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Platelet Rich Plasma Therapy (PRP)

Platelet Rich Plasma (PRP)

In many recent years, much has been written about a preparation called platelet-rich plasma (PRP) and its potential effectiveness in the treatment of sports injuries.

Many famous athletes — Tiger Woods, tennis star Rafael Nadal, and several others — have received PRP for various problems, such as sprained knees and chronic tendon injuries. These types of conditions have typically been treated with medications, physical therapy, or even surgery. Some athletes have credited PRP with their being able to return more quickly to competition.

Even though PRP has received extensive publicity, there are still lingering questions about it, such as:

  • What exactly is platelet-rich plasma?
  • How does it work?
  • What conditions are being treated with PRP?
  • Is PRP treatment effective?

What Is Platelet-rich Plasma (PRP)?

Although blood is mainly a liquid (called plasma), it also contains small solid components (red cells, white cells, and platelets.) The platelets are best known for their importance in clotting blood. However, platelets also contain hundreds of proteins called growth factors which are very important in the healing of injuries.

PRP is plasma with many more platelets than what is typically found in blood. The concentration of platelets — and, thereby, the concentration of growth factors — can be 5 to 10 times greater (or richer) than usual.

To develop a PRP preparation, blood must first be drawn from a patient. The platelets are separated from other blood cells and their concentration is increased during a process called centrifugal. Then the increased concentration of platelets is combined with the remaining blood

How Does PRP Work?

Although it is not exactly clear how PRP works, laboratory studies have shown that the increased concentration of growth factors in PRP can potentially speed up the healing process.

To speed healing, the injury site is treated with the PRP preparation. This can be done in one of two ways:

  • PRP can be carefully injected into the injured area. For example, in Achilles tendonitis, a condition commonly seen in runners and tennis players, the heel cord can become swollen, inflamed, and painful. A mixture of PRP and local anesthetic can be injected directly into this inflamed tissue. Afterwards, the pain at the area of injection may actually increase for the first week or two, and it may be several weeks before the patient feels a beneficial effect.
  • PRP may also be used to improve healing after surgery for some injuries. For example, an athlete with a completely torn heel cord may require surgery to repair the tendon. Healing of the torn tendon can possibly be improved by treating the injured area with PRP during surgery. This is done by preparing the PRP in a special way that allows it to actually be stitched into torn tissues.

What Conditions are Treated with PRP? Is It Effective?

Research studies are currently being conducted to evaluate the effectiveness of PRP treatment. At this time, the results of these studies are inconclusive because the effectiveness of PRP therapy can vary. Factors that can influence the effectiveness of PRP treatment include:

  • The area of the body being treated
  • The overall health of the patient
  • Whether the injury is acute (such as from a fall) or chronic (an injury developing over time)

Chronic Tendon Injuries

According to the research studies currently reported, PRP is most effective in the treatment of chronic tendon injuries, especially tennis elbow, a very common injury of the tendons on the outside of the elbow.

An injection of PRP is used to treat tennis elbow.

The use of PRP for other chronic tendon injuries — such as chronic Achilles tendonitis or inflammation of the patellar tendon at the knee (jumper’s knee) is promising. However, it is difficult to say at this time that PRP therapy is any more effective than traditional treatment of these problems.

Acute Ligament and Muscle Injuries

Much of the publicity PRP therapy has received has been about the treatment of acute sports injuries, such as ligament and muscle injuries. PRP has been used to treat professional athletes with common sports injuries like pulled hamstring muscles in the thigh and knee sprains. There is no definitive scientific evidence, however, that PRP therapy actually improves the healing process in these types of injuries.

Surgery

More recently, PRP has been used during certain types of surgery to help tissues heal. It was first thought to be beneficial in shoulder surgery to repair torn rotator cuff tendons. However, the results so far show little or no benefit when PRP is used in these types of surgical procedures.

Surgery to repair torn knee ligaments, especially the anterior cruciate ligament (ACL) is another area where PRP has been applied. At this time, there appears to be little or no benefit from using PRP in this instance.

Knee Arthritis

Some initial research is being done to evaluate the effectiveness of PRP in the treatment of the arthritic knee. It is still too soon to determine if this form of treatment will be any more effective than current treatment methods.

Fractures

PRP has been used in a very limited way to speed the healing of broken bones. So far, it has shown no significant benefit.

Summary:

Treatment with platelet-rich plasma holds great promise. Currently, however, the research studies to back up the claims in the media are lacking. Although PRP does appear to be effective in the treatment of chronic tendon injuries about the elbow, the medical community needs more scientific evidence before it can determine whether PRP therapy is truly effective in other conditions.

Even though the success of PRP therapy is still questionable, the risks associated with it are minimal: There may be increased pain at the injection site, but the incidence of other problems — infection, tissue damage, nerve injuries — appears to be no different from that associated with cortisone injections.

If you are considering treatment with PRP, be sure to check your eligibility with your health insurance carrier. Few insurance plans, including workers’ compensation plans, provide even partial reimbursement.

To schedule for an Appointment, please call us at +65 6471 2744 or SMS to: +65 9235 7641 (24 Hours)

Achilles Tendon Rupture

Are you suffering from Achilles Injury? Not being able to walk normally and tip-toeing? You are at the Right Place. Get immediate treatment on your Achilles Injury today. Call +65 64712744 or SMS to +65 92357641 for Appointment.

A total rupture of the achilles tendon is a complete tear of the tendon and typically affects men over the age of 40 involved in recreational sport.

A complete rupture of the achilles tendon is not always recognized at the time of injury, however it is very important it is treated properly as soon as possible to increase the chances of a good recovery.

Symptoms

Symptoms include a sudden sharp pain in the achilles tendon which is often described as if being physically struck by an object or implement. A load snapping noise or bang may also be heard at the time. A gap of 4 to 5 cm in the tendon can be felt which may be less obvious later as swelling increases.

After a short while the athlete may be able to walk again but without the power to push off with the foot. There will be a significant loss of strength in the injured leg and the patient will be unable to stand on tip toes. There may be considerable swelling around the achilles tendon and a positive result for Thompson’s test can help confirm the diagnosis.

Treatment

If you suspect a total rupture of the achilles tendon then apply cold therapy and compression and seek medical attention as soon as possible. In most cases surgery is required and the sooner this takes place the higher the chances of success. If the injury is left longer than two days then the chances of a successful outcome decrease. Cold and compression can also be applied throughout the rehabilitation phase as swelling is likely to be an issue with such a serious injury.

