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Home What We Treat Lateral Epicondylitis (Tennis Elbow)

Personalized boutique services supported by cutting-edge integrative diagnostics and advanced holistic therapies.

Tennis Elbow (Lateral Epicondylitis)

Lateral epicondylitis – commonly known as tennis elbow – is an overuse injury affecting the tendons that attach your forearm muscles to your elbow. While it gets its popular name from tennis injuries, lateral epicondylitis can arise from a variety of activities that exert repetitive force on the forearm and outer elbow. If left untreated, tennis elbow can be painful and slow to heal, often persisting for months on end. Today, advanced regenerative technologies, orthobiologics and innovative therapies are revolutionizing the way tennis elbow is diagnosed and treated, reducing recovery time from months to just a handful of treatment sessions.

NYDNRehab stays on the cutting edge of rehabilitative medicine by embracing the latest evidence-based methodologies and making them available to our patients. Our integrative patient-centric approach combines highly skilled diagnostics with advanced technologies, for a speedy restoration of pain-free elbow function without drugs or surgery.

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We’re located on 25th street in Manhattan NYC.
Open Monday-Friday, 10am-8pm.

table of contents

Who are doctors Kalika and Brosgol? Why does tennis elbow take so long to heal? What is biotensegrity and how does it affect elbow function? How is tennis elbow diagnosed at NYDNRehab? What other conditions mimic tennis elbow symptoms? What are the symptoms and causes of tennis elbow? When do I begin physical therapy? What methodologies do you use for tennis elbow treatment at NYDNRehab? What are orthobiologics and how do they help relieve elbow pain? What are orthobiologics and how do they help relieve elbow pain? Tennis Elbow FAQs

Dr. Kalika and Dr. Brosgol are Changing the Game in Injury Rehab

Dr. Lev Kalika
Dr. Lev Kalika

Clinical director & DC RMSK

Dr. Lev Kalika, DC clinical director of NYDNRehab, is an internationally recognized expert in diagnostic and musculoskeletal ultrasonography, with multiple research papers to his credit. Dr. Kalika has studied with some of the world’s most prestigious experts in diagnostic, fascia, and nerve ultrasonography, and has presented his research at multiple international conferences.

Dr. Kalika is an active member of the American Institute of Ultrasound in Medicine (AIUM), and has developed his own unique approach to Dynamic Functional and Fascial Ultrasonography.

Dr. Yuri Brosgol

Orthobiologic specialist

Dr. Yuri Brosgol, MD is a neurologist with 20+ years of experience in treating pediatric and adult myofascial pain. Dr. Brosgol is an expert in ultrasound guided prolotherapy, having studied directly under Dr. Stephen Cavallino, a leading Prolotherapy expert and director of the European School of Prolotherapy.

Dr. Brosgol learned fascial hydro release methodology directly from Dr. Carla Stecco, the world’s leading specialist in fascial science. Dr. Brosgol has become a pioneer in the use of orthobiologic solutions, blazing the trail for transformative advancements in the treatment of myofascial disorders.

Together, Dr. Kalika and Dr. Brosgol are combining their skills to revolutionize the way musculoskeletal pain and injuries are treated. Dr. Kalika’s successful track record of diagnosing and rehabilitating musculoskeletal injuries, combined with Dr. Brosgol’s expertise in treating myofascial pain, makes NYDNRehab the clinic of choice for injury rehab in NYC.

Why Tennis Elbow is Slow to Heal

The lateral epicondyle is the bony bump on the outside of the elbow where the tendons of the wrist and forearm muscles attach to the humerus bone. Tendons are tough collagenous structures that are continuous with their associated muscles. The extensor carpi radialis brevis (ECRB), the forearm muscle that extends the wrist, is most frequently involved in tennis elbow.

The condition is caused by repetitive wrist extension and supination (palm-up rotation) of the forearm that leads to microtears. The radial nerve and its branches are often affected, especially the posterior interosseous nerve (PIN) and the superficial radial nerve. Fascial restrictions in the forearm can increase pressure on the tendons and nerves, intensifying pain.

