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Orthopedic Procedures

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As the home of the region's most experienced orthopedics team, we can return you to the comfort and quality of life you deserve.Our orthopedists are specialists in treating arthritis-related joint degeneration:

  • Fractures
  • Sprains
  • Back and neck problems
  • Foot, ankle, shoulder and hand injuries
  • Sports injuries
Orthopedic Procedures

Arthritis

Joint Inflammation

Definition

Symptoms vary according to the type of arthritis and how severe it is. However, common symptoms include the following:

  • Difficulty with weight-bearing activities, such as walking, bending, and moving
  • Joint deformity
  • Joint pain and swelling
  • Joint stiffness, especially in the early morning
  • Limping or making other adjustments to protect the affected joint
  • Warmth or redness in a joint
  • Weakness of the joint

What are the causes and risks of the condition?

  • There are many types of arthritis, with a host of different causes, such as:
  • Ankylosing spondylitis, which affects the spine and other joints
  • Arthritis caused by mechanical problems, such as bone fracture or dislocation
  • Gout, which is caused by an accumulation of uric acid crystals in the joint
  • Infectious arthritis, which is caused by an infection such as Lyme Disease or a gonococcal infection
  • Osteoarthritis, a degenerative process that is also called wear-and-tear arthritis
  • Pseudogout, which is caused by an accumulation of calcium pyrophosphate crystals in the joint
  • Psoriatic arthritis, which develops in some people who have a chronic skin condition known as psoriasis
  • Reactive arthritis, which may develop after an infection of the urinary tract, bowel, or other organs
  • Rheumatoid arthritis, an autoimmune disorder in which the body makes antibodies to its own tissues
  • Some of the risk factors for arthritis are as follows:
  • Aging changes in the bones and joints
  • Bodywide infections that affect the joints
  • Diabetes
  • Genetic or hereditary tendency to arthritis
  • Immunodeficiency disorders, such as HIV
  • Injury to the joints
  • Menopause, which increases a woman's risk for osteoarthritis
  • Overweight or obesity

Smoking, which doubles a woman's risk for rheumatoid arthritis

What can be done to prevent this condition?

Following sports safety guidelines for children, adolescents, and adults may help prevent some joint damage. Injuries and infections should be treated promptly. For example, a severe ankle sprain that is not properly splinted may lead to osteoarthritis. Untreated gonococcal infections may lead to infectious arthritis.

How is the condition diagnosed?

Diagnosis of arthritis starts with a medical history and physical examination. Joint x-rays may be normal at first, perhaps showing some swelling. Later the x-rays may show narrowing of the joint space, roughness of the joint surface, or poor alignment of the joint. Bone spurs, which are calcium deposits at the edge of the joint, may also be seen.

Blood tests, including a complete blood count, or CBC, can help detect some types of arthritis. Joint aspiration, which means removing joint fluid with a needle under local anesthesia, can sometimes provide useful information. Rarely, a magnetic resonance imaging, or MRI, is needed to determine the cause or extent of the arthritis.

What are the long-term effects of the condition?

If the arthritis progresses, joint function may keep declining. The person will have more joint pain, stiffness, and swelling. The amount and rate of decline depend on the type of arthritis and how well the available treatments work.

What are the risks to others?

Arthritis is not contagious. It poses no risk to others. If the arthritis is caused by an infection, such as gonorrhea, the infection may be contagious.

What are the treatments for the condition?

Treatment varies quite a bit, depending on the type of arthritis and its severity. The age, health, and activity level of the person also are factors to consider. Education about the disease can help bring about improved daily self-management and coping skills.

Nonsteroidal anti-inflammatory drugs, or NSAIDs, such as ibuprofen and aspirin, are often used to treat early symptoms of arthritis. COX-2 specific inhibitors, such as rofecoxib or celecoxib, can also help to relieve symptoms. For some forms of arthritis, corticosteroids such as prednisone can work very well. Corticosteroids can be taken by mouth or injected into the joint. Depression and sleep disorders may be treated with low doses of antidepressant medicines such as amitriptyline.

