The laws of medicine

Field notes from an uncertain science by Siddhartha Mukherjee

In this excellent treatise by Siddhartha Mukherjee,fascinating historical details and clinical anecdotes are intertwined diligently. This greatread provides some insights into the struggles and eureka moments that people outside of the medical profession rarely see.

Siddhartha Mukherjee’s three laws

1)  A strong intuition is much more powerful than a weak test.

2) “Normals” teach us rules; “outliers” teach us laws.

3)  For every perfect medical experiment, there is a perfect human bias.


Tennis Elbow

Tennis elbow usually presents with pain over the lateral aspect (outer aspect) of elbow. Pain often occurs when making a fist, lifting of objects, gripping or twisting of the hand and wrist.The wear and tear of the tendon, ECRB at its origin at the lateral epicondyle is the main pathology in tennis elbow.The repetitive  use of the tendons that extend the wrist (move the hand back) can be the main reason for this. The pain can be disabling and there are methods to improve the pain and speed up recovery.

First line treatment includes the following.

  • Modification of activities to avoid pain and review of sports techniques.
  • Short course of anti-inflammatory medications during the acute phase.
  • Tennis elbow support to give rest to the affected muscles.
  • Physiotherapy –Local ultrasound therapy and TENS therapy are useful to relieve the pain. After a period of rest for 3 weeks, stretching exercises can be started. Then one can gradually proceed to strengthening Pain may worsen when you start the exercise; however usually it will settle down gradually by 3 weeks time. The use of a strict exercise programme has been found to be effective.
  • Local steroid injections and PRP injecions are found to be useful to relieve the pain. The downside of local steroid injections are chance of recurrence of symptoms and a temporary depigmentation of skin.
  • Surgery – I have observed that debridement of the angiofibroblastic tissue following the technique advised by Nirschl is very effective when conservative treatment fails.