Pain, tenderness and weakness near your outer elbow may be symptoms of lateral epicondylitis, commonly known as tennis elbow. The condition is an overuse injury affecting the tendons that attach your forearm muscles to your elbow. It can occur from suboptimal form when playing tennis, using hand tools, and other activities that repeatedly load the forearm. Lateral epicondyle pain can also be caused by compression of the posterior interosseous nerve inside the radial tunnel, or by instability of the lateral collateral elbow ligaments.
Because other conditions share similar symptoms, misdiagnosis of tennis elbow is not uncommon, often resulting in mistreatment of undertreatment that prolongs the patient’s suffering. Accurate diagnosis using high-resolution ultrasound is key to differentiating tennis elbow from other conditions.
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With over 25 years of experience treating tendinopathies, Dr. Kalika has formulated his own unique approach to diagnosis and treatment of overuse injuries. As an expert in diagnostic ultrasonography, he has published multiple scientific publications that have helped to take diagnostic medicine to the next level.
Based on the latest scientific evidence and years of experience treating elbow pain, Dr. Kalika considers not only the wrist and elbow, but also the complexities of the upper arm kinetic chain when diagnosing epicondylitis. His expertise in high resolution ultrasonography allows him to visualize the elbow and its associated structures in real time, to differentiate tennis elbow from other conditions with similar symptoms.
Dr. Kalika’s expertise in diagnostic ultrasonography makes him one of the most sought-after specialists in NYC for diagnosing and treating tennis elbow.
Because multiple structures converge at the elbow, it is impossible to know, based on symptoms alone, if your lateral elbow pain is caused by damage to the tendons that connect your forearm muscles to your elbow, or if other structural damage has taken place.
In many cases, lateral elbow pain does not originate in the tendon, but arises from compression of the posterior interosseous nerve (PIN). Even when PIN compression is not the primary cause of pain, it can be a significant contributor. Pain can also be caused by instability of the lateral collateral elbow ligaments. In severe cases, multiple structures involving the elbow and forearm may be affected, requiring a multifaceted treatment approach.
At NYDNRehab, we use the highest resolution diagnostic ultrasonography available, to closely examine the elbow and its surrounding structures. Ultrasound enables us to view the tissues in real time, with the elbow in motion, to rule out all possible causes of lateral epicondylar pain. With a precise and accurate diagnosis, we are able to provide the best condition-specific elbow pain treatment. Our use of regenerative technologies gives us nearly 100% success in resolving lateral elbow pain.
Ultrasound imaging takes the guesswork out of diagnosis and ensures that the multiple factors that may contribute to elbow pain are accurately identified and treated. Ultrasound imaging takes place in the comfort of our clinic on your very first visit. Quick and accurate diagnosis means you can begin therapy right away, with no wait time for lab results.
With diagnostic ultrasound, we can:
For years, MRI has been considered the gold standard for musculoskeletal imaging, but advancements in technology have catapulted high-resolution diagnostic ultrasonography to the top of the heap.
Ways in which high resolution ultrasound is superior to MRI:
Because tennis elbow and golfer’s elbow are fairly common conditions, many doctors are quick to diagnose elbow epicondylitis based on symptoms alone, without ruling out other potential issues. Consequently, patients often go mistreated or undertreated, prolonging their pain without resolving their condition.
Recent research on elbow epicondylitis was presented at the International Society for Medical Shockwave Treatment (ISMST) Congress:
Without ultrasound imaging, diagnosis of elbow epicondylitis is a hit-or-miss proposition. Misdiagnosis can cause critical conditions to go untreated, costing the patient time and money while prolonging their pain and dysfunction.
Most people take everyday mobility for granted until an injury occurs or pain sets in. Sometimes pain and reduced mobility seem to arise out of nowhere, with no apparent cause of onset. Regardless of whether your pain is caused by trauma or by something less obvious, tensegrity plays a key role.
Tensegrity refers to tensile integrity – a state where a system of individual components is held together under continuous elastic tension. In the human body, tensegrity is created by the myofascial system, the network of muscles and fascia that work together to produce, control, and guide forces, and to hold the body’s various organs and structures in place during movement.