A wide variety of medicines are used to treat rheumatoid arthritis:

  • Antibiotics, such as doxycycline and minocycline
  • Anti-inflammatory medicines
  • Corticosteroids, such as prednisone
  • COX-2 specific inhibitor NSAIDs
  • Disease-modifying medicines, such as D-penicillamine, which slow down the progression of the disease
  • Immunosuppressant medicines, such as methotrexate, which change the body's immune response
  • Infliximab and etanercept, which block the effects of an important protein

If there is a bacterial infection of the joint, antibiotics are critical. The joint may be drained by repeated aspiration or by open surgical drainage.

A change in diet may help some forms of arthritis. People who have arthritis might experience loss of appetitie or anemia, which is low red blood cell count. Frequent small feedings or protein supplements may be prescribed. Some medicines, such as oral corticosteroids, can stimulate the appetite and lead to weight gain. Losing excess weight can help, especially when the leg joints are affected. Foods high in protein, iron, and vitamins contribute to tissue building and repair.

Physical activity is important in the treatment of arthritis. Thirty minutes of moderate exercise a day can help to prevent complications of arthritis, as well as, heart disease, stroke, and diabetes. Low impact aerobics and water aerobics are two exercises that minimize joint stress.

A recent study focused on adults with osteoarthritis who used tai chi, a form of Chinese exercise that uses slow, fluid movements. Study participants reported better management of their symptoms, along with improved physical and mental health.

Surgery may be indicated when pain cannot be controlled or function is lost. Several types of surgery may be done:

  • Arthroplasty, which is the partial or total replacement of a joint, such as knee joint replacement or a hip joint replacement
  • Arthroscopy, a procedure that uses a small scope and instruments to get inside the joint without opening it
  • Arthrotomy, which involves opening the joint through a larger incision
  • Osteotomy, or realignment of the bone next to the joint
  • Synovectomy, or removal of the lining of the joint

There has been a great deal of interest lately in the use of glucosamine and chondroitin. These dietary supplements may decrease joint pain asssociated with arthritis. A large scale study is currently being conducted to determine their effectiveness.

What are the side effects of the treatments?

Medicines used to treat arthritis may cause stomach upset, allergic reaction, and decreased resistance to infection. Surgery may cause bleeding, infection, or allergic reaction to anesthesia.

What happens after treatment for the condition?

Most types of arthritis require lifelong treatment. Exercises to maintain range of motion and muscle strength are very important.

How is the condition monitored?

A healthcare provider will monitor the person's level of comfort and function of the joint. Any new or worsening symptoms should be reported to your doctor.  
  

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Carpal Tunnel Syndrome

Median Nerve Compression or Entrapment

Carpal tunnel syndrome (CTS) is a condition in which the median wrist is compressed. This causes numbness and pain in the fingers and hand.

What is going on in the body?

A ligament and the bones at the base of the palm of the hand, just beyond the wrist, form the carpal tunnel. Through this tunnel passes the median nerve and tendons going to the fingers and thumb. The median nerve conducts sensation from the palm side of the thumb and fingers, except for the little finger. It also carries impulses to small muscles in the hand, particularly at the palm side of the base of the thumb. If the pressure in the carpal tunnel increases enough, the median nerve is compressed.

What are the signs and symptoms of the condition?

CTS usually starts gradually, with a vague aching in the wrist, extending into the hand and forearm. Acute onset occurs when the compression of the nerve happens suddenly. This sudden onset is more likely to cause pain. The numbness and tingling is felt in the thumb, index finger, long finger, and half of the ring finger on the palm side. Sharp pains may radiate up through the arm or shoulder.

Often a person will wake up at night with pain or numbness. The individual may shake or massage the wrist in order to "improve the circulation." Similar symptoms can occur during the day, particularly when performing repetitive weakness of the thumb muscles and a tendency to drop things.

What are the causes and risks of the condition?

CTS can be caused by anything that increases pressure on the nerve in the carpal tunnel. CTS has been associated with repetitive stress injury. This type of injury occurs when a part of the body is used repeatedly or overused. People who use computers or vibrating tools are at particular risk. Factory workers on assembly lines, or those who do repeated actions involving the wrist, may develop CTS.