A medical professional will take MRI scans to confirm the diagnosis and indicate the extent of the injury. Sometimes the leg is put in a cast and allowed to heal without surgery. This is generally not the preferred method, particularly for young active people. Surgery is the most common treatment for an achilles tendon rupture. 

You can expect to be out of competition for 6 to 9 months after achilles tendon surgery. This is increased to 12 months if the ankle is immobilized in plaster instead of operated on. There is also a greater risk of re-injury if you do not have the surgery.

A complete rupture of the achilles tendon is a serious injury and rehabilitation should be a very gradual process taking 6 to 9 months.

The following guidelines are for information purposes only. We recommend seeking professional advice before attempting any self treatment.

Aim of rehabilitation

  • To allow the tendon to heal, reducing pain swelling and inflammation.
  • To restore the tendon and muscles to their original flexibility and strength.
  • To gradually return to normal activity and training levels.

There are two methods of treatment; surgical and non surgical or conservative. The speed at which a patient can progress with the rehabilitation will vary and should at all times be done under the supervision of a qualified professional. The timescales indicated below are only a rough guide and you should always take the advice of your consultant.

Surgical approach

The surgical approach is usually the preferred one, especially for young and active people. Immediately following injury the principles of PRICE should be followed which are protection rest, ice, compression, elevation. Go as soon as you can to a sports medicine professional or accident and emergency unit. Surgery will usually be performed within 48 hours or as soon as possible.

Non surgical approach

This will follow a similar pattern to that of the surgical approach although will take a lot longer. A plaster cast will be applied in a plantar flexed position (toes and foot pointing down). Sometimes after four weeks this may be altered to allow less plantar flexion. After 8 weeks the tendon is usually healed.

Rehabilitation program

Week 1 to 8

  • A plaster cast is applied after surgery.
  • No stretching or exercise, just let it heal.
  • You may be able to work the upper body.
  • Try to do something positive, it will certainly help your state of mind.

Week 8 onwards

Stage 1 – range of motion and flexibility.

  • Place heel raises (1-2cm) in the shoes to take some of the pressure off the achilles tendon.
  • Sports massage techniques and ultrasound can aid in this process by helping to realign the new fibres in line with the tendon.
  • Active stretching. Pull your toes upwards to stretch the achilles tendon. Very gently at first and gradually build up.
  • If active stretches produce no pain then passive stretches can commence. This involves someone or something assisting in the stretching process.
  • When a full range of motion has returned (the ruptured leg is as flexible as the other leg) then a gradual strengthening programme can start.
  • Balance exercises should also be introduced as the sense of balance and positioning is often decreased after tendon or ligament ruptures and if not re-gained, can lead to future injuries. Wobble boards (balance boards) are great for this.

Sports massage can play a part in the rehabilitation of this injury by improving blood flow to the area, helping the muscles relax and become more supple.

Stage 2: Strengthen the achilles tendon and calf muscles.

  • Great care must be taken when commencing a strengthening programme. There is a fine line between strengthening the tendon and re-injuring it.
  • You can start strengthening exercises as soon as they can be tolerated. It may be a full month after the cast comes off before exercises can begin.
  • The athlete may feel a little pain when you first start these exercises. If the pain is intolerable then do not continue.
  • Gradually each day the pain should be less. The athlete should not attempt to increase the level of exercise until there is no pain during or after the exercises.
  • The strengthening exercises must be done after a gentle warm up and stretch. The muscles can be warmed up by raising the heels up and down on the toes while seated. Heat applied directly to the tendon for example by a hot water bottle can also help.
  • Flexibility training must be continued throughout.
  • Remember to apply cold therapy or ice after exercise, this will help keep inflammation down.
  • Avoid explosive or ballistic movements or this may lead to a re-rupture.

Return to fitness 

  • When the patient has gone at least a week without pain then they may begin to return to training.
  • If they feel pain when returning to training then stop. Begin each training session with a walk to warm up followed by stretching.

Day 1: walk 4 minutes jog 2 minutes repeat four times

Day 2: rest

Day 3: walk 4 minutes jog 3 minutes repeat three times

Day 4: rest

Day 5: walk 3 minutes jog 4 minutes repeat 4 times

Day 6: rest

Day 7: walk 2 minutes jog 6 minutes repeat 4 times

Continue this gradual progression until you can confidently run and resume normal training.

How long until I am back to full fitness?

  • Most athletes can expect to be out of competition for 6 to 9 months after surgery.
  • This is increased to 12 months if the achilles was immobilized in plaster instead of operated on. There is also a greater risk of re injury if the athlete does not have the surgery.

CURE YOUR ACHILLES TENDON RUPTURE TODAY! CALL US AT +65 64712744 OR EMAIL TO: INFO@BONECLINIC.COM.SG FOR APPOINTMENT

Rotator Cuff Injury

When one or more of the rotator cuff tendons is torn, the tendon no longer fully attaches to the head of the humerus. Most tears occur in the supraspinatus muscle and tendon, but other parts of the rotator cuff may also be involved.

In many cases, torn tendons begin by fraying. As the damage progresses, the tendon can completely tear, sometimes with lifting a heavy object.

There are different types of tears.

  • Partial Tear. This type of tear damages the soft tissue, but does not completely sever it.
  • Full-Thickness Tear. This type of tear is also called a complete tear. It splits the soft tissue into two pieces. In many cases, tendons tear off where they attach to the head of the humerus. With a full-thickness tear, there is basically a hole in the tendon.

Cause

There are two main causes of rotator cuff tears: injury and degeneration.

Acute Tear

If you fall down on your outstretched arm or lift something too heavy with a jerking motion, you can tear your rotator cuff. This type of tear can occur with other shoulder injuries, such as a broken collarbone or dislocated shoulder.

Degenerative Tear

Most tears are the result of a wearing down of the tendon that occurs slowly over time. This degeneration naturally occurs as we age. Rotator cuff tears are more common in the dominant arm. If you have a degenerative tear in one shoulder, there is a greater risk for a rotator cuff tear in the opposite shoulder — even if you have no pain in that shoulder.

Several factors contribute to degenerative, or chronic, rotator cuff tears.

