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From: [log in to unmask] <[log in to unmask]>
To: [log in to unmask] <[log in to unmask]>
Date: 12 March 1998 22:08
Subject: RE: tennis elbow (was RCGP. Time to be NICE?)
< Having had tennis elbow myself, and having had it injected by my GP,
I've stopped doing them. It was so ****** painful! Could hardly use
my arm (left) for a week. Had to change gear with my right arm:-(
I think it only got better because of the iatrogenic enforced rest.
Our local orthopaedic upper limb specialist says *don't* inject
tennis elbows as it is causes necrosis at the inject site in the
tendon. Use analgesics/physio. If patient desperate he will consider
surgery, but that doesn't always work either:-( >
But you probably stayed away from the GP for a few weeks ;) Just remember,
the more it hurts the more good it will do ;))
I wonder whether your orthopod is seeing similar patients to us. This is
typical consultant speak and he is influenced by his own prejudices as much
as any of us. Injection can cause tissue necrosis at site of injection but
I have never seen it. I wonder what the experience of others is. Of all
the things I try to do in surgery I think joint and tennis elbow injections
generate the most thanks and are extremely rewarding. I wouldn't go on
repeating injections however. A tiny fraction of patients need referring to
an orthopod. These are refractory cases who may have already had 2 or 3
injections. At this stage further injection probably wouldn't be
appropriate.
Consultants often aren't well qualified to advise on how things should be
managed in GP.
Martin Bradley
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