Case Study: Chronic Lateral Elbow Pain in Older Adult Female

Our Patient

Our patient is a 65 year-old female complaining of chronic lateral elbow pain and vague sensory issues involving her thumb.

The Challenge

The patient’s condition had persisted for 3+ years, and she had sought help from multiple physical therapists and pain management doctors. She was treated with multiple epidural steroid injections, but nothing helped.

Our Diagnostic Process

Clinical Exam

Upon our initial exam, it became immediately apparent that the patient had multiple issues related to posture, biomechanics, structural instability and fascial dysfunction.

Ultrasound Exam

We conducted a dynamic, proximal-to-distal exam using high-resolution ultrasound. Our exam indicated that the usual suspects involved in lateral elbow pain – the ECRB and EDC tendons – were not the primary cause of her condition.

Our dynamic ultrasound images revealed:

• Loss of tensegrity at C-5 ligamentum nuchae and interspinous ligament which improve with cervical extension and scapular depression.
• Severe multi segment facet joint arthrosis, contributing to altered segmental motion.
• Dynamic tension in the brachial plexus tension affecting multiple nerves.
• Subtle scapulothoracic dyskinesis, altering neural and fascial gliding between the shoulder blades and the rib cage.
• Glenohumeral microinstability, with early labral degeneration and glenohumeral osteoarthritis.

We concluded that the patient’s nerve pain involved dynamic compression of multiple proximal and distal nerves, driven by poor posture and inefficient biomechanics, along with osteoarthritis. In other words, the source of pain was not isolated to the elbow or compression of a specific nerve. The problem was a whole-body combination of poor motor control, inefficient muscle coordination, fascial dysfunction, and global instability which created tension to brachial plexus .

Our Treatment Protocol

Our treatment began with treating distal medial compression with Prolotherapy injections, Stecco fascial manipulation, and extracorporeal shockwave therapy. After 3 injections, 4 shockwave sessions and 4 Stecco sessions, the patient’s elbow pain was reduced by 75%.

We then moved on the shoulders and cervical spine, with more injections and multiple fascial manipulation sessions. The patient was 100% pain-free after 8 weeks of treatment. We continued with physical therapy to improve her posture, enhance her stability, and optimize her mobility.

Discussion

In younger patient’s, lateral elbow pain typically arises from repetitive overuse, often from sports, exercise, or occupation. But in older patients, it is important to consider other biomechanical factors that affect the neuromuscular system, and to explore issues further along the kinetic chain. Treatment should be strategic, and include manual therapy, orthobiologics, energy technologies, and physical therapy, addressing the whole patient, not just the locus of pain.

By contrast, modern medicine suffers from tunnel vision that compartmentalizes pain and segregates body parts and systems. This approach often leads to misdiagnosis, mistreatment, pharmaceutical dependency, and unnecessary surgeries. From our perspective, personalized integrative medicine is the future of health care.