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I'm on my high school tennis team. Last year I developed tennis elbow. Despite resting it over the summer, the pain has come back even worse than before. I don't want surgery. Is there any point in seeing my doctor for this problem anyway?

Tennis elbow, also known as lateral epicondylitis can be a very difficult problem to treat. For a tennis player, switching back and forth between forearm pronation (palm down) and supination (palm up) positions can bring on this condition.

Repetitive wrist extension adds to the microtrauma occurring at the elbow. The extensor carpi radialis brevis (ECRB) tendon, joint capsule, and surrounding ligaments can all be involved.

Many people with tennis elbow do get better over time with rest and over-the-counter (OTC) antiinflammatories. But further care may be needed for those who don't and for athletes like you.

There are many ways to treat tennis elbow without surgery. For example, if needed, your physician can prescribe a more powerful antiinflammatory medication than you can get OTC. Only about 10 per cent of patients who see their doctor for this problem need surgery.

You may be helped by a physical therapist. He or she can provide supportive forearm bracing, ultrasound to the tendon, and friction massage to realign the tendon fibers during the healing phase. Specific muscle strengthening called eccentric muscle training is a new treatment approach that works well with other tendon problems and may be equally useful for lateral epicondylitis.

There are also some treatment options that are semi-invasive but do not require surgery. For example, BOTOX injections can partially paralyze and numb the elbow. This method keeps you from repeatedly using the muscles that are aggravated. Steroid injections combined with a numbing agent have also been found effective for some patients.

See your doctor and find out what are all of your options. Choose the one that best fits your goals and expectations. If one method is not successful in eliminating your pain and improving function, you can try another one. It may take a while, but you should be able to find the right combination of treatment techniques to help.

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