Tensegrity can be disrupted when myofascial tissues are injured or damaged in some way. When that happens, nerves and blood vessels can become entrapped, preventing them from gliding among other structures and producing pain. At the same time, the elastic tension that governs joint alignment and controls movement becomes compromised, creating motor deficits that undermine mobility and stability.
Many doctors do not understand the crucial role of the myofascial system in preventing pain syndromes, movement disorders, and disease. In fact, most medical doctors have no idea how to correct myofascial dysfunction or even recognize it as a factor. They simply treat pain symptoms with medications and eventually recommend surgery.
At NYDNRehab, we understand that the body’s systems work together as an integrated whole, and that treating pain is not enough to eliminate its source. We use dynamic high-resolution ultrasound to explore the myofascial system in real time. Ultrasound imaging lets us visualize muscles, fascia, nerves and other structures in motion, to identify places where tensegrity has been disrupted.
Once we identify the problem, we use the most advanced therapeutic approaches to restore myofascial integrity and promote tissue healing.
Identifying and treating underlying issues prior to beginning physical therapy is key to getting fast and effective results. Failure to pre-treat your condition can completely undermine your treatment protocol, and in some cases, your condition may even worsen.
At NYDNRehab, we use a broad range of regenerative technologies and integrative therapeutic approaches to resolve issues that can stand in the way of successful physical therapy. Our staff is certified in a diverse array of holistic treatment methodologies, and our one-on-one treatment sessions are personalized, based on your unique diagnostic profile.
Once we pre-treat your damaged tissues and eliminate compensation patterns, your body will be ready to begin physical therapy.
The human body has its own innate healing mechanisms, but tendons sometimes need a nudge to accelerate the healing process. Regenerative technologies help to jump-start healing by stimulating tissue repair at the cellular level. Our outpatient regenerative therapies expedite recovery with minimal discomfort for the patient.
Most injuries involve more than one tissue type. When used together, our advanced shockwave technologies enable us to specifically target multiple tissue types with the most effective shockwave treatment. Your tennis elbow treatment plan may include a combination of regenerative therapies, along with physical therapy to restore pain-free functional movement.
SoftWave is a groundbreaking regenerative mechanotransduction technology that accelerates tissue healing. Its patented electro-hydraulic applicator delivers high-speed soundwaves that can penetrate up to six inches in depth. SoftWave’s defocused and linear focused shockwaves recruit maximum stem cells to the treatment site to promote healing. SoftWave’s wider and deeper penetration using defocused energy is a preferred treatment option for a broad spectrum of conditions, ranging from orthopedic injuries to pelvic health. SoftWave is the only unfocused shockwave technology currently available. According to recent research, SoftWave defocused waves combined with focused and radial shockwaves have maximum regenerative potential.
MyACT is a new type of focused shockwave technology that allows for deeper compression of the focused waves. Its higher frequency allows for precise neuro modulation under ultrasound guidance, with a special linear head for treating myofascial pain. MyACT transforms the mechanical energy of shockwaves into biochemical signals that precisely target damaged tissues. Most injuries involve more than one tissue type. When used together, our advanced shockwave technologies enable us to specifically target multiple tissue types with the most effective shockwave treatment.
Focused ESWT is used as a regenerative treatment for damaged tendon, muscle and bone tissue. This technology produces high frequency sound waves to stimulate the body’s own reparative mechanisms. It is especially effective for chronic degenerative tendon disorders and myofascial pain syndrome.
EMTT is a fairly new technology that transmits high energy magnetic pulses to targeted tissues. The magnetic waves synchronize with the body’s own magnetic fields, causing a disturbance that triggers a regenerative response. EMTT waves can penetrate deep tissues up to 18 cm beneath the skin’s surface, to target difficult-to-reach tendons, muscles, bones and nerves.
Extracorporeal Magnetic Transduction Therapy (EMTT)
Extracorporeal Pulse Activation Technology (EPAT)
EPAT, sometimes called defocused shock wave therapy, is not a true shockwave. It uses mechanical pressure waves to enhance blood circulation, improving oxygen and nutrient delivery to muscle and fascia tissues, but has minimal regenerative properties.The mechanical properties of EPAT make it especially effective for fascial manipulation in combination with focused shockwaves. We combine EPAT with different types of shockwaves for holistic treatment, without additional cost to the patient.
