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: 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.

Tennis Elbow Pain

Tennis elbow otherwise known as lateral epicondylitis, is commonly caused by inflammation of the extensor carpi radialis brevis tendon at the outer edge of the elbow. Tendons attach muscle to bone.  The extensor carpi radialis muscle attaches to the lateral epicondyle of the humerus bone.

Symptoms typcially include pain on the outside of the elbow and weakness in the wrist.

Correct diagnosis is essential.   At the Centeno-Schultz Clinic  a complete evaluation is the standard.  Entrapment of the radial nerve and cervical degenerative disc disease with nerve root irritation is always evaluated. 

Overuse or repetitive strains are the most common causes of tennis elbow pain.

Conservative treatment options include ice, resting the joint and using a support brace.  Treating the dysfunction muscle with myofascial release techniques (IMS) is critical to resolving the pain assoicated with tennis elbow.  In cases which are refractory to conservative care, a novel technique is now available in which a patient utilizes their own stem cells.  It is a needle-in, needle-out procedure which allows one’s own mesenchymal stem cells to repair the damaged tissue.

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