Multiple factors slow down the tendon healing process:

  • Collagen-rich tissues like tendons have a limited blood supply, inhibiting the delivery of oxygen, nutrients and growth factors needed for tissue healing.
  • The collagenous architecture of tendons makes them tough and elastic, but reduced metabolic activity prolongs collagen regeneration and remodeling.
  • Sparcer cell density compared to other tissues means tenocytes – specialized cells responsible for remodeling the tendon’s extracellular matrix – are more spread out, making healing less efficient.
  • Ongoing daily mechanical stress can slow the healing process, causing new microtears in damaged tissues. For many people, total immobilization of the elbow is not an option.
  • Chronic tendinopathies are difficult to heal, and reduced regenerative resources can cause them to degenerate over time if not properly rehabilitated.
  • Age-related factors like reduced collagen production, increased systemic inflammation and limited stem cell activity can dramatically delay healing.
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Steer Clear of Steroid Injections for
Tennis Elbow

Medical doctors often treat tennis elbow with corticosteroid injections, but patients should beware of steroid toxicity in the common extensor tendons that can lead to tendon degeneration and reduced performance.

Negative effects of steroid injections on tendon tissue include:
  • Muscle and tendon atrophy and weakness
  • Infections
  • Tendon ruptures
  • Accelerated osteoarthritis progression
  • Injury to adjacent bones
  • Cartilage damage to associated joints
At NYDNRehab, we use advanced regenerative therapies and orthobiologic procedures to override factors that slow the healing process, while protecting the tendons from steroid toxicity. Our holistic approaches tap into the body’s innate healing mechanisms to stimulate and accelerate cell regeneration in stubborn tissues. Addressing damaged joint tissues is the first step toward restoring functional elbow mobility.

Biotensegrity – the Key to
Functional Mobility

Biotensegrity refers to a physiological state where a system of individual components is held together under continuous elastic tension. In the human body, biotensegrity is created by the myofascial system, a complex network of muscles and fascia that exert elastic tension to control and guide movement, and to mediate outside forces. Biotensegrity is especially important in sports, where precise and efficient movement plays a key role in athletic performance.

Biotensegrity can be disrupted when myofascial tissues are injured or damaged, causing improper joint alignment and compromising efficient mechanics. Nerves and blood vessels can become entrapped in damaged fascia, preventing them from gliding among other structures and producing pain. Muscle coordination patterns can be altered, reducing mechanical efficiency. Factors that disrupt biotensegrity include:
  • Traumatic injury that affects multiple tissue types
  • Overuse injuries from sports, exercise or occupation
  • Old injuries that were never properly rehabilitated
  • Sedentary lifestyle with excessive sitting
  • Obesity that overloads the body’s structures
  • Inadequate hydration that deprives soft tissues of water needed to function
  • Diet high in sugar and carbs that causes myofascial tissue glycation, making it dense and sticky
Many doctors do not understand or even recognize the crucial role of the myofascial system in preventing musculoskeletal injuries. Conventional injury treatment revolves around pain management with drugs and steroids, or surgery when structural damage is severe. Patients are then referred to physical therapy for rehabilitation. At NYDNRehab, we pretreat your tissues prior to beginning physical therapy, with the goal of accelerating the healing process and optimizing biotensegrity.

