Tennis Elbow Treatment

Tennis elbow, or lateral epicondylitis, is a painful overuse condition, characterized by soreness on the outside (lateral) part of the elbow. Along with golfer’s elbow (medial epicondylitis) it is a form of tendinitis and one of several painful conditions that have been successfully treated at NYDNRehab.

Tennis elbow is caused by repetitive stress on the muscles and tendons connected with the lateral epicondyle, a bony prominence located on the outside of the elbow. When the muscles responsible for extension of the wrists and fingers are placed under stress, micro-tears can develop at the lateral epicondyle. These micro-tears result in tennis elbow pain. Tendons are made up of strands of collagen; strains and tears trigger the body’s self-repair mechanisms, causing scar tissue to form at the site of degeneration. However, repetitive injury prevents the tissue from healing properly.

Because the tendons have a tendency to degenerate as we age, tennis elbow is more likely to occur in older people. Moreover, once injured, the body is more likely to experience re-injury. The major feature distinguishing tennis elbow from golfer’s elbow is that patients suffering from tennis elbow experience pain on the outside elbow while those suffering golfer’s elbow experience pain on the inner side of the elbow. A patient may also experience difficulty performing actions that involve twisting or gripping, such as holding a cup of coffee or playing the violin. Other symptoms may include elbow tenderness, stiffness, and weakness. Those whose occupations depend on repetitive stress in this area are especially prone to suffer from tennis elbow. This includes people such as carpenters and dentists.

Typically tennis elbow can be treated with conventional treatment methods like rest and medication. In cases where anti-inflammatory medication doesn’t help to relieve symptoms, cortisone injections may prove helpful. Cortisone injections provide more powerful and longer-lasting pain relief than most standard medications. A physician may also prescribe a brace to protect the tendon by restricting total contraction of the muscles. A physician may also prescribe tennis elbow physical therapy, including specific exercises to strengthen the muscles of the forearm.

At NYDNRehab we have fifteen years of experience treating sports and orthopedic injuries, including tennis elbow and shoulder pain. The success of our method lies in combining conventional medical treatment with the most advanced technological methods. On the one hand, our physicians will guide the patient in developing and implementing a specific form of tennis elbow physical therapy. On the other hand, we may use extracorporeal shockwave therapy (ESWT) to relieve pain and regenerate damaged tissue. ESWT works by applying either low-intensity or high-intensity sound waves (depending on the severity of the injury and needs of the patient) to the site of injury. These sound waves initiate the body’s own process of healing, bringing blood circulation, oxygenation, and nutrients and gradually restoring the injured tendons. Though ESWT is a recent development in the field of rehabilitation, it is one of the most effective and proven methods for treating degeneration.

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In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)

image

Complete tear of rectus femoris
with large hematoma (blood)

image

Separation of muscle ends due to tear elicited
on dynamic sonography examination

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