Hacker's Hazard

A handshake becomes an ordeal. Turning a doorknob sends twinges of pain through the forearm. Swinging a racket at a tennis ball--especially if the ball hits off center--causes a sensation that some players compare with being hit in the elbow by a hammer. These are all symptoms of an ailment that has long been familiar to doctors and athletes but is now becoming epidemic in America: tennis elbow.

Javelin throwers, football and baseball players and even violinists often suffer identical symptoms. But it is because of the mushrooming popularity of tennis that doctors' waiting rooms are filling with victims of the condition; about half a million new players have taken up the game in the U.S. each year for the past three.

Tennis elbow is apparently set off by the repeated, jarring impact of the ball on the racket. The shock is transmitted to the arm, where it raises havoc--for reasons that doctors, despite long experience with tennis-elbow victims, still do not fully understand. Most of the pain seems to be caused by inflammation of the ligaments that join the two bones of the forearm--the radius and ulna--to the two spurs, or epicondyles, on the end of the humerus, or upper arm bone (see diagram).

That inflammation may well result from the partial avulsion, or tearing away, of the ligaments and tendons from their bony moorings. But gout or other arthritic disease, as well as softening of the cartilage--a normal result of the aging process--can also contribute to it. Indeed, tennis elbow is often an affliction of the aging athlete. The ailment rarely affects anyone under 30; most of its victims are over 40.

No one seems certain about the best way to treat tennis elbow. Some doctors recommend complete rest for the arm. Some players, influenced by folklore, wear copper bracelets and report beneficial effects--despite the scoffing of medical scientists. A few doctors and many tennis pros suggest a more practical remedy: wearing a tight elastic band below the elbow, on the theory that compression of the arm decreases the tension on the forearm muscles.

Usually doctors recommend aspirin, which appears to have an anti-inflammatory effect, to relieve minor cases of tennis elbow. Some find that phenylbutazone, a nonhormonal, anti-inflammatory drug that combats both inflammation and the pain that accompanies it, will help in more serious instances. Persistent cases can be treated by injections of cortisone, a process that many tennis addicts find as painful as tennis elbow itself. As a last resort, some doctors even advise surgery to release the tension on arm tendons or ligaments or trim down oversize epicondyles. In some cases, however, tennis elbow disappears almost as suddenly as it began, often without treatment.

Dr. Jeffrey Minkoff, orthopedic surgeon at the new Institute of Sports Medicine at New York City's Lenox Hill Hospital, believes that the best cure for tennis elbow is prevention. He points out that weak forearm muscles, an improper grip or a tendency to hit the ball incorrectly can all contribute to tennis elbow. He recommends exercises to strengthen arm muscles and lessons that will improve stroking and serving, thus reducing shock to the arm. In support of his treatment, he notes that professionals seldom suffer from tennis elbow;* the ailment is endemic among once-a-week players and hackers.

Professional or amateur, most tennis addicts with tennis elbow are determined to keep playing at any cost. Some go so far as to relearn the game with their other arm. Others bravely endure the pain that each stroke brings. One Manhattan buff has even found a bright side to the affliction. "When I hit a backhand, I often scream in pain," he explains. "My opponent is usually so disconcerted that he can't return the shot."

* Although hoth Arthur Ashe and Tony Roche have been victims.

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