Some aspects of “Tennis Elbow” with homoepathic mode of treatment

Also referred to as ‘Lateral epicondylitis’, Tennis elbow is an eponym given to many painful conditions about the elbow & is the pain & tenderness on the lateral side of the elbow, some well defined & some vague that results from repetitive stress. Because people who play tennis or other racquet sports sometimes develop this condition due to faulty playing technique, it is known as “tennis elbow”. Tennis elbow usually affects the dominant arm but it can also occur in the nondominant arm or both.

Seen in-
(1)All levels of tennis players in whom ‘Backhand Stroke’ appears to be the prime cause in most of the players but ‘SERVE’ also plays a role.
(2) Seen in other sports also.
(3) May be occupational etc.

Causes in tennis players-A majority of tennis players all over the world are affected with this problem over 35 years of age.
(1)Novice.
(2)Excessive playing of games per week.
(3) Age over 35 years.
(4) Equal sex incidence.
(5)Backhand stroke appears to be the cause in most of the players followed by ‘SERVE’.
But ‘Forehand stroke’, ‘Backhand volley’, ‘Overhead smash’, or ‘Forehand volley’ may play a role.

Contributing factors in tennis players-
(1) Little playing experience.
(2) Consistent missing of ‘sweet spot’ while hitting.
(3) Poor stroke techniques: use of arm instead of body.
(4)Poor power or flexibility.
(5)Heavy stiff racket, large handle size, too tight racket stringing.
(6)Heavy duty wet balls.
(7)Playing surface-balls bounce quicker off the cement court (quicker bouncing like Playing surface).

Sex-It affects men more than women.

Age-It affects people between ages of 30 & 50, although people of any age can get it.

Site of lesion-Lateral tennis elbow involves the common tendon to the extensor muscles of the wrist & hand. The tendon of the extensor carpi radialis brevis has been identified as the most common site of the lesion.

Clinical Features-
Symptoms-At the very beginning due to acute inflammation, the patient complains of pain during activity. The pain is very soon felt both during activity & at rest due to chronic inflammation. Ultimately the patient complains pain at rest, & pain during daily activities & even night pains.

Signs-
(1) Local tenderness over the lateral humeral epicondyle at the common extensor origin with aching pain in the back of the forearm.
(2) Extension of the wrist against resistance with elbow in full extension elicits pain at the outside of the elbow.
(3) Passive wrist flexion & pronation with elbow in extension produces pain.

Investigations- Tennis elbow cannot be diagnosed from blood tests. Radiographs only rarely reveal soft tissue calcification near the lateral humeral epicondyle, & MRI is of questionable aid in making the diagnosis. It is rather usually diagnosed by description of pain & certain findings from physical exam. However, MRI has been shown to be helpful in diagnosing cases of early Tennis elbow.

Differential Diagnosis- Other causes for lateral elbow pain should be considered, including radiocapitellar arthritis & posterior interosseous nerve compression,elbow arthritis, radial tunnel syndrome etc.

Treatment-
[A] General measures to be taken are-
(1) Rest.
(2) Restriction or total stoppage of activities causing pain.
(3) Avoidance of lifting of heavy items especially with palm facing downwards.
(4) Wrapping of a band around forearm near the elbow.
(5) Wearing of a wrist splint.
(6) Exercises to stretch & strength the wrist extensor muscles. But exercise should be started when healing has occurred to the level that the exercises do not increase pain.
(7) Physiotherapy.
(8)In tennis players exercises, light racket, smaller grip, elbow strap etc are helpful.

[B] Homeopathic medicines to be used – Homeopathy plays a vital role in treatment of Tennis elbow. Constitutional treatment is essential specific remedies include Ruta Graveolens (Ruta) & Rhus toxicodendron (Rhus tox). If it is due to any previous injury, Arnica can be very effectively used. If it is supposed to be due to overuse, Bryonia should be tried.

Prevention-
(1) Correct technique of play to be adopted, backhand stroke to be played with whole body & not just with the wrist.
(2) Use of a forearm brace wrist or elbow is weak.
(3) Wet, heavy balls should always be avoided.
(4) Use of a light racket in case of an occasional player.
(5) Strings should not be too tight.
(6) Activities requiring repetitive wrist & forearm motion should be avoided.
(7) Change in size or type of tennis racquet or tool may be helpful.
(8) Change of occupation to prevent further injury may also help in some cases.

In short, Tennis elbow is manifested pain & tenderness on the lateral side of the elbow & is to be treated by Rhus tox, Ruta, Arnica etc.

But in every case, a doctor should be consulted.

