>The Original Tennis Elbow

>I’m now taking an advanced physical exam course, and as part of it, we are given the original articles describing some of these physical exam findings. I just liked the way the one presented today was written and have included a few highlights. Journals definitely seemed to have a bit more panache back then (and are not available online as PDFs!)

The Treatment of “Tennis Elbow”

G. Percival Mills

British Medical Journal, Jan 7, 1928

There is probably nothing which brings the surgical profession into greater discredit at the present time than its inability to cure a “tennis elbow”.  The condition is extremely common, and so helpless have we been in its treatment that most sufferers now never consider consulting a medical man at all.. For while we have been gravely considering what may be the pathology of a curious condition the osteopaths  and non medical manipulators have been curing the patients in hundreds.  Let us neglect the pathology and consider what we really know about it clinically.

In the first place it is most confined to tennis players, golfers and workers in certain trades which involve the constant use of a hammer.

Secondly, the onset of the condition is insidious: there is seldom a history of any sudden strain or accident.

Thirdly, the patient can commonly do anything with his arm without pain except  the particular exercise with which the pain is associated.  On the other hand, during the acute stage at any rate, a patient may suddenly bungle some perfectly simple action owing to his accidentally getting his arm into the position which produces the pain.  A favorite trick of this sort is to drop a tea cup when reaching out the hand to take it from a tray.. Indeed, the action of holding a tea cup will often produce the pain of tennis elbow, and the fact is of help in making a diagnosis.

Fourthly, in the acute stage, which may come on rather suddenly and in which the patient simply cannot hold a racket at all, there is very strong subject sensation that “something is out of place”.

Fifthly, all these symptoms are present without any physical signs adequate to explain them.  This represents only a superficial point of view and is not strictly true. i shall return to it later.

Finally, the condition is frequently cured by non medical manipulators by some form of forcible manipulation. The test of cure is that the patient can play tennis without pain, or with only a feeling of soreness quite different from the incapacitation pain…..

….My first case was rather dramatic.  The patient was a big strong man, and I insisted on an anaesthetic.  Under nitrous oxide I wrenched the arm as follows; with the wrist and fingers flexed and the forearm fully pronated I forced the elbow into hyper-extension, making at the same time firm pressure with my left thumb over the tender spot by the external epicondyle.  There was a snap like a pistol shot and the horrified anesthetist insisted that I had broken the arm.. The cure was as dramatic as the manipulation.  it was a long standing case and had been very severe, but the patient assured me that for the first time for many years he was able to take a hard back hand volley without pain. …

About ER Jedi

I’m a resident doctor in Emergency Medicine and I’ve learned during the past few years that 1) I’ve had some pretty amazing experiences 2) I have a very bad short-term memory. So this blog is just a place for me to write about some of these experiences, from the ER, medical school, the wards and life in general. At least that way I’ll have some idea as to where I’ve been all this time. A scrap-book of sorts, a place to vent, organize some clinical tools and post a few good songs I’ve heard along the way.

Posted on February 1, 2011, in Back when I was your age.... Bookmark the permalink. Leave a comment.

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