Other factors can also increase a person's risk for carpal tunnel syndrome. Examples include the following:

  • Chronic renal failure, a form of kidney failure
  • A cyst on the tendon
  • Diabetes
  • Gout, a form of arthritis
  • Hemodialysis, a procedure for filtering blood of people with kidney failure
  • Hypothyroidism, or low levels of thyroid hormone
  • Obesity
  • Oral contraceptives
  • Pregnancy
  • Rheumatoid arthritis
  • Trauma, or injury, to the wrist
  • Tuberculosis

Carpal tunnel syndrome is more common in women than in men. It is most common in middle-aged individuals.

What can be done to prevent the condition?

Any underlying cause of CTS should be diagnosed and corrected. For example, medicine can be used to correct hypothyroidism.

Overuse of the wrist and fingers should be avoided. A small recovery time is needed to rest and lubricate the flexor tendons. Variety is the key , workers whose motions are repetitious and prolonged are at risk. A mixture of activities, such as typing interspersed with filing, may help to rest the affected areas. Finding a new way to use the hand, by using a different tool, may help some individuals. Using the nondominant hand more often might help to relieve stress on the dominant extremity.

Computer workstations should be designed so that the wrists are well supported in a neutral position. Care should be taken to avoid striking the palm side of the wrist on hard surfaces. Special on-the-job equipment and training may be available.

Early identification of symptoms is important. Early symptoms, such as tingling in the fingers, may occur several hours after the aggravating activity has stopped. Making the connection between activities and symptoms is important. This gives the person a chance to correct working conditions. This may help to prevent further or worsening symptoms.

How is the condition diagnosed?

The diagnosis of carpal tunnel syndrome begins with a medical history and physical exam. The healthcare provider may order additional tests, incuding:

An electromyogram, or EMG, which tests the electrical activity of the muscle

A nerve conduction velocity test, which measures electrical conduction along the median nerve

What are the long-term effects of the condition?

If carpal tunnel syndrome isn't treated, the hand may become weaker and number. Permanent numbness and weakness can result.

What are the risks to others?

Carpal tunnel syndrome is not contagious and poses no risk to others.

What are the treatments for the condition?

Underlying diseases, such as diabetes, underactive thyroid, and rheumatoid arthritis should be treated. Weight loss or reduced salt intake may be helpful.

Repetitive use of the hand with the wrist bent must be avoided. Frequent changes of activity, with breaks for five minutes every hour, can help prevent overuse. Certain exercises can be done to increase flexibility in the wrist and fingers. People with CTS should not sleep on their hands or with wrists bent down. It is very important to sit properly at the computer, with good support for the wrists. Yoga-based exercises may be effective.

For mild cases, the first treatment is to splint the wrist at night and during the day if possible. A splint keeps the wrist from moving but allows for mostly normal hand activity. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen, can be used for a short time. If these do not help, a corticosteroid can be injected into the carpal tunnel. This may help permanently or only temporarily.

Surgery, called carpal tunnel repair, is reserved for people with muscle wasting and decreased sensation. This surgery is considered only when the symptoms are no better after several months of treatment.

What are the side effects of the treatments?

NSAIDs can cause stomach upset or allergic reactions. Injecting corticosteroids rarely can accidentally injure the nerve. Surgery can cause bleeding, infection, nerve damage, or allergic reaction to anesthesia.

What happens after treatment for the condition?

After the surgery, the wrist is immobilized for a short time. Exercises help to regain mobility of the wrist and fingers. It is important to practice proper use of the wrist.

How is the condition monitored?

Any new or worsening symptoms should be reported to your doctor. 

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Hip Joint Replacement

Total Hip Replacement, THR, Total Hip Arthroplasty

Definition  Hip joint replacement is a surgical procedure to replace the hip joint. The new joint is artificial and has two parts. The first part is the hip's socket, called the acetabulum. This is a cup-shaped bone in the pelvis. The second part is the "ball" or head of the femur, also called the thighbone.

These artificial parts together are called a prosthesis. The artificial socket is made of high-density plastic. The artificial ball, which is attached to a stem is usually made of a strong, stainless metal. The goal of the surgery is to relieve pain and improve mobility and function in the hip joint.

Who is a candidate for this procedure?

This surgery is most commonly done to relieve severe arthritis, which can wear down the hip joint. People with other conditions, such as injury, bone tumors and avascular necrosis, or a loss of bone caused by a lack of blood supply also need a hip joint replaced. An individual is usually advised to consider surgery when the following conditions apply:

  • The pain is severe enough to restrict not only work and recreation but also the normal activities of daily living.
  • The pain is not relieved by arthritis medications.
  • The person is not helped by the use of a cane or walker.
  • There is significant stiffness of the hip that limits activities.
  • Joint X-rays show advanced arthritis or other severe problems.