Accurate Diagnosis is Critical to Effective Treatment

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. It is important to note that 40% of patients with tennis elbow pain exhibit instability of the capitellum – an underlying pathology unrelated to repetitive overuse that causes wear and tear of the elbow tendons.To emphasize the frequency of misdiagnosis, recent research on elbow epicondylitis was presented at the International Society for Medical Shockwave Treatment (ISMST) Congress:
  • In one study of 56 patients who had been diagnosed with elbow tendinopathy, 16 percent (9 patients) had nerve compressions, and 32% (18 patients) had pain generated from trigger points.
  • In another study of 51 patients diagnosed with insertional epicondylar tendinopathy, one had humeral osteochondritis, and another had radio-ulnar synovitis.
At NYDNRehab, we use dynamic high-resolution ultrasound to explore the myofascial system in real time. For years, MRI has been considered the gold standard for musculoskeletal imaging, but advancements in technology have made diagnostic ultrasonography the imaging method of choice for a broad spectrum of musculoskeletal disorders. High-resolution diagnostic ultrasonography has many advantages over MRI:
  • Ultrasound lets us visualize muscles, fascia, nerves and other structures in motion, and helps us identify areas where biotensegrity has been disrupted.
  • Much higher resolution means ultrasound can visualize small lesions and anomalies that are often missed by MRI.
  • Ultrasound allows for dynamic evaluation that can reveal factors like ligament laxity, radial nerve entrapment, and other conditions that mimic tennis elbow – factors that cannot be detected by static MRI.
  • We can compare the injured and uninjured elbows in the same session, to account for anatomical issues.
  • Ultrasound lets us view long bodies like nerves, muscles, fascia and bones along their entire path.
  • We can visualize fascial densifications, adhesions, and myofascial trigger points.
  • We are able to detect the exact site of nerve compression or entrapment.
  • We can easily view multiple tissues and structures in a single session, with no extra cost to the patient.
  • We can elicit patient feedback during the imaging session, to identify actions that cause pain or discomfort.
  • Compared to MRI, ultrasonography is fast, effective and relatively inexpensive.
  • Ultrasound imaging can be performed on-site in the doctor’s clinic, with no wait time for lab results.
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. Once we identify the problem, we use the most advanced therapeutic approaches to promote tissue healing and restore biotensegrity.

Beware of Tennis Elbow Imposters

Tennis elbow is a relatively common condition, and symptoms-based diagnosis can steer your elbow treatment in the wrong direction. Many other conditions mimic tennis elbow symptoms, and require different types of treatment. To get fast and effective results, it is important to work with a doctor who is able to differentiate lateral epicondylitis from its copycats.

Tennis elbow imposters include:

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Radial tunnel syndrome, where the radial nerve is compressed or irritated, causing pain in the outer elbow, along with forearm weakness and burning sensations.
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Compression of the posterior interosseous nerve (PIN).
3
Instability of the lateral collateral elbow ligaments.
4
Cervical radiculopathy, where a pinched nerve in the neck radiates pain to the elbow, mimicking tennis elbow symptoms.
5
Elbow osteoarthritis, where the joint is inflamed and/or degenerated, causing pain and stiffness around the elbow.
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Bursitis, where the bursa pad near the elbow becomes inflamed, causing localized pain and swelling.
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Tendinitis in other forearm muscles, such as the wrist flexors or extensors.
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Synovitis, where the elbow joint becomes inflamed, causing pain that radiates to the lateral side of the elbow.

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Referred pain from the shoulder or wrist Issues in cases of rotator cuff injuries or carpal tunnel syndrome.

Symptoms, Causes and Risk
Factors of Lateral Epicondylitis

Symptoms

  • Tenderness, burning and outer elbow pain
  • Pain that spreads to your forearm and wrist
  • Pain while gripping small objects
  • Pain while carrying loads with the elbow extended
  • Weakened grip

Causes

  • Improper grip during tennis or racquet sports
  • Poor trunk rotation when striking
  • Poor backhand form
  • Frequent use of tools like jackhammers or chainsaws
  • Occupational overuse among dentists, hairdressers, musicians, butchers and carpenters

Risk Factors

  • Being out of shape for your activity
  • Using improper technique during racquet sports
  • Not being properly fitted for a racquet
  • Engaging in an occupation that repeatedly overloads the wrist and forearm
  • Being middle aged

Why Physical Therapy Alone is Not Enough
to Resolve Tennis Elbow

Identifying and treating underlying issues prior to beginning physical therapy is key to getting fast and effective results. Failure to pre-treat your tissues can completely undermine your treatment protocol, and in some cases, your condition may even worsen.