  • Repetitive stress. Repeating the same shoulder motions again and again can stress your rotator cuff muscles and tendons. Baseball, tennis, rowing, and weightlifting are examples of sports activities that can put you at risk for overuse tears. Many jobs and routine chores can cause overuse tears, as well.
  • Lack of blood supply. As we get older, the blood supply in our rotator cuff tendons lessens. Without a good blood supply, the body’s natural ability to repair tendon damage is impaired. This can ultimately lead to a tendon tear.
  • Bone spurs. As we age, bone spurs (bone overgrowth) often develop on the underside of the acromion bone. When we lift our arms, the spurs rub on the rotator cuff tendon. This condition is called shoulder impingement, and over time will weaken the tendon and make it more likely to tear.

Risk Factors

Because most rotator cuff tears are largely caused by the normal wear and tear that goes along with aging, people over 40 are at greater risk.

People who do repetitive lifting or overhead activities are also at risk for rotator cuff tears. Athletes are especially vulnerable to overuse tears, particularly tennis players and baseball pitchers. Painters, carpenters, and others who do overhead work also have a greater chance for tears.

Although overuse tears caused by sports activity or overhead work also occur in younger people, most tears in young adults are caused by a traumatic injury, like a fall.

Symptoms

The most common symptoms of a rotator cuff tear include:

  • Pain at rest and at night, particularly if lying on the affected shoulder
  • Pain when lifting and lowering your arm or with specific movements
  • Weakness when lifting or rotating your arm
  • Crepitus or crackling sensation when moving your shoulder in certain positions

Tears that happen suddenly, such as from a fall, usually cause intense pain. There may be a snapping sensation and immediate weakness in your upper arm.

A rotator cuff injury can make it painful to lift your arm out to the side.

Tears that develop slowly due to overuse also cause pain and arm weakness. You may have pain in the shoulder when you lift your arm to the side, or pain that moves down your arm. At first, the pain may be mild and only present when lifting your arm over your head, such as reaching into a cupboard. Over-the-counter medication, such as aspirin or ibuprofen, may relieve the pain at first.

Over time, the pain may become more noticeable at rest, and no longer goes away with medications. You may have pain when you lie on the painful side at night. The pain and weakness in the shoulder may make routine activities such as combing your hair or reaching behind your back more difficult.

Doctor Examination

Medical History and Physical Examination

Your doctor will test your range of motion by having you move your arm in different directions.

After discussing your symptoms and medical history, your doctor will examine your shoulder. He or she will check to see whether it is tender in any area or whether there is a deformity. To measure the range of motion of your shoulder, your doctor will have you move your arm in several different directions. He or she will also test your arm strength.

Your doctor will check for other problems with your shoulder joint. He or she may also examine your neck to make sure that the pain is not coming from a “pinched nerve,” and to rule out other conditions, such as arthritis.

Imaging Tests

Other tests which may help your doctor confirm your diagnosis include:

  • X-rays. The first imaging tests performed are usually x-rays. Because x-rays do not show the soft tissues of your shoulder like the rotator cuff, plain x-rays of a shoulder with rotator cuff pain are usually normal or may show a small bone spur.
  • Magnetic resonance imaging (MRI) or ultrasound. These studies can better show soft tissues like the rotator cuff tendons. They can show the rotator cuff tear, as well as where the tear is located within the tendon and the size of the tear. An MRI can also give your doctor a better idea of how “old” or “new” a tear is because it can show the quality of the rotator cuff muscles.

Treatment

If you have a rotator cuff tear and you keep using it despite increasing pain, you may cause further damage. A rotator cuff tear can get larger over time.

Chronic shoulder and arm pain are good reasons to see your doctor. Early treatment can prevent your symptoms from getting worse. It will also get you back to your normal routine that much quicker.

The goal of any treatment is to reduce pain and restore function. There are several treatment options for a rotator cuff tear, and the best option is different for every person. In planning your treatment, your doctor will consider your age, activity level, general health, and the type of tear you have.

There is no evidence of better results from surgery performed near the time of injury versus later on. For this reason, many doctors first recommend nonsurgical management of rotator cuff tears.

Nonsurgical Treatment

In about 50% of patients, nonsurgical treatment relieves pain and improves function in the shoulder. Shoulder strength, however, does not usually improve without surgery.

Nonsurgical treatment options may include:

  • Rest. Your doctor may suggest rest and and limiting overhead activities. He or she may also prescribe a sling to help protect your shoulder and keep it still.
  • Activity modification. Avoid activities that cause shoulder pain.
  • Non-steroidal anti-inflammatory medication. Drugs like ibuprofen and naproxen reduce pain and swelling.
  • Strengthening exercises and physical therapy. Specific exercises will restore movement and strengthen your shoulder. Your exercise program will include stretches to improve flexibility and range of motion. Strengthening the muscles that support your shoulder can relieve pain and prevent further injury.
  • Steroid injection. If rest, medications, and physical therapy do not relieve your pain, an injection of a local anesthetic and a cortisone preparation may be helpful. Cortisone is a very effective anti-inflammatory medicine.

The chief advantage of nonsurgical treatment is that it avoids the major risks of surgery, such as:

  • Infection
  • Permanent stiffness
  • Anesthesia complications
  • Sometimes lengthy recovery time

The disadvantages of nonsurgical treatment are:

  • No improvements in strength
  • Size of tear may increase over time
  • Activities may need to be limited

Surgical Treatment

Your doctor may recommend surgery if your pain does not improve with nonsurgical methods. Continued pain is the main indication for surgery. If you are very active and use your arms for overhead work or sports, your doctor may also suggest surgery.

Other signs that surgery may be a good option for you include:

  • Your symptoms have lasted 6 to 12 months
  • You have a large tear (more than 3 cm)
  • You have significant weakness and loss of function in your shoulder
  • Your tear was caused by a recent, acute injury

Surgery to repair a torn rotator cuff most often involves re-attaching the tendon to the head of humerus (upper arm bone). There are a few options for repairing rotator cuff tears. Your orthopaedic surgeon will discuss with you the best procedure to meet your individual health needs.

Cure Your Rotator Cuff Injury today. Call us at +65 6471 2744 or Email to: info@boneclinic.com.sg for Appointment.

Patient Guide to Frozen Shoulder

Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by stiffness and pain in your shoulder joint. Signs and symptoms typically begin gradually, worsen over time and then resolve, usually within one or two years.