How is the procedure performed?

The surgeon first removes the diseased bone and cartilage. Replacement parts are implanted into healthy areas of the pelvis and thighbone. The surgery is done in the operating room under general anesthesia or regional anesthesia. General anesthesia means the person is put completely to sleep, regional anesthesia means the person will be awake but numb below the waist. A drug may be given to make the person drowsy. The procedure usually takes 2 to 3 hours to perform.

What happens right after the procedure?

After the surgery, the person is taken to the surgery recovery room for a brief period of close observation. Vital signs, such as the blood pressure and pulse, are checked frequently. Close attention is paid to the circulation and sensation in the legs and feet. The hip is usually braced with pillows or a special device that holds the hip in the correct position. The person is given fluids through an intravenous tube, or IV, to replace fluids lost during surgery. A tube may have been placed near the incision to drain fluid. Pain medication will be given as needed.

While in the hospital, the individual will begin physical therapy to strengthen the hip. He or she will also learn how to perform the activities of daily living in ways that can prevent injury to the new hip. For example, proper ways to bend and sit are taught. Most people are sent home from the hospital in 2 to 3 days.

What happens later at home?

By the time the person leaves the hospital, he or she should be able to get around using crutches or a walker. Physical therapy may be continued after discharge.  Complete recovery from this surgery usually takes 3 to 6 months.

What are the potential complications after the procedure?

Surgery may cause bleeding, infection, and allergic reactions to anesthesia. Pain medications or antibiotics may cause stomach upset, allergic reactions, or rash.

Following are the most common complications of a hip joint replacement:

Blood clot in the leg, or deep venous thrombosis. To prevent blood clots, medications called blood thinners may be given. The person is asked to become mobile shortly after surgery.

Wound infection. To prevent this complication, antibiotics may be given.

Bleeding. Sometimes a blood transfusion may be needed.

Hip dislocation, which means the ball becomes dislodged from the socket. This may occur if the hip is placed in certain positions. The person is taught exercises before leaving the hospital to help prevent this. The individual will also learn which activities to avoid, such as crossing the legs, to prevent hip dislocation.

To prevent infection in the future, people will need to take antibiotics beforehand whenever they have any dental work done.

Any new or worsening symptoms should be reported to your doctor.

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Knee Joint Replacement

Total Knee Replacement, TKR, Total Knee Arthroplasty, Total Knee Joint Replacement

Knee joint replacement is surgery to replace a damaged or diseased knee with an artificial joint, or prosthesis. The goal is to improve the main function of the knee joint and reduce pain.

Who is a candidate for the procedure?

Knee joint replacement may be used for long-standing knee pain or arthritis that has not responded to treatment with medication. It may also be used when arthritis causes the knee to function poorly, or for some knee fractures. The procedure is used for people who have a great deal of knee pain. This pain is so severe that the person cannot work, has trouble sleeping, and cannot walk more than three blocks. Most people who have a knee joint replacement are over the age of 55, but it can be done for anyone.

How is the procedure performed?

Knee joint replacement is performed under general anesthesia or regional anesthesia. General anesthesia means the person is put to sleep with medications. Regional anesthesia means the person will be awake, but numb below the waist. A drug may be given to make the person drowsy. The ends of the thighbone, or femur, and the shinbone, or tibia, are removed. The underside of the kneecap, or patella, may also be removed. The new knee consists of a metal shell on the end of the femur and a metal and plastic piece on the tibia. If needed, there is also a plastic button in the kneecap. The surgery itself takes about two hours. In many cases people donate two units of their own blood in the weeks before surgery to be used during or shortly after the operation.

What happens right after the procedure?

After the surgery, the person will be taken to the surgery recovery room to be watched closely for a short time. Vital signs, blood pressure, pulse, and breathing will be checked frequently. Close attention will be paid to the circulation and sensation in the legs and feet. The person will receive intravenous fluids to replace those lost during surgery. There may be a tube near the incision to drain the fluid.