Obstacles to physical therapy success include:

  • Scar tissue and fascial adhesions
  • Neurogenic inflammation
  • Joint edema
  • Inflamed soft tissues
  • Myofascial trigger points
  • Compressed or entrapped nerves
  • Tendons that have degenerated and lost their elastic properties
  • Compensation patterns developed post-injury

At NYDNRehab, we use a combination of regenerative technologies, orthobiologics, and integrative therapies to restore tissue integrity before starting physical therapy. Our holistic treatment protocols are personalized, tailoring your recovery journey to your unique diagnostic results. Once we pre-treat your damaged tissues and eliminate compensation patterns, your body will be ready to begin physical therapy.

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Orthobiologics are Transforming Tendon Treatment

Advanced treatment approaches are changing the game in injury rehab, and NYDNRehab is on the cutting edge. Our clinic features the latest evidence-based technologies and innovative methodologies that are only now emerging in the injury rehab space.

Dr. Kalika and Dr. Brosgol are pioneers in holistic rehabilitative medicine, leveraging the most current methodologies to tap into the body’s own healing mechanisms, to renew and repair tissues without drugs or surgery. Orthobiologic injection therapies use natural/neutral solutions, injected with precision thanks to ultrasound guidance. The injected solutions stimulate cellular repair by either nourishing or irritating the targeted cells.

For needling procedures, Dr. Kalika and Dr. Brosgol work together as a team, with Dr. Kalika providing ultrasound guidance to ensure that the needles hit their mark. Treatment results are dramatically enhanced when tissues are pre-treated with focused extracorporeal shockwave therapy (fESWT) and myofascial release techniques.

Orthobiologic procedures available at NYDNRehab include:

Platelet Rich Plasma (PRP)

PRP therapy uses a sample of the patient’s own whole blood, spun in a centrifuge to extract a high concentration of platelets. When injected into damaged tissues, PRP initiates tissue repair by releasing biologically active agents such as growth factors, cytokines, lysosomes and adhesion proteins. To be effective, it is critical to use the right concentration and quality of platelets, and to and follow proper isolation techniques. When administered correctly, PRP can help to jump-start tissue healing in chronic injuries and accelerate repair in acute injuries.

Matrix PRP

For tendon ruptures, Matrix takes PRP therapy to the next level by creating a collagenous bridge between the walls of the tear and the rest of the tendon. Matrix is a highly concentrated PRP, diluted and mixed with fibrinogen. At the injection site, the solution becomes a gel-like collagenous substance that adheres to the walls of the tear and fills the space between them, creating a fibrin matrix that helps to stabilize growth factors and attract stem cell migration to the treatment site.

Platelet Releasate Therapy

Platelet releasate therapy involves injecting platelet releasate – a mixture of growth factors and biomolecules – into injured muscles and tendons to promote healing. Platelet releasate works by activating leukocytes and endothelial cells, and stimulating blood vessel growth, to increase the flow of oxygen, nutrients and growth factors to the damaged tissues.

Alpha-2-Macroglobulin (A2M)

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 and Prolozone

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. Prolotherapy is often used for slow-to-heal tendon and ligament ruptures, where low vascularity inhibits tissue healing. Prolozone takes Prolotherapy to the next level by adding a combination of procaine, anti-inflammatory medications, vitamins, and minerals, followed by a mixture of ozone/oxygen gas, injected into targeted joints or tissues. When performed under ultrasound guidance, Prolozone therapy quickly reduces pain and inflammation while jump-starting the healing process.

Hyaluronic Acid Injections

Hyaluronic acid is a natural component of joint synovial fluid. Its slippery gel-like properties provide lubrication that reduces friction, enabling joints, muscles and fascia to move freely without pain. In arthritic patients, synovial hyaluronic acid tends to break down, causing bony structures to rub against one another. Hyaluronic acid replenishes synovial fluid to reduce friction and relieve pain. Hyaluronic acid is also a primary component of fascial tissue, providing its slippery gliding properties. Hyaluronic acid injections can help to restore hydration to densified fascia, to revitalize its functional properties.