Your risk of developing frozen shoulder increases if you’re recovering from a medical condition or procedure that affects the mobility of your arm — such as a stroke or a mastectomy.

Treatment for frozen shoulder involves stretching exercises and, sometimes, the injection of corticosteroids and numbing medications into the joint capsule. In a small percentage of cases, surgery may be needed to loosen the joint capsule so that it can move more freely.

SYMPTOMS OF FROZEN SHOULDER

Frozen shoulder typically develops slowly, and in three stages. Each of these stages can last a number of months.

  • Painful stage. During this stage, pain occurs with any movement of your shoulder, and your shoulder’s range of motion starts to become limited.
  • Frozen stage. Pain may begin to diminish during this stage. However, your shoulder becomes stiffer, and your range of motion decreases notably.
  • Thawing stage. During the thawing stage, the range of motion in your shoulder begins to improve.

For some people, the pain worsens at night, sometimes disrupting normal sleep patterns.

CAUSES OF FROZEN SHOULDER

The bones, ligaments and tendons that make up your shoulder joint are encased in a capsule of connective tissue. Frozen shoulder occurs when this capsule thickens and tightens around the shoulder joint, restricting its movement.

Doctors aren’t sure why this happens to some people and not to others, although it’s more likely to occur in people who have recently experienced prolonged immobilization of their shoulder, such as after surgery or an arm fracture.

RISK FACTORS OF FROZEN SHOULDER

Although the exact cause is unknown, certain factors may increase your risk of developing frozen shoulder.

Age and sex
People 40 and older are more likely to experience frozen shoulder. Most of the people who develop the condition are women.

Immobility or reduced mobility
People who have experienced prolonged immobility or reduced mobility of their shoulder are at higher risk of developing frozen shoulder. Immobility may be the result of many factors, including:

  • Rotator cuff injury
  • Broken arm
  • Stroke
  • Recovery from surgery

Systemic diseases
People who have certain medical problems appear to be predisposed to develop frozen shoulder. Examples include:

  • Diabetes
  • Overactive thyroid (hyperthyroidism)
  • Underactive thyroid (hypothyroidism)
  • Cardiovascular disease
  • Tuberculosis
  • Parkinson’s disease

TESTS AND DIAGNOSIS:

During the physical exam, your doctor may ask you to perform certain actions, to check for pain and evaluate your range of motion. These may include:

  • Hands up. Raise both your hands straight up in the air, like a football referee calling a touchdown.
  • Opposite shoulder. Reach across your chest to touch your opposite shoulder.
  • Back scratch. Starting with the back of your hand against the small of your back, reach upward to touch your opposite shoulder blade.

Your doctor may also ask you to relax your muscles while he or she moves your arm for you. This test can help distinguish between frozen shoulder and a rotator cuff injury.

Frozen shoulder can usually be diagnosed from signs and symptoms alone. But your doctor may suggest imaging tests — such as X-rays or an MRI — to rule out other structural problems.

TREATMENTS AND DRUGS:

Most frozen shoulder treatment involves controlling shoulder pain and preserving as much range of motion in the shoulder as possible.

Medications
Over-the-counter pain relievers, such as aspirin and ibuprofen (Advil, Motrin, others), can help reduce pain and inflammation associated with frozen shoulder. In some cases, your doctor may prescribe stronger pain-relieving and anti-inflammatory drugs.

Therapy
A physical therapist can teach you stretching exercises to help maintain as much mobility in your shoulder as possible.

Surgical and other procedures
Most frozen shoulders get better on their own within 12 to 18 months. For persistent symptoms, your doctor may suggest:

  • Steroid injections. Injecting corticosteroids into your shoulder joint may help decrease pain and improve shoulder mobility.
  • Joint distension. Injecting sterile water into the joint capsule can help stretch the tissue and make it easier to move the joint.
  • Shoulder manipulation. In this procedure, you receive a general anesthetic so you’ll be unconscious and feel no pain. Then the doctor moves your shoulder joint in different directions, to help loosen the tightened tissue. Depending on the amount of force used, this procedure can cause bone fractures.
  • Surgery. If nothing else has helped, you may be a candidate for surgery to remove scar tissue and adhesions from inside your shoulder joint. Doctors usually perform this surgery arthroscopically, with lighted, tubular instruments inserted through small incisions around your joint.

PREVENTION OF FROZEN SHOULDER:

One of the most common causes of frozen shoulder is the immobility that may result during recovery from a shoulder injury, broken arm or a stroke. If you’ve had an injury that makes it difficult to move your shoulder, talk to your doctor about what exercises would be best to maintain the range of motion in your shoulder joint.

CURE YOUR FROZEN SHOULDER TODAY! CALL +65 6471 2744 OR EMAIL TO: info@boneclinic.com.sg TO SCHEDULE FOR AN APPOINTMENT

Top 10 Sports Injuries

The most common sports-related injuries primarily are overuse injuries. As the name implies, an overuse injury results from wear and tear on the body, particularly on joints subjected to repeated activity.

Certain types of injuries plague sports participants. Most of them, however, are minor. Knowing the early signs and what to do can help prevent them from becoming nagging problems.

Here’s a look, from head to toe, at the Top Ten sports injuries you’re most likely to face:

Muscle Pull
Probably the most common sports injury is a muscle pull, which can happen to almost any muscle in the body. No matter how diligently you warm up and stretch, or cool down and stretch, you may pull a muscle from overuse, fatigue or taking a fall. There is little you can be done to prevent a muscle pull except to stay limber and work your muscles regularly.

A muscle pulls when a sudden, severe force is applied to the muscle and the fibers are stretched beyond their capacity. If only some of the fibers tear, that is a muscle pull. If most of the fibers tear, that is a muscle tear.

Neck Pain

A pulled muscle or a muscle spasm in the neck can happen when a tennis player looks up to serve or hit an overhead smash. The pain is on one side of the neck, and the neck may be pulled over slightly to that side. It is particularly painful to turn the head in the direction of the pain. That is, if the pain is on the left side of the neck, the player can turn to the right, but not to the left.

Cyclists who use racing handlebars may also feel neck stiffness. With your back bent low over the handlebars, you have to tilt your neck up to see ahead. After a long ride, the neck muscles may tighten up and go into spasm from this awkward position.