HEIT delivers high-intensity magnetic pulses to peripheral nerve tissues, to stimulate neuroplasticity. We leverage this FDA-approved methodology to treat pain and regenerate nerve fibers, for enhanced motor control.
High Energy Inductive Therapy (HEIT)
INDIBA is a form of TECAR therapy that helps to restore the ionic charge of damaged cells, for faster injury healing and rehabilitation.
NESA generates a low-frequency electrical current of intermittent and cyclical stimuli that soothes hypersensitized nerves and restores optimal signaling between the autonomic nervous system and the brain. We leverage this FDA-approved methodology to treat pain and regenerate nerve fibers, to enhance motor control.
Injection therapies use orthobiologic solutions that stimulate cellular repair by either nourishing or irritating the targeted cells. Guidance by ultrasound ensures that the injected substances hit their mark, for maximum effectiveness.
PRP therapy uses a sample of the patient’s own whole blood, which is spun in a centrifuge to extract a high concentration of platelets. When injected into damaged tissues, PRP initiates tissue repair by releasing biologically active factors such as growth factors, cytokines, lysosomes and adhesion proteins. The injected solution stimulates the synthesis of new connective tissues and blood vessels. PRP can help to jump-start tendon healing in chronic injuries and accelerate repair in acute injuries.
Alpha 2 macroglobulin (A2M) is a naturally occurring blood plasma protein that acts as a carrier for numerous proteins and growth factors. As a protease inhibitor, A2M reduces inflammation in arthritic joints and helps to deactivate a variety of proteinases that typically degrade cartilage.
Prolotherapy uses a biologically neutral solution to irritate stubborn tissues, triggering the body’s innate healing mechanisms to grow new normal tendon, ligament and muscle fibers.
Tendon injuries often involve fascial tissue that has become densified and/or formed adhesions, entrapping nerves and blood vessels, causing pain and restricting movement. Hydrodissection is a procedure where a saline solution is injected into densified fascia under ultrasound guidance. The solution works by separating fascial layers and freeing up entrapped nerves and blood vessels. We often use hydrodissection in conjunction with manual fascial manipulation.
The Stecco Method of fascia manipulation is one of the most effective methods for reversing fascia densifications and restoring the ability of fascial layers to glide among muscles, nerves and other structures. Stecco therapy involves deep friction that heats up tissues and stimulates mechanical action. When performed by a trained professional, Stecco fascial manipulation is a fantastic and evidence-based methodology for breaking up scar tissue and releasing adhesions, to restore the integrity of fascia tissue. Patients often report immediate pain relief after a single Stecco session.
SM neuromuscular electrical stimulation (NMES) dynamically interacts with the patient during therapeutic exercises, providing real-time sensory, auditory and visual biofeedback to the patient. This breakthrough technology helps patients to recalibrate muscle actions, to optimize joint function. SMNMES has helped numerous patients to avoid unnecessary shoulder, knee and ankle surgeries, even in complex scenarios.
During PENS treatment, filament-thin needles are inserted through the skin into muscle tissue adjacent to the targeted nerve. A low frequency electrical current is then delivered via the inserted needles to stimulate the dysfunctional nerve. PENS normalizes nerve activity, improves brain plasticity and optimizes muscle recruitment patterns. This therapy is so effective that patients typically need only 4-6 treatment sessions.
At NYDNRehab, we treat the whole patient, not just your symptoms. We never use one-size-fits-all rehab protocols or antiquated recovery timelines. We believe that every injury is unique, and treatment should be based on a holistic approach that factors in the patient’s unique profile.
Once we have successfully pre-treated damaged tissues, we can begin one-on-one physical therapy to restore strength and stability, optimize mobility, and re-establish optimal neuromuscular pathways and muscle coordination patterns.
Advancements in technology are changing the game in rehabilitative medicine, enabling us to accelerate healing and restore performance at an unprecedented pace. The clinic at NYDNRehab features some of the most advanced therapeutic equipment currently available, and rarely found in private clinics.
Your tendinopathy therapy may include the use of high-tech equipment:
Follow these guidelines to avoid lateral epicondylitis:
Get a biomechanical analysis from the sports medicine lab at NYDNRehab, to identify mechanical errors and enhance your performance.