While in the hospital the person will have physical therapy to learn exercises to strengthen the knee. The person will start bearing weight on the knee, using a walker, the first day after surgery. He or she will also be taught using the most appropriate assistive device. Most people are discharged from the hospital 2 to 3 days after the operation.

What happens later at home?

By the time the person is ready to go home, he or she should be able to get around with a walker. People use a walker initially, and then progress to other more appropriate assistive devices such as crutches or a cane. No walking aids are typically needed after 3 weeks to 2 months. Physical therapy is continued after leaving the hospital.

Sometimes people need to go to a rehabilitation center after the hospital. There they can gain the independence they need to be able to get around at home. Recovery from knee joint replacement usually takes from 3 to 6 months.

About 90% of artificial knee joints last for 10 years, and 80% last for 20 years. This often depends on the person's activity level.What are the potential complications after the procedure?

There are complications with any surgery or anesthesia. These include bleeding, infection, and reactions to the anesthesia drugs. Other possible complications are blood clots in the leg or the lung. To prevent infection in the future, people will need to take antibiotics beforehand whenever they have any dental work done. 

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Rotator Cuff Tendinitis

Supraspinatus Tendinitis, Shoulder Impingement Syndrome

Rotator cuff tendinitis is an inflammation of the tendons of the shoulder. A tendon is a fibrous band that connects muscles to bones.

The muscles of the rotator cuff connect the humerus, or upper bone of the arm to the shoulder. At the end of each muscle is a tendon that attaches the muscle to the bone. The four muscles of the rotator cuff are able to move bones by pulling on these tendons. These muscles and tendons allow movement and rotation of the arm and shoulder. Since these tendons are in frequent motion they are susceptible to injury, pain and inflammation.

What are the signs and symptoms of the injury?

Symptoms of rotator cuff tendinitis include:

  • Shoulder pain, especially with movement and at night
  • Weakness in the arm and shoulder
  • A snapping sensation in the shoulder with movement
  • Tenderness and swelling in the upper front part of the shoulder
  • In severe cases, inability to raise the arm to shoulder height

What are the causes and risks of the injury?

The causes of rotator cuff tendinitis may include:

  • Injury to part of the shoulder or muscles of the shoulder
  • The shoulder blade rubbing, pinching, or irritating the tendon
  • Repetitive stress injury, especially if the person's arm is repeatedly raised above the shoulder
  • Poor posture, which puts extra pressure on the muscles and tendons
  • Sudden increase in duration and intensity of exercising that arm and shoulder
  • Calcium deposits in the rotator cuff
  • Musculoskeletal or inflammatory conditions, such as arthritis
  • The normal aging process of the body
  • A person involved in sports before the injury may find a decrease in the normal range of motion in the shoulder. Chronic pain or soreness in the shoulder may occur. Rupture of the tendon is also possible.

What can be done to prevent the injury?

Prevention of rotator cuff tendinitis is related to the cause. For example, avoiding stress and overexertion can prevent many cases of rotator tendinitis. Sports safety guidelines for children, adolescents, and adults can be helpful in avoiding injuries. Many causes cannot be prevented.

How is the injury recognized?

The healthcare provider will want to know when the pain occurs, and if anything helps the pain. Based on the medical history and physical exam, the provider may order a number of tests, such as:

  • Joint x-ray
  • MRI
  • Arthrogram or an arthroscopy, in which a small fiberoptic tube is inserted into the shoulder to allow the doctor to see inside the joint
  • Blood tests, including a complete blood count or CBC, to check for infection
  • Biopsy of any fluid near the rotator cuff

What are the treatments for the injury?

  • Minor pain or injury involving the rotator cuff may require RICE thereapy:
  • Rest or reduced activity
  • Ice or cold packs applied to the shoulder
  • Compression of the shoulder, such as with ace bandages
  • Elevation
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, may be used to reduce inflammation and discomfort. In some cases, a corticosteroid, such as triamcinolone, may be injected into the shoulder. Physical therapy helps to increase the strength of the tendons and muscles. Ultrasound may be used to warm the muscles and improve the blood flow. If conservative treatment is not successful, surgery may be needed. Surgery called rotator cuff repair is done to relieve tendons that are being pinched by the shoulder blade.

What are the side effects of the treatments?