Shoulder Impingement
The shoulder bones are held together by a group of muscles known as the rotator cuff muscles. These muscles (supraspinatus, infraspinatus, subscapularis and teres minor) are responsible for the shoulder’s fine movements, such as throwing a ball. Because of the shoulder’s shallow socket and lack of ligament strength, any weakness of the small, rotator cuff muscles makes it easy for the head of the shoulder to slide around in the joint.

If the shoulder joint is continually stressed with the arm in an overhead position, as it is in softball, tennis, volleyball, swimming and weight training, the small rotator cuff muscles begin to stretch out. This allows the head of the joint to become loose within the shoulder socket. If the head of the shoulder is loose, when the arm is extended backwards over the shoulder the head will slide forward, catching the tendon of short head of the biceps between the ball and the socket. The same thing happens when the arm is raised to the side above parallel to the ground. The head will drop in the socket and the tendon of the long head of the biceps or the supraspinatus becomes impinged.

This impingement causes the tendons to become inflamed and painful. Tennis players feel the pain when they try to hit an overhead or serve. The same thing can happen to golfers in both the backswing and the follow-through when their shoulders are above parallel to the ground.

Lower Back Strain
Almost everyone who participates in sports experiences lower back strain at one time or another, usually from twisting awkwardly, lifting a heavy weight or doing some unpracticed activity. Virtually all lower back injuries are due to weak or tense muscles or muscle strain. Suddenly overloading muscles may pull or tear muscle fibers, sending the back muscles into spasm and causing pain.

Weightlifters, golfers, martial artists and tennis players are prone to back injuries because these sports involve unilateral motions. A golfer rotates the lumbar spine in only one direction, which is the equivalent of lifting weights with only one side of body. Martial artists generally have one dominant leg and kick with that one more than the other.

Tennis Elbow
Tennis elbow is really an inflammation of the muscles of the forearm and the tendon that connects the muscles to the bones in the elbow. These muscles bend the wrist backward and cause the wrist to turn the palm face up. When the muscles and tendon become inflamed from overuse, the pain is felt on the outside of the elbow (lateral epicondylitis).

A tennis player most often aggravates the elbow by hitting the ball late on the backhand side, straining the forearm muscles and tendon. Constantly turning the wrist to put more spin on the serve also can cause pain.

Golfers also suffer from tennis elbow, but on the non-dominant side, that is, a right-handed golfer will feel the pain in the left elbow. Pulling the club through the swing with the left wrist causes irritation in the left elbow.

A second type of tennis elbow is known as medial epicondylitis. This causes pain on the inside of the elbow. It is most often seen among golfers, baseball pitchers, tennis players who hit topspin forehands and weight lifters.

Runner’s Knee
The most common cause of knee pain is runner’s knee, known medically as chondromalacia patella. This is due to misalignment of the kneecap in its groove. The kneecap normally goes up or down in the groove as the knee flexes or straightens out. If the kneecap is misaligned, the kneecap pulls off to one side and rubs on the side of the groove. This causes both the cartilage on the side of the groove and the cartilage on the back of the kneecap to wear out. On occasion, fluid will build up and cause swelling in the knee.

Runners are not the only ones who develop runner’s knee. Pain can develop around the back of the kneecap or in the back of the knee after participating in any running sport.

Shin Splints
Shin splints are pains in the muscles near the shin bones. They can be caused by running or jumping on hard surfaces or simply overuse. They occur most often in people unaccustomed to training, although they can also plague experienced athletes who switch to lighter shoes, harder surfaces or more concentrated speed work.

The pain occurs on the inner side of the middle third of the shin bone. The muscle responsible for raising the arch of the foot attaches to the shin bone at that spot. When the arch collapses with each foot strike, it pulls on the tendon that comes from this muscle. With repeated stress, the arch begins to pull some of its muscle fibers loose from the shin bone. This causes small areas of bleeding around the lining of the bone, and pain.

If the irritated area is about the size of a 50-cent piece or smaller, or shin pain suddenly increases, you may have a stress fracture. The twisting of the tibia can cause the bone to crack. A stress fracture may not show up on an x-ray, and therefore a bone scan is indicated.

Ankle Sprain
The most common ankle sprain happens when the foot rolls to the outside and sprains the ligaments on the outside of the ankle. The outside of the ankle swells up and throbs, and may turn black and blue around the injury.

When a jogger steps gently off a curb and “twists” an ankle, this simply stretches the ligaments, with no real tearing, and is considered a mild sprain. When a tennis player lunges out over a poorly planted foot, partially tearing the fibers of the ligament, that is considered a moderate sprain. When a volleyball player jumps and lands on another player’s foot, twisting and forcing the ankle violently to the court, most or all of the fibers tear, and this is a severe sprain.

If weight-bearing is possible on the ankle after a sprain, the ankle probably is not broken. If you feel pain on the inside of the ankle, then it should be x-rayed to rule out a hair-line fracture.

Achilles Tendinitis
The Achilles tendon in the back of the ankle is the largest tendon in the body. It transfers the force of muscle contractions to lift the heel. Achilles tendinitis is an inflammation of the tendon, usually due to overuse, such as frequent jumping in basketball or volleyball. The most common cause is excessive pronation of the ankle and foot, which causes the Achilles tendon to pull off center.

The pain of a torn Achilles tendon feels like a gunshot in the leg. A partial tear is harder to spot. If the width of the injured Achilles tendon is smaller than the healthy one, or you feel intense pain when standing on your toes, see a doctor for treatment, and possibly surgery.

Arch Pain
The elastic covering on the sole of the foot–the plantar fascia–runs the length of the foot and holds up the arch. When this shock-absorbing pad becomes inflamed, this is called plantar fasciitis, causing a dull ache along the length of the arch.

The ache is due to over-stretching or partially tearing the arch pad. This happens most often to people with rigid, high arches. They feel the pain when they put weight on their foot or when pushing off for the next stride. Pain is particularly intense upon arising or after sitting for a long while.

Plantar fasciitis is particularly common among middle-aged people who have been sedentary and who suddenly increase their level of physical activity. Runners are most susceptible, but almost any sport that keeps the athlete standing can lead to arch pain. Inappropriately fitting shoes or a weight gain of 10 to 20 pounds can also contribute to the condition.

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Patient Guide to Achilles Tendinitis

Achilles tendinitis is an overuse injury of the Achilles (uh-KIL-eez) tendon, the band of tissue that connects calf muscles at the back of the lower leg to your heel bone.

