years ago before I was a BC, so I was out for 7 or 8 weeks.

[mike_belben]

Inflammation caused by the extremely high omega 6 to 3 ratio in our standard drive thru diet. 

Go strictly carnivore for 1 week and see how it feels.

Absolutely ensure you do not eat anything processed in that week. no polyunsaturated seed oils. Soy, canola etc.  Mayo, peanut butter and dressing were the hardest for me to quit.  All my lifelong joint pain and swelling is gone, unless i flirt with just a little seed oil.  If so, That night i will be kept up by pain in knees elbows spine knuckles etc.


Eat all the meat eggs dairy fish seafood butter cheese and tree nuts you can. Coffee, water, tea, milk for beverages.. minimal sugar.  Itll change your everything.

[firefighter ontheside]

Thanks for the suggestions, Mike.  I definitely need to cut back on sugar and have been working on it the last few weeks.

[doctorb]

While there are all kinds of alternative and nutritional medical philosophies out there, the idea that a week or two dietary change can cure lateral epicondylitis is probably overly optimistic  Give the dietary regimen a try if you wish, but I would not hold out much hope.  This is an area of tendon attachment which has a relatively poor blood supply, which gets repeatedly re-injured with common daily activities.   PT with strengthening, tendonitis elbow straps, altering daily activities, and injections are standard therapies.  it takes a long time for this to get better.

[mike_belben]

I required 2 shoulder surgeries for years while i waited to win my lawsuit to get them done.  I am a righty and hurt my right shoulder at work first, then my left, but the company doc referred me to  physical therapy under my private insurance rather than comp on purpose (which is what he did to everyone during his career to protect the self insured account from paying out.)  Once i went to that first PT, comp got to call it a private injury and private insurance then said no way, you got hurt at work so i was stuck between the twin money pillars.  I learned from my right shoulder mistakes how to make the claim for my left that eventually i won in comp court. They cut out a redundant shoulder tendon, sawed back a bone and deburred under the hood.  After about a year of terrible pain from the surgery in 2011 right when my daughter arrived, the left became my strong shoulder and my right remained weak and at times agonizing but between the lawsuit aggravation, the surgery trauma, losing houses, fleeing taxachusetts and barely surviving on hard manual labor like logging and quarrying i just said forget it, i cant have it fixed, i will live in pain and consider myself a lefty.  Ive got the images of a torn left tendon that was discovered in the procedure and still, the left became my strong side because the right was so bad.  The left always hurt too.  I never slept because of pain, thats why i know so much useless information.. i was always up reading boring technical crap overnight to fall asleep thru low level continual pain.



Today i avoid processed food, sugar, seed oils and polyunsaturated fats. I quit bread/wheat upon discovery of what your stomach SHOULD feel like after a 2 day fast.  it was the staple of my life and had me thinking low level stomach pain was normal for 40some years. I now eat a huge amount of saturated fat mostly via butter and all my inflammation is gone.  When my white blood count is nearing 7 i am a hurtin all over and i can turn that all back on with 2 days of wrong eating. Ive got a fused C2/C3, several degenerated lumbar disc images, stenosis between some mid back vertebrae, a torn knee from 30 yrs ago, etc etc etc. 

With correct diet none of it bothers me anymore.  Im 43, i can do 20 pullups and run 3ks again every day if i want. I feel better than i did whe. I got out of the marines at 23 and that was also as a surfer in hawaii so i paddled for miles and miles.. i wasnt underexercised and i lived in chronic pain, lived on 1000mg naprosyns every day.

Today my WBC stays in the 5s and my right shoulder, with zero repair work, is the strong one again.  Neither one hurts at all.

So you guys take it for what its worth.  Eat whatever you want and endure the pain, or give up what you love to taste and get a level of pain relief you never experienced before.  Id rather eat zero, and often do for a day or two, than go back.   Best sleep, best mental and physical feeling ive ever had Praise the Lord. My only use for health insurance anymore is to pay for labs to put numbers to the feelings.    Quest labs say normal white blood count high limit is 10.  You dont want to feel a level 10.. youll swear you need surgery on every inch of your body.

