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Performing Surgery While Under Treatment for Liposuction Surgery - Induced Tennis Elbow

002 AMERICAN JOURNAL OF COSMETIC SURGERY
VOL. 19, NO. 3, 2002

Letter to the Editor: After several years of liposuction experience, then several weeks of arm abuse during the use of a reciprocating power liposuction tool, I began to have medial, then lateral, epicondylic tenderness and pain. Lateral and medial epicondylic are well-known entities in orthopedic practice. (Lateral epicondylitis, also know as "tennis elbow," is a much more refractory problem than medial epicondylic and frequently requires steroid injections.) Unfortunately, there are many sometimes conflicting points of view about proper treatment of this condition. Although the instrument I was using was marginally faster than manual suction, I began spending any time I saved in the offices of various "healers." Here is the advice I was given, what helped, and my conclusions after my adventures.

Orthopedist number 1: "For tennis elbow: Use a heating pad set on low for 10 minutes, and then actively contract your forearm muscles, flexing your wrist with your arm extended out from your body. Do 10 isometric contractions, each lasting a minute. Then ice for 10 minutes more. Repeat this 4 times a day. This really helps — it's what the professional baseball pitchers do. If you can't get rid of it this way, we'll inject it." (Elbow X-rays were normal.)

Chiropractor number 1: "The Accuscope (a physical therapy machine) helps most. We'll use it every other day until you're healed. Don't get an injection, whatever you do. Stretch the forearm passively and gently 20 to 40 times a day for just a few seconds each time, both in extension and flexion. An elbow band may help. Put it about three-fourths of an inch in front of the epicondyles."

Orthopedist number 2: "You originally had a little separation of the bone from the tendon. It's only tendonitis and it will eventually heal, although it may take many months. Massage the sore area many times a day. Just try to irritate the area as much as you can. Alternate heat and ice massage, right on your skin. If you get a masseuse, just get a rubdown; don't go for the deep tissue massage. We operate on only about one in 300 cases. The surgery is a big hassle. If you want to get it injected, come in right before your vacation so you can give it a rest. Limit any weightlifting curls to palms up, not palms down."

Orthopedist number 3: "Just apply deep pressure to the area 10 times a day. This will help the inflammation. Don't massage it, whatever you do; this will make it worse. You will have a little pain, but it's a happy pain. An injection won't solve the problem — it will just be a temporary fix."

Consultation with textbook1: Extension and flexion exercise with a Theraband, a piece of rubber like a bicycle inner tube, is helpful. High repetitions help most.

Chiropractor number 2: "We like our physical therapy machine better than the Accuscope. It's called an H wave. You'll need long term treatment for many months. Painful deep massage also helps a lot. [And so it was — painful. The H wave caused all my forearm muscles to contract painfully, and the massage was...really painful.]

And you should ice-massage the area with the ice directly on the skin for 3 to 5 minutes right after every activity. Watch out for those orthopedists; they'll try to stick a needle in you. And cortisone can be dangerous stuff. You might try this Dynabee that all the tennis players are using."

Fellow Sufferer number 1: "As an oral surgeon and weight lifter, I got so I couldn't sleep at night with my elbow pain. I just couldn't lay off my weight lifting, and eventually had all four of my elbow epicondyles operated on. Today I'm pain free, but I've lost 40 pounds of muscle because I can't lift weights like I used to."

Massage therapist: "I'll do some moderately deep work. You'll have a little discomfort, but you'll feel better. I can tell just where the problems are by the way you feel. You've been under a lot of stress lately, haven't you?" You will need treatments every week indefinitely."

Family Practitioner: "You really need to get an injection. Nothing else works. I had mine for 6 months before I had my injection. We use Kenalog, the real thing, not the generic. The particles in it make it really long lasting, much better than the "smooth stuff," which doesn't work as well."

Fellow sufferer number 2 (longevity physician): "I've had maybe 20 injections of my right outer elbow. You've got to get that inflammation early rather than let the inflammation set in. Some people will tell you to lay off for a while after the injection, but you should just go out and have fun and weight lift right away — I always do. Wear your elbow band, and strap it down tight. Take plenty of DHEA, human growth hormone, testosterone, and supplements, too."

Tennis pro: Tennis elbow? It's a thing of the past. Get a Dynabee and work it every other day for 10 minutes and make that forearm burn. Every tennis player carries them around these days."

And so, after 2 injections of long-acting steroid separated by 3 months, various supplements, several vacations, and ongoing rehabilitation with my Dynabee after the last steroid injection, I'm pain free 9 months into my problem. I carefully lift weights again, using an elbow band. The masseuse was the best of the alternative therapies. Two weeks of Feldene at 20 mg per day and later, a week of prednisone 40 mg per day were ineffective. What really helped the most was my assistant at surgery. My surgical results are actually better because I do not get as tired. Also, in an attempt to recover, we operate only Monday, Wednesday, and Friday and do laser peels, blepharoplasty, and hair transplantation on the other days. The Dynabee was the biggest surprise and the best therapy. It is an enclosed gyroscope designed to exercise and stretch the forearm and is available at most sporting goods stores.