Achilles tendinitis most commonly occurs in runners who have suddenly increased the intensity or duration of their runs. It’s also common in middle-aged people who play sports, such as tennis or basketball, only on the weekends.

Most cases of Achilles tendinitis can be treated with relatively simple, at-home care under your doctor’s supervision. Self-care strategies are usually necessary to prevent recurring episodes. More-serious cases of Achilles tendinitis can lead to tendon tears (ruptures) that may require surgical repair.

Symptoms for Achilles Tendinitis:

The pain associated with Achilles tendinitis typically begins as a mild ache in the back of the leg or above the heel after running or other sports activity. Episodes of more severe pain may occur after prolonged running, stair climbing or sprinting.

You might also experience tenderness or stiffness, especially in the morning, which usually improves with mild activity.

When to see a doctor
If you experience persistent pain around the Achilles tendon, call your doctor. Seek immediate medical attention if the pain or disability is severe. You may have a torn (ruptured) Achilles tendon.

Causes of Achilles Tendinitis:

Achilles tendinitis is caused by repetitive or intense strain on the Achilles tendon, the band of tissue that connects your calf muscles to your heel bone. This tendon is used when you walk, run, jump or push up on your toes.

The structure of the Achilles tendon weakens with age, which can make it more susceptible to injury — particularly in people who may participate in sports only on the weekends or who have suddenly increased the intensity of their running programs.

Risk Factors of Achilles Tendinitis:

A number of factors may increase your risk of Achilles tendinitis, including:

  • Your sex and age. Achilles tendinitis occurs most commonly in middle-aged men.
  • Physical problems. A naturally flat arch in your foot can put more strain on the Achilles tendon. Obesity and tight calf muscles also can increase tendon strain.
  • Training choices. Running in worn-out shoes can increase your risk of Achilles tendinitis. Tendon pain occurs more frequently in cold weather than in warm weather, and running on hilly terrain also can predispose you to Achilles injury.
  • Medical conditions. People who have diabetes or high blood pressure are at higher risk of developing Achilles tendinitis.
  • Medications. Certain types of antibiotics, called fluoroquinolones, have been associated with higher rates of Achilles tendinitis.

Complications of Achilles Tendinitis:

Achilles tendinitis can weaken the tendon, making it more vulnerable to a tear (rupture) — a painful injury that usually requires surgical repair.

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Tendinitis

Tendinitis is inflammation or irritation of a tendon — any one of the thick fibrous cords that attaches muscle to bone. The condition causes pain and tenderness just outside a joint. While tendinitis can occur in any of your body’s tendons, it’s most common around your shoulders, elbows, wrists and heels.

Some common names for various tendinitis problems are:

  • Tennis elbow
  • Golfer’s elbow
  • Pitcher’s shoulder
  • Swimmer’s shoulder
  • Jumper’s knee

If tendinitis is severe and leads to the rupture of a tendon, you may need surgical repair. But most cases of tendinitis can be successfully treated with rest, physical therapy and medications to reduce pain.

Symptoms:

Signs and symptoms of tendinitis occur at the point where a tendon attaches to a bone and typically include:

  • Pain, often described as a dull ache, especially when moving the affected limb or joint
  • Tenderness
  • Mild swelling, possibly

When to see a doctor
Most cases of tendinitis can respond to self-care measures. See your doctor if your signs and symptoms persist and interfere with your day-to-day activities for more than a few days.

Causes:

Although tendinitis can be caused by a sudden injury, the condition is much more likely to stem from the repetition of a particular movement over time. Most people develop tendinitis because their jobs or hobbies involve repetitive motions, which put stress on the tendons needed to perform the tasks. Using proper technique is especially important when performing repetitive sports movements or job-related activities. Improper technique can overload the tendon — which can occur, for instance, with tennis elbow — and lead to tendinitis.

Risk factors for developing tendinitis include age, working in particular jobs or participating in certain sports.

Risk Factors:

Age
As people get older, their tendons become less flexible — which makes them easier to injure.

Occupations
Tendinitis is more common in people whose jobs involve:

  • Repetitive motions
  • Awkward positions
  • Frequent overhead reaching
  • Vibration
  • Forceful exertion

Sports
You may be more likely to develop tendinitis if you participate in certain sports that involve repetitive motions, especially if your technique isn’t optimal. This can occur with:

  • Baseball
  • Basketball
  • Bowling
  • Golf
  • Running
  • Swimming
  • Tennis

Complications:

Without proper treatment, tendinitis can increase your risk of experiencing tendon rupture — a much more serious condition that may require surgical repair.

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Repetitive strain injury (RSI)

About Repetitive Strain Injury (RSI)

Repetitive strain injury (RSI) describes a painful condition generally associated with doing a particular activity repeatedly or for long periods of time. It often occurs as a result of working with computers and typing or repetitive manual work, but you can also develop it if you don’t regularly carry out these sorts of tasks.

The term RSI covers a number of musculoskeletal injuries that can affect your hands, arms and upper body. It can be split into type 1 and type 2. Type 1 RSI means that the disorder can be classed as a recognised medical condition, such as:

  • tendonitis – inflammation of a tendon (the tissue that joins muscles to bones)
  • carpal tunnel syndrome
  • tennis elbow (epicondylitis)
  • rotator cuff syndrome
  • Dupuytren’s contracture
  • writer’s cramp (cramp of the hand)

A doctor will be able to recognise and diagnose type 1 RSI conditions. For example, tennis elbow is caused by repeatedly using your arm in a twisting movement. This can damage the tendons in your elbow making the outside of it painful.

Type 2 RSI means either that your symptoms don’t fit into type 1 RSI and you don’t have any inflammation or swelling, or the pain doesn’t stay in one area. This is also known as non-specific or diffuse pain. Doctors are less clear how to treat type 2 RSI and there is little scientific evidence about which treatments are effective.

There are different stages of RSI and if treated early enough, you may make a full recovery. It’s harder to treat if your symptoms have gone unchecked for a while. You may also be more likely to develop further injury as a result.

Causes of RSI

A number of factors put you at risk of developing RSI. These include:

  • repetitive activities
  • doing an activity that involves force, such as lifting or carrying heavy objects
  • carrying out an activity for a long period of time without adequate rest periods
  • poor posture or activities that require you to work in awkward or tiring positions

It’s important that your working environment (for example, your desk layout or assembly line set-up) is designed so you can work with your body upright and without having to twist or stretch. For example, working with your arm raised above your head or sitting in a fixed position for long periods of time may increase your risk.
There is a wide variety of jobs that may lead to RSI, such as data-entry or typing, working on an assembly line or doing supermarket check-out work. Therefore, it’s important for you to take steps to minimise risks. Speak to your employer about this – see Prevention of RSI for more information.

