Elbow Pain: Accurate Diagnosis and Treatment

Pain on the outside of the elbow which is referred to as lateral epicondylitis can be disabling.  Typically seen in 30-60 year olds, patients complain of point tenderness over the outside aspect of the  elbow ( lateral epicondyle) aggravated by gripping and activities that extend the wrist.

The pain is thought to arise from degenerative changes in the muscles that attach to lateral epicondyle called the extensor muscles.  These muscles allow the arm to extend(bent backward) .

The diagnosis is made by clinical signs and symptoms.  A common diagnostic test is the Cozen test. Conservative treatment includes PT, NSAIDs, heat, ice and rest.  Injection of cortisone has been demonstrated to be no different than placebo.  Complications from repeated steroid injections include fat atrophy and potential weaking of the tendon.

Not all lateral elbow pain is lateral epicondylitis. 

LF  presented with a 5 month history of lateral elbow pain after tripping over her dog and striking her elbow on her granite countertop.  Conservative therapy had failed and her physician had referred her for PRP injection.  At the Centeno-Schultz Clinic therapeutic injections are performed with either x-ray or ultrasound to confirm accurate placement. LF’s ultrasound exam was significant for tendosis (tendosis) of the extensor muscles which are commonly associated with lateral epicondylitis.  More important was the significant tendosis and partial muscle tear of the triceps muscle (not typically seen with lateral epiconduylitis).  Identifying this second site of injury was cardinal as it represented another source of pain which needed to be treated for maximal clinical outcome.  At the Centeno-Schultz Clinic  an accurate diagnosis and appropriate placement of regenerative therapies whether it be stem cell therapy, prolotherapy, APC or PRP injections  is our standard.

Elbow Pain Now Addicted to Narcotics

55 year old patient presented with a 2 year history of left elbow pain which was constant in duration, 8/10 in severity, progressive in nature, localized on the lateral (outside) aspect of elbow without any radiations.  Patient drives a city bus and sustained a slip and fall injury in which he struck his left elbow. He denied any neck or arm pain.  Treatment to date had included massage, x-rays, cortisone injections into the joint and oral narcotics.  Narcotics were started “since other therapies had failed”.  Patient had a known addictive personality and was a recovering alcoholic. He was using up to 8 Vicodin /day as prescribed.

On physical examination he had extreme tenderness over the outside aspect of the elbow (lateral epicondyle) and multiple tender points along the extensor muscles in his forearm. His neurologic exam was normal.

Lateral epicondylitis  is theorized to be an injury of repetitive microtrauma/overuse.

It is commonly caused by  commonly associated with playing tennis  and other racquet sports.

It can also be caused by sustained contraction of the extensor muscles in the forearm which result in excessive force on the tendon where it is attached on the bone.  Treatment is two-fold: relax the dysfunctional muscle and promote healing.  This is possible by IMS and prolotherapy.

Following regenerative therapy at the Centeno-Schultz Clinic, patient had reduction in his pain, increase in range of motion and elimination of all narcotics.

Elbow Pain: PRP and Prolotherpy

Pain localized on the outside of the elbow is referred to as tennis elbow or lateral epicondylitis.

A group of muscles called the extensors attach to the outside bony surface of the elbow.

Tendons attach  muscle to bone.  To better visualize this, image the rope that extends from your tent to the stake.  During a wind storm there is increased tension on the rope which starts to pull on the tent stake.  The greater the stress on the rope, the greater the force on the stake.  So to with increasing tightness in muscle:  there is more tension on the stake (tendon attachment to bone).  The result is PAIN.

Treatment at the Centeno-Schultz Clinic begins with a thorough evaluation and examination.  Prolotherapy and PRP are effective therapies to reduce the inflammation and irritation at the site where the extensor tendons attach to the bone.  Equally important is to treat the underlying cause:  the dysfunctional tight muscles, like the tent rope, which are straining its anchor.  This is treated with IMS. Treatment at the Centeno-Schultz Clinic includes treating the pain as well as addressing the underlying issue that gave rise to the pain.