I have recently seen a member of staff who has been diagnosed with Golfers Elbow in both sides. She is a telephonist working in a Switchboard so is sitting at the computer for the majority of the day and has very few tasks that will allow her to change posture. Her workstation is generally well set up and she is not required to do long reams of typing; for each call she has to type in the name of a person or work area.
When I did an assessment with this lady she had a cushion under each arm and was desperate for an arm rest. I contacted her physio to get her thoughts on an arm rest (didn’t want to contradict her advice). The Physio seemed to think that the arm rest wouldn’t do any good at all. I know the GP wants this lady to have injections which she is resisting so I’m a little stuck as to whether there is anything I can recommend that will actually do any good!
Thanks in advance.
Whether the employee has medial epicondylitis (golfer’s elbow) or latyeral epicondylitis (tennis elbow), the use of a compression band or cuff (available OTC at most stores/pharmacies) can provide substantial relief of symptoms caused by overuse of the forearm muscles. The compression force of the band creates a more stable binding of the muscle distal to its anatomical origin, thereby providing relief of tensile forces on the proximal tissues coming off the bone. The keys are to apply the compression just distal to the point of pain detected by direct palpation of the muscle or myotendinous junction and to make sure that the compression force is high enough (i.e., adjustable band is snug enough) to relieve symptoms. Using a band/cuff over time usually stops the inflammatory process, tissue healing occurs and the employee can begin gentle stretching of the forearm muscles used in wrist flexion/extension and strengthening for pronation/supination in a graduated program for return of pain-free function for her work tasks. Also, while recovering, the use of the band/cuff at work (assuming normal loads and staying within physical capacity) provides some protection from aggravating the injury further.
This is a more conservative way to manage the employee’s condition; I would wait on cortisone injections until physical therapy treatment cannot produce satisfactory outcomes. Most physios can manage her condition quite well without medical intervention.
Out of curiosity I did a quick check of the evidence regarding effectiveness of treatments for epicondylitis and found a 2002 Dutch RCT examining the outcomes of corticosteroid injections, physiotherapy, and wait-and-see policy for lateral epicondylitis. This study scored 8/10 on PEDRO scale and involved random assignemt of 185 patients. At 6 weeks, corticosteroid injections were significantly better than the other 2 options and success rates were 92% for injections, 47% for physiotherapy (US, cross-friction massage, ROM), and 32% for wait-and-see policy. However, long term (1 yr) success differences were better for physiotherapy (91%) as comared to injections (69%) and wait-and-see (83%). Use of compression band/cuff was not included as an intervention and I couldn’t locate a similar quality study that examined the efficacy of compression for epicondylitis.
As with most musculoskeletal conditions that occur with work tasks we have to weigh costs with the benefits, both short term and long term. As stated by the Dutch authors, patients should be informed about the advantages/disadvantages of the treatment options.
How is her overall posture at the work station? Head forward/shoulders rolled or hunched?
Any ring/pinky finger sx?
Neck or shoulder pain/sx?
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