Some people find that their pain is linked to stress, often work-related.

Symptoms of RSI

There are a wide range of symptoms including pain and tenderness in your muscles and joints. You will probably notice symptoms most when you’re doing the activity that caused them. The pain may get worse so that it’s there all the time, even when you’re resting. It may get so bad that you aren’t able to do routine work or household activities.

This is why it’s important that you see a doctor as soon as you notice any pain in a particular area that lasts for more than a couple of weeks.

Symptoms include:

  • a sharp or a dull ache
  • stiffness
  • tingling
  • numbness
  • weakness
  • cramp

You may have some swelling but it’s also possible that you won’t have any physical signs, even though your hand or arm feels painful.

If you’re in constant pain, you may find it difficult to sleep. If you’re feeling stressed because you’re worrying about the possible consequences of RSI, this can make sleep problems worse.

Diagnosis of RSI

A doctor will ask about your symptoms and examine you. He or she may also ask you about your medical history. If you have type 1 RSI symptoms, the doctor will be able to identify definite conditions, such as carpal tunnel syndrome, when you describe your symptoms and by examination.

With type 2 RSI symptoms diagnosis is more difficult. The doctor may refer you for an X-ray to rule out any other conditions that could be causing pain, such as osteoarthritis. If a recognised condition can’t be confirmed, you may be diagnosed with type 2 RSI.

Please note that availability and use of specific tests may vary from country to country.

Treatment of RSI

There is no single treatment for RSI. However, there are often specific treatments for recognised conditions, such as carpal tunnel syndrome. If you’re diagnosed with a particular condition, follow the recommended treatment. This may involve steroid injections or possibly surgery.

You may be referred to a physiotherapist (physical therapist) for exercises to build up strength in the affected muscles and for advice about ways to improve and strengthen your posture.
Although you should try to rest the affected area regularly, it’s not helpful for you to rest for long periods as it can weaken your muscles. Gently massaging and flexing the affected limb stimulates circulation and can prevent your muscles from weakening.

Self-help

You can make changes to your working environment and how you work by examining what you do and how you do it, and modifying the activity causing the problem. If you can, carry on working but reduce the amount of time you spend on the activity that causes the pain. If you can’t stop doing it completely, take regular short breaks to stretch and flex your arms and hands.

Split up when you do different tasks so that you don’t spend long periods of time doing the same thing.

Learn to touch type if you use a keyboard regularly. This will enable you to keep looking straight ahead and not down or to the side.

Exercise such as swimming, pilates or yoga may help to ease your symptoms.
There are a number of support groups for RSI. You may find it helpful to talk to other people with RSI as they may be able to offer advice and suggest things that could improve your symptoms.

Medicines

Medicines generally aren’t helpful in treating RSI, although a doctor may recommend over-the-counter painkillers or non-steroidal anti-inflammatory drugs (NSAIDs). Low doses of antidepressants are also thought to have some specific painkilling effect in chronic pain conditions such as RSI.

However, it’s not generally a good idea to take painkillers as they dull the pain and allow you to carry on doing the harmful activity, aggravating your RSI.

If you do take medicines, follow the instructions on the patient information leaflet and ask your pharmacist for advice.

If you’re having trouble sleeping, you may be prescribed sleeping tablets for only a few days because of the risk of becoming dependent on them.

Prevention of RSI

Your work area needs to be suitable and comfortable for you. The risk of an accident or injury occurring should be reduced as much as possible.

If you use a computer, make sure:

  • your chair supports your back and you sit up straight
  • your chair is the right height for you; if not use a footrest
  • your monitor is around 60cm from your eyes
  • your screen, keyboard and mouse are directly in front of you with the mouse as close to the keyboard as possible
  • when you type, your arms aren’t extended forwards, your forearms are horizontal and your fingers are at the same height as the middle row of keys
  • your legs have room to move under the desk or table
  • you only use a wrist rest when having a break from typing – don’t place your wrists on it while typing

If you have been off work because of RSI, when you return try not to do the activity that causes the pain. You may need to modify your job when the pain is severe. Take regular breaks and alternate tasks to prevent long periods of repeating the same movement.

Complementary therapy

Although there is no evidence to suggest that complementary therapies can successfully treat RSI, some people say that techniques such as massage and osteopathy ease their symptoms and help them to relax.

Availability and use of different treatments may vary from country to country. Ask your doctor for advice on your treatment options.

Rotator Cuff Tendonitis

Rotator ruff tendonitis, also known as bursitis, is the term used to describe the inflammation, swelling and irritation of the tendons around the shoulder. Rotator cuff tendonitis is a very common condition, effecting men and women of any age and demographic. In most cases the condition can be easily treated without seeing your doctor. On this page we’re going to take a look at the causes, symptoms, treatment and preventionof rotator cuff tendonitis.

Causes of Rotator Cuff Tendonitis

There are 4 main reasons why rotator cuff tendonitis is likely to occur. Usually the problems center around a general weakness in the joint, but in some cases the problem starts at birth. Here are the 4 common causes:

  1. From Birth
    Some people are born with a “hooked” acromion that will predispose them to getting rotator suff tendonitis.
  2. Weakness Around The Rotator Cuff
    A rotator cuff weakness causes the humerus to ride up and pinch the cuff. This means that the bursa (a water-balloon type structure that acts as a cushion between the rotator cuff and acromion/humerus) gets inflamed.
  3. Excess Stress & Repetition
    This is the common cause amoungst sports people and professional athletes. This may be due to training or playing too hard for too long or excess strain being placed on in the form of weight (weight lifter/bodybuilder).
  4. Through Injury
    Other shoulder injuries may lead to rotator cuff tendonitis.