Interfascial Plane and Nerve Hydrodissection

Injuries often involve damaged fascial tissue that has thickened and become sticky, often adhering to other structures. In the process, nerves and blood vessels can become entrapped, causing pain and restricting mobility. The hydrodissection procedure injects a saline solution into densified fascial layers under ultrasound guidance, separating the layers and releasing entrapped nerves and blood vessels. Hydrodissection is often used in conjunction with manual fascial manipulation, to fully restore fascial integrity.

Tips for Preventing Tennis Elbow

Tennis elbow is mostly a repetitive overuse injury, and symptoms often arise without warning. In addition to racquet sports, people in many occupations are prone to lateral epicondylitis, such as construction workers, cooks and chefs, mechanics, hairdressers, dentists, musicians, and many more.

Follow these guidelines to avoid lateral epicondylitis:

  • Seek professional guidance when choosing your racquet, to ensure you have the proper size racquet with the appropriate grip.
  • Hire a coach or trainer to teach you proper form.
  • Allow for adequate recovery time between sports or work sessions.
  • When using hand tools, take frequent breaks throughout the day to rest your forearm muscles.
  • Apply ice to your achy elbow at the first signs of pain.
  • Seek early treatment if your pain persists for more than several days..
  • Get a biomechanical analysis from the sports medicine lab at NYDNRehab, to identify mechanical errors that increase your risk of tennis elbow.
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Get Fast and Effective Tennis Elbow Relief in NYC

Modern medicine’s reductionist approach to tennis elbow focuses on treating the locus of pain, without considering other structures that impact elbow function. While pain management may provide temporary relief, it does not resolve the mechanical issues that contribute to tendon pathology. At NYDNRehab, our holistic approach ensures that all contributing factors are addressed, so you can return to your sport or occupation with confidence.

Your high-resolution ultrasound exam takes place on your first visit, enabling us to differentiate lateral epicondylitis from other issues that cause outer elbow pain. Our personalized one-on-one treatment approach is based on your unique diagnostic results. Our advanced regenerative technologies, orthobiologics and cutting-edge therapies accelerate healing, so you can quickly get back to your favorite activities without pain or dysfunction.

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    Clinical Case Studies
    NYDNRehab

    Case Study: Patient with Elbow Pain Self-Misdiagnoses

    Our Patient Our patient is a 57 year-old barber and recreational bodybuilder complaining of “tennis elbow” that would not go away. The pain worsened while lifting weights at the gym, and he reported pain and stiffness after waking up in the morning. He had previously had physical therapy, and an orthopedist had blindly injected a […]

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    Case Study: Lateral Epicondylitis

    Our Patient Our patient is a 56 year-old male jeweler who came to us with lateral elbow pain. The patient is a very athletic tennis player who works out at the gym on a regular basis. He stated that his pain initially started at the front of his elbow and eventually moved toward his lateral […]

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    Lateral Epicondylitis FAQs

    I've never played tennis in my life – how can I have tennis elbow?
    Tennis elbow can arise from a number of sports, occupations and activities that repeatedly overload the tendons, bones, and muscles used for gripping and wrist action. Tennis elbow often affects painters, dentists, construction workers, and people who lift weights, to name a few.
    What is the difference between tennis elbow and golfer's elbow?
    Simply put, tennis elbow (lateral epicondylitis) symptoms appear at the outer elbow, affecting the muscles and tendons you use to bend your wrist backward and straighten your fingers. By contrast, golfer’s elbow (medial epicondylitis) symptoms arise at the inner elbow, affecting the muscles and tendons you use to flex your wrist forward and close your fingers into a fist. Both can be painful and debilitating.
    Will my tennis elbow symptoms go away on their own?
    If proper care is taken to treat your symptoms and avoid activities that cause lateral epicondylitis, it will most likely self-resolve over time. Rest, ice, and compression can help speed recovery. However, symptoms can persist for months, especially if you continue to play tennis or engage in other activities that overload your forearm. Treatment with regenerative therapies and orthobiologics can accelerate tissue healing and dramatically shorten your recovery time.
    I've had tennis elbow multiple times – what am I doing wrong?
    Recurrent bouts of tennis elbow are often related to your racquet technique. Your grip, wrist motion and trunk rotation can all affect your elbow. A 3D motion analysis can help you identify and correct faulty motor mechanics that are overloading your elbow – it can even improve your tennis game!
    Once I begin treatment, how long will it take for my tennis elbow to stop hurting?
    It all depends on your unique condition and the type of therapy you receive. At NYDNRehab, our diagnostic technologies, regenerative therapies and personalized holistic approach work together to expedite recovery, so you can get back to your favorite activities as quickly as possible.

