Ask the Lab: Hip Pain and Tennis Elbow

June 16, 2011 04:54 PM
Tennis elbow is a problem of wear and tear on the tendon that starts on the outside of the elbow.
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Question: My son is 13 years of age. He plays tennis and soccer and has pain in one of his hips that comes and goes. Can be that related to growing, or is it related to his sport activity? He has never directly injured his hips. Thanks, Vittorio
Dr. Evan Peck: Hip pain in an adolescent or child can be due to a number of causes. Some of these are more benign conditions; others are more concerning. 
The most common cause of hip pain in a child is a condition called transient synovitis, a condition characterized by hip joint inflammation with possible fluid inside the joint. There is not always an obvious cause. Transient synovitis is twice as common in boys as girls, occurs most frequently in the 4-10 years age group, and typically resolves with rest.
It is important for children with hip pain to be evaluated by a sports medicine physician or orthopedic surgeon to rule out a more serious condition, including slipped capital femoral epiphysis (a problem with the hip bone's growth plate), Legg-Calve-Perthes disease (a problem with blood supply to the hip bone), or septic arthritis (an infection in the hip joint). Left untreated, these conditions can have long-term negative consequences. 
In addition, abdominal and back injuries may cause referred hip pain. A history and physical examination, and selected laboratory tests or x-rays as warranted, will be helpful in determining the cause of your child's pain.
It is important to remember that children are not "little adults." Their bodies are different than adults and hip pain in children has a much different meaning than hip pain in an adult. Although your son's hip pain may seem mild, I recommend he be evaluated by a physician to determine the cause and to outline a treatment plan.
Question: Hi, I play tennis but recently I was shoveling dirt and noticed the next day that the outside of my elbow hurt. I played tennis one time after I noticed this pain and could not continue. I have rested the elbow since them (approximately four months) but I am still having problems and pain. Even carrying a bag of groceries can aggravate it. Can you offer any advice about how to get back in shape to play tennis? Jayne
Dr. Evan Peck: Based on the symptoms you describe, you may have lateral epicondylosis, commonly referred to as "tennis elbow." This is a problem of wear and tear on the tendon that starts on the outside of the elbow and feeds into the muscles that extend the wrist (to extend the wrist, place your palm flat on a table, and bend the wrist up to lift the hand). Despite the name, this condition is actually more common in non-tennis players. There are some other things that could also cause pain in this area, including a trapped nerve in the neck or the forearm, arthritis in the elbow, or injury to the ligaments of the elbow. 
After carefully evaluating a patient and confirming a diagnosis of lateral epicondylosis, a treatment plan will typically include modification of activities (for example, avoiding activities that cause symptoms for a period of 2-6 weeks), some type of bracing (such as a wrist splint and/or an elbow counter force strap), temporary use of oral and/or topical medications, physical therapy, and sometimes a corticosteroid injection. 
It is important to include eccentric-biased strengthening in the physical therapy program, which is a type of strengthening where the lowering of the weight is emphasized. There are scientific studies supporting the use of this type of strengthening for improving problems with this tendon and other tendons in the body. A physical therapist or athletic trainer can be very helpful in setting up and instructing patients in a proper eccentric-biased strengthening program suited to their condition.
For those who play tennis and have this condition, certain modifications to the racquet may be helpful, including increasing the grip width of the racquet and decreasing the string tension. Both of these modifications decrease the strain on the tendon on the outside of the elbow. In addition, it is important to have a qualified tennis coach assess your technique, particularly if your symptoms occur while playing tennis. Elite tennis players with refined technique rarely develop lateral epicondylosis, as they are able to distribute the force of ball contact throughout the body rather than on the lateral elbow.
About the Author
Dr. Evan Peck is a sports medicine physician at Cleveland Clinic Florida in West Palm Beach. His clinical interests include diagnostic and interventional musculoskeletal ultrasound, sports injury rehabilitation, concussion, and biological treatments of tendon and ligament injury. He completed his medical degree at the University of Virginia, residency training in physical medicine and rehabilitation at Baylor College of Medicine, and fellowship training in sports medicine at the Mayo Clinic in Rochester, Minnesota.