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Insider Arthritis Tips February 2009 Newsletter
February 15, 2009

Table of Contents



Wei's World

"We must all suffer from one of two pains: the pain of discipline or the pain of regret. The difference is discipline weighs ounces while regret weighs tons."

-- Jim Rohn, Motivational Coach


This condition typically occurs during the 4th and 5th decades of life. Patients describe a history of activities contributing to overuse of the forearm muscles that originate at the elbow. Patients with epicondylitis report pain during or following bending or straightening the elbow.

People with lateral epicondylitis are tender on the outside part of the elbow. They report pain during resisted wrist and finger straightening, and with bending of the wrist with the elbow extended.

People with medial epicondylitis have tenderness along the inside part of the elbow. Pain is worsened by resisted forearm pronation (turning the arm so the palm faces down towards the floor) and resisted wrist bending.

Diagnostic tests such as x-ray, magnetic resonance imaging, and diagnostic ultrasound with Doppler may help confirm the diagnosis.

Of these, x-ray is the least useful.

Careful physical examination to exclude referred pain from the neck or other conditions that mimic epicondylitis such as biceps tendonitis, arthritis, and radial nerve entrapment.

Most patients will have complete resolution of symptoms with arm rest using a strap and anti-inflammatory medicine. Patients with continued symptoms may require further treatment, including physical therapy, injection therapy with glucocorticoid, shock wave therapy, or surgical debridement. An important note: surgery is rarely indicated.

Percutaneous needle tenotomy is a minimally invasive procedure using local anesthetic with ultrasound guidance, where the tendon is “peppered” using a small gauge needle. Platelet rich plasma is then injected. This procedure is usually curative.

Why I love Panera....

Panera Bread is a chain of restaurants that sells baked goods, sandwiches and the like.

My son Benji, like most high school students, had a community service requirement- 100 hours in order to graduate. As a senior in high school, he was fairly close to that number, but my wife wanted to make sure there would be no room for error. So she signed him up for one more project.

Panera bread, as part of their mission statement, is willing to donate all their unsold baked goods at the end of a business day to a charity. But here’s the catch- someone has to be willing to pick it up at closing and deliver it to the charity.

So Benji signed up to do this. Every Tuesday at 9 PM, he goes to Panera Bread in Gaithersburg and takes the baked goods to the men’s shelter on Gude Drive in Rockville.

Now Benji and his mother have been doing this, but one evening, Judy had another commitment so I stepped in to help. We went to Panera and the manager was happy to see us; she collected all the baked goods into a number of large plastic bags. We loaded the bags into the car and drove to the shelter. If you were just driving by without knowing it was there, you would miss the place. It’s a nondescript building. And it’s surrounded by a chain link fence. When we got out, we had a couple of bags slung over our shoulders. On the porch as we entered I saw and heard men smoking and coughing.

The staff announced our arrival. “We have some donations.” And many men came over to help us. I looked around. The room was huge and filled wall to wall with cots. Men were either sitting or lying down on them. Some of the men were young but many were much older.

The look in their eyes spoke of hardship and sadness and ... even hopelessness.

We unloaded about eight or nine big bags. And we kept hearing, “Bless you”... “Thank you”.... and other words of gratitude.

I got a lot out of that experience. Probably a lot more than the men who were receiving the donations. Because it reminded me …despite the ups and downs that hit all of us in life, I need to give thanks for what I have. And second, I realized that it’s important for everyone to do something that helps others that are less fortunate.

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Insider Arthritis Tips A monthly ezine on arthritis written by a board-certified rheumatologist with tons of excellent and useful information for anyone interested in arthritis

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