Some aspects of Student’s elbow with homoepathic mode of treatment

Also referred to as Olecranon bursitis, it is a chronic inflammation of the olecranon bursa. It is so called as it is found in students who tend to keep their elbows repeatedly over the table, bench etc over long periods during writing, reading etc & the resulting chronic friction leads to its development.

Aetiology -
(1) Repetitive minor injuries or irritation.
(2) Microcrystalline deposition.

Clinical features-
(1) Usually a swelling on the bony bit at the back of the elbow.
(2) Associated pain if there is inflammation.
(3) Gradually pain at rest & during movement of elbow.
(4) Restriction of elbow movement.
(5) On bleeding into the bursa, the swelling as well as the pain increases.

Investigations-Aspiration & culture of the bursal fluid to exclude the possibility of an infectious aetiology.

Treatment-
(1) Rest & protecting the area from any kind of trauma.
(2) Application of ice.
(3) Immobilization of the arm.
(4) Homeopathic medicines to be used are usually Benzoicum acidum (Benz.ac), Bryonia or Belladonna (Bell) etc. The potency & frequency of dosage varies with the severity of the condition & the individual. Usually a lower potency like 30 C is to be used first for thrice daily & to be continued till the persistence of the symptoms.

Prevention-
(1) Wearing of elbow guards during playing a game in which there is a chance of getting hit on the elbows.
(2) Change of writing or reading habits so that leaning on the elbows for long periods of time can be avoided.

Prognosis- Microcrystalline-induced bursitis has a good prognosis & the symptoms usually resolve after a few days, whether treated or not. But bursitis due to repeated minor irritation is more difficult to treat.

In short, Student’s elbow is a chronic inflammation of the olecranon bursa which manifests as a painful swelling over the tip of the olecranon & is to be treated by Benzoicum acidum (Benz.ac), Bryonia or Belladonna (Bell).

But in every case, a doctor should be consulted.

Some aspects of Ganglion with homoepathic mode of treatment

A ganglion is a localized, tense, painless, cystic, swelling, containing clear gelatinous fluid. It is the most common soft-tissue tumour of the hand & wrist.

Pathology- The cystic structure of ganglion is formed from the lining of a joint or tendon & is filled with a gelatinous fluid but without any synovial or epithelial lining. A stalk can sometimes be identified communicating between the cyst & an adjacent joint or tendon sheath.

Sex- Ganglion formation is more common in females.

Age-Late teens & young adulthood.

Sites of location- It is commonly seen over the wrist, digital flexor sheath & distal interphalangeal joint, but it can also develop on the shoulder, elbows & knees.

Predisposing factors- Chronic repetitive stress & sometimes injury. Occupational factors may play a vital role in its development. The occupations which require overuse of certain joints such as the wrist, may pose a risk for development of ganglion.

Associated diseases- Some joint diseases like Rheumatoid arthritis are occasionally found to be associated with ganglion.

Clinical features- Ganglion presents itself usually as a painless swelling adjacent to a joint or a tendon mostly on the wrist, especially on the back side & fingers. It is usually asymptomatic & is primarily a cause of cosmetic rather than a functional disturbance to the affected person. The condition, however, may become symptomatic if the ganglion presses on any nearby structure such as an artery, vein, tendon or nerve when the impingement of such a structure may cause pain, triggering of a tendon or vascular compromise. If a nerve is pressed upon, the resulting pain may cause restriction of movements & activity of the affected person. Dorsal wrist ganglion which is most commonly encountered may be small when it is barely palpable but is usually highly symptomatic whereas if it is large it is often soft & only mildly symptomatic. Flexor sheath ganglion may present as a firm mass over the palmar aspect of the flexor sheath & is often confused with a bone exostosis due to its severe degree of firmness.

Differential Diagnosis- Ganglion may have to be differentiated from certain conditions. A few of them are-

(1) Fibroma.
(2) Lipoma.
(3) Neuroma.
(4) Hamartoma.
(5) Tenosynovitis.

Treatment- Homeopathy medicine improves re-absorption of fluid from the ganglion & thus cures the condition. In addition chance of recurrence is minimal. Favourable results are usually noticed within 3-6 months. Treatment should be followed till it subsides wholly; otherwise there is chance of recurrence. Calcarea Fluorica (Calc flour) 200 twice daily or Ruta Graveolens (Ruta) 200 twice daily may be used. Ruta may also be used as a local application over the site of ganglion formation. Other medicines which can also be used include Rhus toxicodendron (Rhus tox), Benzoicum acidum ( Benz.ac), Thuya etc.

Prognosis- Ganglion may increase in size or may disappear spontaneously.

In short, ganglion is a painless, cystic swelling found near a joint or a tendon & is treated by Calcarea fluorica or Ruta.

But in every case, a doctor should be consulted.