NSAIDs can cause stomach upset, ulcers, and bleeding, or allergic reactions. NSAIDs may also affect the liver and kidneys. Surgery poses a risk of infection, and allergic reaction to anesthesia.What happens after treatment for the injury?

In some individuals with rotator cuff tendinitis, no further treatment is needed for minor pain and inflammation. For more serious disease or injury, treatment may continue. After surgery, the person will need to take it easy for several days to several weeks. Follow-up care will be needed. Physical therapy and daily strengthening exercises may be recommended.

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Tennis Elbow

Lateral Epicondylitis, Elbow Tendonitis or Tendinosis

Definition

Tennis elbow is the name for a certain pain on the outside of the elbow. The pain occurs at the bony lump on the outside of the elbow, just above the joint. People who have never played tennis may develop this condition.

What is going on in the body?

Sudden or repeated stress can cause tiny tears in certain muscles and at the point where they attach to the outside part of the elbow. These are the muscles that straighten the wrist and fingers when they are bent. These muscles also rotate the forearm so that the palm faces up. Tennis elbow causes pain when these muscles are used, or when the outside area of the elbow is bumped.

What are the signs and symptoms of the condition?

The main symptom is pain on the outside of the elbow when the person uses the muscles that straighten the wrist and fingers. Some people complain of pain throughout the lower arm. Pain can also occur when lifting anything, even a lightweight cup, with the palm facing down. The outside of the elbow is usually tender to the touch. Grabbing or twisting movements of the arm are commonly painful. When the wrist or fingers are straightened against resistance or a tight fist is made, pain may occur. There may be some swelling over the outside of the elbow, but this is unusual. The elbow should have its full range of motion.

What are the causes and risks of the condition?

Tennis elbow can be caused by a sudden tension of the muscle or ligament where it attaches to the outside of the elbow. Often this happens during a backhand stroke in racket sports, especially if the stroke technique is poor. Another cause is overuse of the muscles in a repetitive way. Examples of this are prolonged use of a screwdriver or typing.

What can be done to prevent the condition?

Tennis players can avoid tennis elbow by improving their backhand stroke technique. Stretching before a game and exercises to strengthen the muscles can help prevent injuries. Computer workstations should be set up so that the wrists and fingers are well supported while typing.

How is the condition diagnosed?

The history and physical examination are often enough for a healthcare provider to make the diagnosis. People often mention an activity that strains the involved muscles, such as tennis. The outside of the elbow is tender, and straightening the wrist or fingers against resistance causes pain. X-rays are usually normal. However, these may be ordered in some cases to make sure nothing more serious is present.

What are the long-term effects of the condition?

Long-term effects are related to pain and difficulty in straightening the wrist. This may reduce the ability of people to play tennis or engage in other activities.

What are the treatments for the condition?

Tennis elbow often goes away when the activity that caused it is stopped. It may help to lessen the frequency or intensity of the activity. Taking periodic breaks in the action may also help. Resting the elbow and using ice on it can speed recovery. Physical therapy consists of stretching and strengthening the muscles that straighten the wrist and fingers. Non-steroidal anti-inflammatory drugs (NSAIDs), such as naproxen or ibuprofen may be given for pain. Injections of cortisone may also be used to relieve the pain. A tennis elbow band may be advised. This can be worn around the upper forearm to help stop the muscle forces from being carried up to the elbow. Rarely, an operation on the elbow is needed when other treatments do not work.

What are the side effects of the treatments?

NSAIDs, especially if taken for a long time, can affect the stomach, kidneys, blood or liver. Cortisone injections carry a very small risk of causing infection. Cortisone injections may also weaken the tissues if used too often or cause the skin over the elbow to become pink, shiny, and thin.

If surgery is performed, there is risk of bleeding, infection, and damage to the nearby tissues. For example, nerve damage may rarely occur. This could cause numbness in part of the arm.

What happens after treatment for the condition?

People are usually advised to slowly increase activities. Many people have a full recovery and can return to their normal activities. Regular strengthening or stretching exercises may help prevent tennis elbow from returning. Reducing the intensity of the activity that caused the injury may be advised.

How is the condition monitored?

Tennis elbow is monitored by the affected person, who can notice the comfort level during physical activityArthritis refers to inflammation of a joint. The inflammation may cause pain, swelling, and stiffness.

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