Q: One of my cousins fell down and is now unable to fold his hand upwards. There is some tennis elbow kind of stiffness due to which he cannot fold his hand upwards. The doctor says that it requires surgery after 6 months. Can you please tell me what is the problem in his hand? He is facing this problem from the last three months.

A:I am not clear on the exact nature of your cousin’s problem. Inability to fold the hand up actually means a wrist drop. You are referring to it as Tennis elbow. Is your cousin having pain on straightening the elbow or is there an inability to lift the wrist up? Stretching of the elbow or straightening of the forearm as in tightening a screw or even forceful extension of the wrist into the Namaste position can all cause pain in a tennis elbow. This is usually a self-limiting condition, which settles with restriction of all the activities that cause the pain. Occasionally, pain is severe and you need to have simple anti-inflammatory drugs like Ibuprofen, diclofenac sodium, etc. Some patients have severe pain radiating down and up despite the medicines. Some of these patients benefit from a local anaesthetic injection with or without a steroid. This should be done only on medical advice and done in an operation theatre taking all aseptic precautions. There is a definite risk of infection with this; hence the precautions are mandatory. It is a rare patient (like Sachin Tendulkar who needs to get back to the same activity that causes the pain) who needs surgery. However, there is no rigid time limit criterion for this. So do not start counting days to the 6 months deadline set by your doctor. Wrist drop (as in the way you have described) is something completely different and is caused by a nerve problem. Your cousin needs to consult an orthopaedic surgeon and/or a Neurologist.