So yeah, a week of carnivore wont repair a series injury bit the inflammation reduction will be so drastic anyone who tries it will want to stay pretty close to it.  If i say change your diet for ever no one is gonna do that.  We have all been told to eat right our whole lives and no one ever does. Im not saying carnivore is the only way.. a fast is even better but no one jumps at the chance to stop eating until theyve adapted to ketosis/lipolysis at which time fasting becomes really easy and pain free.  We all need a week of overeating meat, eggs and dairy to ween off carbs.  Extremely addictive.  Now they make me literally sick.

[mike_belben]

While there are all kinds of alternative and nutritional medical philosophies out there,

Doc essentially said something a bit similar on Eds thread thats been on my mind lately and im ready to respond.  Discovering what we truly should eat ought to be primary, not alternative.  Having organs tossed out and taking meds for life that absolutely kill other organs is what should be considered alternative.  Methotrexate for psoriasis shouldnt be the standard of care.. thats the standard of criminal in my opinion and it has wrecked a part of life for my household. 

[doc henderson]

Mike I appreciate your enthusiasm.  I agree many medical issues could be avoided with lifestyle changes.  Most of the patients get to us after that is no longer preventative and not curative.  The ones that get this advice are still young and healthy, and the majority ignore that advice, or lack the long-term commitment to it.  Again, I know you express your respect for the few docs on the forum, so the word "criminal" implies intent to harm others.  The system is a mess, and we are doing the best we can in that system.  You are for sure entitled to your opinion, but in general, Docs are not meaning to harm anyone. 

[Dan_Shade]

I think I'm suffering a case of this in my right arm.  Hurts to pick anything up that requires a squeeze (like a cup/pitcher/firewood).

I think I caused it by loading firewood into my pickup.  Possibly previously aggrivated by starting a  cranky 660.

Any tips on excercizes?

[doc henderson]

If acute, then ICE.  ice, compression, and elevation.  ibuprofen if you can take it (no stomach or kidney issues, not on blood thinners) and a brace if it continues.  PT if you dr. can refer you.  the latter is for more long standing.  avoid for a while the stuff that makes it hurt, and try stretching. 

Lateral Epicondylitis (Tennis Elbow) | Johns Hopkins Medicine

[mike_belben]

If you experience relief from any sort of over the counter anti inflammatory med, then that proves inflammation is a contribitor. 

To take any of these meds long term as i did, will attack your intestines' protective mucosal epithelial lining over time.  That allows the sewage of pathogenic invaders that your intestines are designed to corral to the toilet, to directly attack your epithelial tight junctions and eventually perforate them on a microscopic level.  Then you have a sieve with holes.. aka "leaky gut"

The next step is that your immune mast cells start picking up distress calls as foreign particles spill out where they dont belong and the immune system launches full scale attacks wherever they may land.  Much suffering and lost wages later you get an autoimmine diagnosis named after whichever weak link in your unique anatomy breaks first, and the cure is no cure at all.. to "manage" it by supressing the immune system that you depend on to keep you alive. So really the cure is a delorian to go back in time and prevent that problem before it started.  Today might not technically be the best day, but today is better than tomorrow to start reversing.  Youre better off putting a truck in park before it rolls down the hill than after.

The moral of the story is to not depend on anti inflammatory meds because not all mucosal barriers are created equal and i think doc is also suggesting that as well.  The studies that look at side effects are hired out by the med manufacturer and are designed specifically to pre exclude from the trial anyone likely to have adverse reaction so the numbers look better.

If inflammation is causing you discomfort, do everything possible to lower it by dietary avoidance of inflammatory stuff and increase of anti inflammatory stuff. You can measure inflammation levels by looking at a host of markers that may or may not be there.

White blood count/ wbc ( most routinely tested)
Pla2 or "plac2" or hp-pla2
ESR
Fibrinogen
Oxidized LDL or oxLDL
CRP or C reactive protein
MPO or myelo peroxidase
SAA or serum amyloid A

Any of these being up is indicative of inflammatory activity.  Inflammation is a neccessary ingredient in most brands of slow death so you wanna spot it early on.