Possible Symptoms

The symptoms associated with rotator cuff tendonitis usually build up gradually, starting with some mild pain around the shoulder area. If you suffer from the condition you may experience these symptoms:

  1. Pain
    Pain located primarily on top and in the front of your shoulder. Sometimes you can have pain at the side of your shoulder. Usually is worse with any overhead activity (reaching up above the level of your shoulder). The pain is usually felt during or after exercise or activity but as the tendonitis gets worse the pain may be felt at all times throughout the day.
  2. Weakness
    Your shoulder may feel weaker than usual. This will be especially apparent with overhead and pushing movements.
  3. Popping/Cracking
    Sometimes bursitis that occurs with rotator cuff tendonitis can cause a mild popping or crackling sensation in the shoulder.
  4. Unable to Sleep on Shoulder
    Many sufferers complain about not being able to sleep on the side that is affected by tendonitis.
  5. Hot & Burning Feeling
    You may feel a “hot” or “burning” sensation around the shoulder area

Treating the Condition

In the majority of cases rotator cuff tendonitis can be treated without seeing your doctor. There are several steps you can follow to try and treat the pain and reduce inflammation. Follow these steps:

  1. Stop any activities that can aggravate your symptoms. This may mean you will have to stop sporting activities, work or exercise related activities. You should not attempt any of these activities until the tendonitis has fully healed.
  2. Begin R.I.C.E. treatment. Rest, Ice, Compression and Elevation. You should apply this treatment on and off until the pain subsides.
  3. If needed, take over the counter anti-inflammatory medication.
  4. Strengthen your rotatorcuff.
  5. Slowly ease back into physical activity.

Strengthening your rotator cuff is the key to preventing rotator cuff tendonitis in the future. There are several exercises you can perform with very light weights to help build up some extra strength. These exercises include dumbell above the head press, lateral dumbbell raises, upright row and shoulder machine press. It’s very important that these exercises are performed with very light weights.

Rotator Cuff Tendonitis Prevention

As previously mentioned, a strong rotator cuff is the best defense against tendonitis. There are a few other common sense measures that you can take to help prevent the condition. First, always warm up your shoulder area before sport or exercise. Second, don’t place any uneccessary strain or weight on your shoulder.

Tendonitis

Definition of Tendonitis

A tendon is a tough yet flexible band of fibrous tissue. The tendon is the structure in your body that connects your muscles to the bones. The skeletal muscles in your body are responsible for moving your bones, thus enabling you to walk, jump, lift, and move in many ways. When a muscle contracts it pulls on a bone to cause movements. The structure that transmits the force of the muscle contraction to the bone is called a tendon.

Tendons come in many shapes and sizes. Some are very small, like the ones that cause movements of your fingers, and some are much larger, such as your Achilles tendon in your heel. When functioning normally, these tendons glide easily and smoothly as the muscle contracts.

Sometimes the tendons become inflamed for a variety of reasons, and the action of pulling the muscle becomes irritating. If the normal smooth gliding motion of your tendon is impaired, the tendon will become inflamed and movement will become painful. This is called tendonitis, and literally means inflammation of the tendon.

Causes of Tendonitis

There are hundreds of tendons scattered throughout our body, but it tends to be a small handful of specific tendons that cause problems. These tendons usually have an area of poor blood supply that leads to tissue damage and poor healing response. This area of a tendon that is prone to injury is called a “watershed zone,” an area when the blood supply to the tendon is weakest. In these watershed zones, they body has a hard time delivering oxygen and nutrients necessary for tendon healing–that’s why we see common tendon problems in the same parts of the body.Tendonitis is most often an overuse injury. Often people begin a new activity or exercise that causes the tendon to become irritated. Tendon problems are most common in the 40-60 year old age range. Tendons are not as elastic and forgiving as in younger individuals, yet bodies are still exerting with the same force.

Occasionally, there is an anatomical cause for tendonitis. If the tendon does not have a smooth path to glide along, it will be more likely to become irritated and inflamed. In these unusual situations, surgical treatment may be necessary to realign the tendon.

Symptoms of Tendonitis

Tendonitis is almost always diagnosed on physical examination. Findings consistent with tendonitis include:

  • Tenderness directly over the tendon
  • Pain with movement of muscles and tendons
  • Swelling of the tendon

X-rays & MRIs: Are They Necessary?

Studies such as x-rays and MRIs are not usually needed to make the diagnosis of tendonitis. While they are not needed for diagnosis of tendonitis, x-rays may be performed to ensure there is no other problem, such as a fracture, that could be causing the symptoms of pain and swelling. X-rays may show evidence of swelling around the tendon.

MRIs are also good tests identify swelling, and will show evidence of tendonitis. However, these tests are not usually needed to confirm the diagnosis; MRIs are usually only performed if there is a suspicion of another problem that could be causing the symptoms.

Once the diagnosis of tendonitis is confirmed, the next step is to proceed with appropriate treatment. Treatment depends on the specific type of tendonitis.

Types of Tendonitis

Tendonitis can occur in any tendon in the body, but tends to occur in one of a small handful of the hundreds of tendons scattered throughout our body. The reason these tendons are prone to injury is the result of problems with the blood supply to the area of concern. In these situations, poor blood supply within the so-called “watershed zone” of the tendon leads to a tendency for problems. Some of the types of tendonitis that are seen most frequently include:

  • Wrist Tendonitis
    Wrist tendonitis is a common problem that can cause pain and swelling around the wrist. Wrist tendonitis is due to inflammation of the tendon sheath. Treatment of wrist tendonitis usually does not require surgery.
  • Achilles Tendonitis
    Achilles tendonitis causes pain and swelling in the back of the heel. Understanding this common problem can help with treatment and help to avoid serious complications such as Achilles tendon rupture.
  • Posterior Tibial Tendonitis Tendonitis
    Occuring near Achilles tendonitis, posterior tibial tendonitis is less common, but should be considered in people with symptoms on the inner side of the ankle. Left untreated, posterior tibial tendonitis can result in a flat foot.
  • Patellar (Kneecap) Tendonitis
    Patellar tendonitis, or inflammation of the patellar tendon, is a condition often called Jumper’s Knee. Treatment of patellar tendonitis usually consists of rest and anti-inflammatory medication.
  • Rotator Cuff Tendonitis
    Many patients who have pain are told by their doctor they have shoulder bursitis or rotator cuff tendonitis; learn more about rotator cuff tendonitis and available treatments.
  • Tennis Elbow (Lateral Epicondylitis)
    Tennis elbow is actually a type of tendonitis that causes pain over the outside of the elbow. Commonly associated with people who play tennis, lateral epicondylitis can occur in people who perform other sports or repetitive activities of the wrist and elbow.

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