The usual reasons patients have an elbow replacement are severe osteoarthritis, nonunion of bone fracture at the elbow, or severe joint instability. Elbow replacements are available for younger adults (less than 40 years old) but usually only as a salvage procedure (in other words, to save the joint). Other nonreplacement options are usually recommended first.

A group of orthopedic surgeons from the Rochester, Minnesota Mayo Clinic recently published a study done on total elbow arthroplasty (TEA) in adults 40 years of age or less. They report having done elbow replacements on over 750 patients between 1982 and 2003. About eight per cent of those patients were 40 or younger.

Elbow replacements are available for younger adults (less than 40 years old) but results have not been great. Studies show that success rates are getting better but may not be good enough yet. At the Mayo Clinic, less than 10 per cent of the patients who received a total elbow replacement over a 20-year period were 40 years old or younger. The surgery was done to save the elbow.

Lateral epicondylitis, commonly known as tennis elbow, causes pain that starts on the outside bump of the elbow, the lateral epicondyle. As you have discoverred, this condition is not limited to tennis players.

It sounds like you have a realistic idea of the effect of your workload on your tennis elbow. That may not be negative thinking as much as a certain reality check. Most people with this problem know what their limitations are and if/when they are ready to go back to work.

Tennis elbow has been around for a long time -- and not just in tennis players. The typical patient with chronic tennis elbow is between 30 and 60 (most often around 50 years old) and involved in heavy lifting or repetitive work. The dominant arm is usually the painful one and it's been going on for months without relief. That's true even for the folks who get some kind of treatment for the problem.

Treatment for rheumatoid arthritis is divided into two types: conservative (nonoperative) and surgery. Nonsurgical treatment usually begins with medications to control symptoms and prevent damage to the joint. For some patients, the use of antiinflammatory drugs and disease modifying anti-rheumatic drugs (DMARDs) can completely eliminate all signs and symptoms of rheumatoid arthritis.

Total elbow arthroplasty (replacement) can be helpful for the older adult (65 years or older) who has severe pain and loss of elbow motion and function. The cause of the elbow problems may be from rheumatoid arthritis, osteoarthritis, or years later after a traumatic injury.

The elbow is a hinge-type joint allowing open and close motion. But it really has three separate articulations (joints) to make forearm rotation possible (palm up, palm down). The capsule and surrounding ligaments help hold and support the elbow giving you stability. The muscles give strength. Together, the soft tissues and bone structure of the elbow complex provide mobility.

Your therapist may actually have some alternate ideas to share with you. Don't hesitate to let him or her know of your painful response to the splint. That's not an uncommon reaction but it is one that needs to be corrected. Without some form of holding device, your elbow will only get stiffer.