If you give a kid free tires for life he does lots of burnouts.  If you give a carpenter free wood he makes lots of wood stuff.  If you feed your body abundant omega 6 fatty acids he makes lots of inflammation.

[firefighter ontheside]

Dan, if with your arm held straight there is pain from pushing on the area at the bone of the outside of your elbow it is likely tennis elbow.  As Doc said, icing in the evening to help with pain and swelling.  To stretch it, hold your arm out straight, rotate your wrist so that your palm is facing away from your body, then with the other hand flex your hand.  You should feel the stretch right where you need it.  Don't over-do that stretch if it hurts badly.  You can pick up a band at Walgreens that applies pressure on your forearm just distal to your elbow.  That helps to take up some of the strain that is placed on the area of pain.  I've learned to do some of my activities in a way that doesn't require those muscles as much.  When I carry a bucket of water for my goats for instance, I will carry it such that my palm is rotated out instead of in.  That puts the strain on the muscle of the inner forearm instead of outer.  Also, steroid injections can eliminate the pain for a while.  For some, like me, the pain comes back after a few months.  For others it may never come back.

My surgery is in 2 days and I'm ready.  I'm tired of bumping my elbow on things and it hurting so bad.

[doc henderson]

good luck.  what are they going to do Bill?

[firefighter ontheside]

I had it done 13 years ago to my other elbow.  The way I understand it, they cut the tendon away from the bone, trim the bad end of the tendon off and then suture the end that is left back to the bone.  The scar tissue that forms is what keeps it attached.  This surgeon mentioned that he does it a little different than how the other one did, but I assume the end result is the same.

[firefighter ontheside]

surgery all done.  doctor said my tendon was pretty bad, but surgery was a success.  seems i was in there for 1 1/2 hours.  the nurse was croatian guy and we talked about croatia a bunch.  turns out hes the cousin of another croatian friend of mine.  small world.  bandage comes off in 3 days.  then i have to wear a wrist brace to prevent me from bending wrist, which uses that muscle. 

[thecfarm]

Good luck!!!
I hope all goes well.

[firefighter ontheside]

thanks.  some pain started during the night.  seems the nerve block wore off.  nothiung too bad though.

[doctorb]

I had that surgery too.  I think about it as an attempt to excise an area of chronic inflammation, which is the attachment of your wrist extensor muscles to the lateral epicondyle of the distal humerus.  This damaged area was not able to be rested enough for the attempted healing to outpace the repetitive injury.  Lifting a pot off the stove.  Twisting a tough doorknob.  Shaking hands.  Lots of daily activities that are extremely difficult to avoid recreate this injury constantly.  Most don't end up needing surgery, but a few of us unlucky ones do.  By cutting out the damaged muscle attachment, normal tissue is left behind and the healing progresses without the constant re-injury of inflamed tissue.

[firefighter ontheside]

Thanks for that very good description.  I had the same surgery on my right elbow about 15 years ago and it is doing well.  I just came home from my 2 week surgical followup.  They said it is doing well.  I will start setting up therapy next week for twice a week.  At first they will focus on range of motion and wait til later for strength.  What I remember about last time is that I will need a lot of stretching of my arm.  I go back for next followup in 4 weeks.

[thecfarm]

Sounds like it's going good!!!!!  

[firefighter ontheside]

I guess I should update this.  I'm doing well in  my recovery.  I'd say I'm about 75%.  I'm gonna be going back to work this week on sort of light duty.  I will have a 25lb weight restriction, which means I can't work on a firetruck, but I can do my main job which is Battalion chief.  After my next doctor appt. I may be cleared for everything in mid April.

[Old Greenhorn]

 Glad to read this Bill! Also glad you got through the recovery period (so far) without doing anything dumb to stretch the recovery out. I know many of us (OK, ME) would have trouble sitting around and waiting without 'just tryin to do a little bit of work because I feel good'. I stretched out a shoulder injury by 3 years doing just that. Don't be like Tom.