Lateral epicondylitis, also known as tennis elbow, is a painful condition of the outer elbow where the upper and lower arm bones meet. Recent evidence has placed the condition under the umbrella of Occupational Overuse Syndromes (OOS), sometimes also called repetitive strain injury (RSI) syndromes.
Tennis elbow pain is most pronounced during certain activities like opening a jar or turning a doorknob.
The pain can be quite intense, with a burning quality.
Recent studies have revealed a widespread mechanical hypersensitivity among patients with tennis elbow, where patients’ perception of pain is heightened during normal activities of daily living. Tennis elbow patients are often hypersensitive to pressure or cold applied to the forearm. Research suggests that peripheral sensitization mechanisms may play a role in the initiation of tennis elbow.
In patients under age 45, tennis elbow pain is most often due to repetitive overuse
In patients over age 50 with degenerative joint disease in the cervical spine (arthritis of the neck) tennis elbow may be linked to disruptions in the nerve connections between the neck and arm.
The sensitization phenomenon may play a role in both older and younger populations
Tennis elbow pain falls under one of four subcategories:
Osteogenic — Pain is in the bony prominence of the lateral epicondyle
Myofascial — Muscles attached to the lateral epicondyle are either weak and lax, or overly tight
Arthrogenic — Pain is related to degenerative disease of the cervical spine
Tendonosis — A degenerative process is occurring in the common extensor tendon that originates at the lateral epicondyle
Symptoms and a physical exam are often sufficient to diagnose lateral epicondylitis. At NYDNR, we use diagnostic ultrasound to confirm diagnosis and rule out other possible causes of elbow pain, including:
Sonoelastography is a new technology for measuring tendon stiffness and elasticity. SMI (superior microvascular imaging) is a new development in medicine that makes micro vascularization visible for the first time. Evidence of blood flow in the smallest vessels indicates early inflammation that cannot be detected with any other technologies or blood testing.
Our new Aplio machine features Sonoelastography and SMI. They are not available with any other radiological technology, including MRI, CT scan or Xray. Both are important clinical tools for selecting the best therapy, estimating the time for convalescence and guiding the recovery process.
Please explore more advanced diagnostic option unavailable anywhere else:
Poor grip strength is common in patients with tennis elbow, mostly due to prior weakness and disrupted coordination of the shoulder-elbow-wrist connection. This disruption in motor function leads to pain in the lateral elbow. Treatment focuses on specific therapeutic exercises that target musculoskeletal deficits.
Isometric exercises in a non-compressed position and extracorporeal shock wave therapy are both supported by clinical evidence as effective treatments for chronic lateral elbow pain.
At NYDNR, we use innovative therapies and advanced technologies to treat tennis elbow pain, including:
DNS helps restore alignment, mobility and stability to the elbow, wrist and shoulder.
Lengthening the myofascial tissue can reduce stress to the muscles and tendons at the lateral epicondyle.
This ancient therapy can help eliminate active trigger points that may contribute to elbow pain.
Low intensity shock wave therapy is a non-invasive treatment that stimulates metabolism and enhances blood flow to affected area, accelerating the healing process.
Tennis elbow pain can make even the simplest tasks challenging, interfering with your daily quality of life. The elbow pain specialists at NYDNR are dedicated to identifying the source of your pain and eliminating it, so you can enjoy your life to the fullest.
Lateral epicondylitis, commonly called tennis elbow, is a painful inflammatory condition felt at the outside of the elbow. While the condition is often associated with tennis, it can also occur from occupational overuse from repetitive twisting motions.
Tennis elbow is marked by pain, burning and tenderness at the outside of the elbow, usually on the dominant arm. Inflamed tissue may feel warm to the touch. Pain may escalate when carrying objects with an extended elbow, or during rotating motions like opening a jar or turning a doorknob.
There are four subcategories of lateral epicondylitis:
Clinical diagnosis begins with a health history and physical exam. Diagnostic ultrasound may be used to confirm diagnosis and rule out other causes of elbow pain.
Some conditions that mimic tennis elbow include:
A 48 year old female writer presented at our clinic with pain in her lateral elbow. She had been diagnosed with lateral epicondylitis, and treated with steroid injections. When her symptoms were not resolved, she went to another practitioner who treated her elbow with extracorporeal shock wave therapy (ESWT) and five months of physical therapy. Nine months later, she was still in pain.
We used diagnostic ultrasonography to examine her elbow, and found no evidence of tendinosis at the lateral epicondyle, but we did discover a compression of the posterior interosseous nerve (PIN), which is a common mimicker of tennis elbow, and which is easily missed on MRI. Diagnostic ultrasound provides a clear image of the structures of the elbow in motion, in real time, offering precise insight into the nature and cause of the patient’s elbow pain. Early diagnosis with ultrasound can spare the patient ineffective conservative treatment approaches, and unnecessary surgery.
There are several risk factors that predispose a patient to tennis elbow:
Poor grip strength associated with disrupted coordination of the shoulder-elbow-wrist connection is a primary dysfunction of people with tennis elbow, which in turn leads to pain in the lateral epicondyle. Therapeutic exercise has long been the mainstay of treatment for severe elbow pain. Isometric exercise is sometimes effective in reducing pain when held in a non-compressed position. Extracorporeal shockwave therapy has been shown to have a high rate of success in treating lateral epicondylitis.
At NYDNR, we use a holistic and comprehensive approach to treat our patients with tennis elbow pain. After diagnosis using real-time ultrasound, we follow up with innovative therapeutic treatments, including:
For the best elbow pain treatment to help you heal quickly and improve your performance, contact NYDNR today. We are the very best clinic to treat tennis elbow in NYC.
and a faulty diagnosis can make treatment a total waste of time.
Failure to accurately diagnose a condition in its early stages can lead
to chronic problems and sometimes devastating results.
Diagnostic musculoskeletal sonography (MSUS) provides the perfect tool for the rehab practitioner. Yet many doctors and physical therapists have no experience with MSUS, are unaware of its advantages, and have no idea how to use it as a diagnostic tool.
Below is a prime example of how ultrasound can take the guesswork out of diagnosis.Successful Treatment
A bad physical therapy experience is one of the primary causes of unnecessary surgery.
We have equipped our clinic with the latest research-grade technology to arrive at objective and accurate diagnoses, and to objectively measure our patients’ progress.
Most importantly, we are the only facility in the US where structural medical diagnosis is reflected in functional treatment, and vice versa.
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)
Complete tear of rectus femoris
with large hematoma (blood)
Separation of muscle ends due to tear elicited
on dynamic sonography examination
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