    Certificates and Continuing Education

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    Research at NYDNRehab

    18 Mar 2020 Efficacy of Extracorporeal Shock Wave Therapy for Lateral Epicondylitis: A Systematic Review and Meta-Analysis
    03 Nov 2021Extracorporeal shock wave therapy (ESWT) versus local corticosteroid injection in treatment of lateral epicondylitis (tennis elbow) in athletes: clinical and ultrasonographic evaluation
    Bubnov, Rostyslav & Kalika, L. & Pilecki, Zbigniew & Pilecki, Grzegorz. (2023). Conditions that mechanically block shoulder movement and can be evaluated using ultrasound – considerations for dry needling under ultrasound guidance. Neurologie und Rehabilitation. 29. S46. 10.14624/NR23S1001#page=50.https://www.researchgate.net/publication/375744515
    Cole B, Lam P, Hackett L, Murrell GAC. Ultrasound-guided injections for supraspinatus tendinopathy: corticosteroid versus glucose prolotherapy – a randomized controlled clinical trial. Shoulder & Elbow. 2017;10(3):170-178. doi:10.1177/1758573217708199Ultrasound-guided injections for supraspinatus tendinopathy: corticosteroid versus glucose prolotherapy–a randomized controlled clinical trial
    Ličen, Teja, et al. "Injury prevention in tennis players, linking the kinetic chain approach with myofascial lines: A narrative review with practical implications." Strength & Conditioning Journal 44.4 (2022): 104-114.Injury prevention in tennis players, linking the kinetic chain approach with myofascial lines: A narrative review with practical implications
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    Physical therapy and rehab can be time consuming,
    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.

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    Below is a prime example of how ultrasound can take the guesswork out of diagnosis.

    Learn more »
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    Accurate Diagnosis Is the ONLY way to
    Successful Treatment
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    A bad physical therapy experience is one of the primary causes of unnecessary surgery

    At NYDNR, we believe in
    medical innovation

    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.

    • С.A.R.E.N.
    • Kineo
    • Proteus shoulder arm recovery
    • Zebris
    • Manuthera 242
    • ESWT
    • Vertimax
    • Ankle Stabilizing Device
    • Blood Flow Restriction
    С.A.R.E.N. С.A.R.E.N. Kineo Kineo
    Proteus shoulder atm recovery Proteus shoulder atm recovery Zebris Zebris
    Manuthera 242 Manuthera 242 ESWT ESWT
    Vertimax Vertimax Ankle Stabilizing Device Ankle Stabilizing Device Blood Flow Restriction Blood Flow Restriction Training
    • Aplio i800
    • Vibration Platform
    • Sensa mat
    • Force Plate
    • Fascial Gun
    • ShooTools Slider
    • Redcord
    • Cryo Therapy
    • Skier's Edge
    Aplio i800 Aplio i800 Vibration Platform Vibration Platform Sensa mat Sensa mat
    Force Plate Force Plate Fascial Gun Fascial Gun ShooTools Slider ShooTools Slider
    Redcord Redcord Cryo Therapy Cryo Therapy Skier's Edge Skier's Edge

    Most importantly,

    we are the only facility in the US

    where structural medical diagnosis is reflected in functional treatment, and vice versa.

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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)

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    Complete tear of rectus femoris
    with large hematoma (blood)

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

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