Tennis Elbow (Lateral
Epicondylitis)

About Tennis Elbow

Pain, tenderness and weakness near your outer elbow may indicate 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 incorrect form when playing tennis or other racquet sports. or from other types of repetitive overuse during sports, or from everyday activities like using tools.

In addition to overuse of tendons and muscles, lateral epicondyle pain can be caused by compression of the posterior interosseous nerve inside the radial tunnel, or by instability of the lateral collateral elbow ligaments. Accurate diagnosis that differentiates the underlying cause of your elbow pain is key to successful treatment.

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Dr. Lev Kalika
Dr. Lev Kalika

Clinical director & DC RMSK

About Elbow Pain
Specialist Dr. Lev Kalika

Dr. Kalika, clinical director of NYDNRehab, is one of the world’s foremost experts in musculoskeletal ultrasonography and has published peer-reviewed research on the topic. High resolution diagnostic ultrasonography is considered to be the best tool for diagnosing and differentiating the source of lateral elbow pain. Dr. Kalika’s expertise in ultrasonography makes him one of the most sought-after specialists in NYC for diagnosing and treating tennis elbow.

Why NYDNRehab is Your Clinic of Choice
for Tennis Elbow Therapy in NYC

At NYDNRehab, we never base our treatment protocols on symptoms alone. We use high resolution diagnostic ultrasound to image your elbow in real time, to precisely pinpoint the underlying mechanisms of your lateral elbow pain. Once the cause of your elbow pain has been accurately identified, we devise a personalized treatment plan based on your unique diagnostic results.

Run-of-the-mill physical therapy clinics often take a one-size-fits-all approach to lateral elbow pain, treating all patients with routine therapies and exercises that do not always promote healing. In some cases, inaccurate diagnosis can lead to treatment that aggravates your condition, prolonging the healing process. If you want to eliminate your lateral epicondylar pain for good, in the shortest time possible, NYDNRehab is your clinic of choice for tennis elbow treatment in NYC.

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 sport

  • Poor trunk rotation when striking

  • Poor backhand form

  • Frequent use of tools like jackhammers or chainsaws

  • Occupational overuse among dentists, 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 overloads the arm

  • Being middle aged

High Resolution Diagnostic Ultrasound Means Accurate Diagnosis and Successful Treatment

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. Pain may be due to posterior interosseous nerve compression, or to instability of the lateral collateral elbow ligaments. In severe cases, multiple structures involving the elbow and forearm may be affected.

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, to speed up the healing process.

High Resolution Diagnostic Ultrasound Means Accurate Diagnosis and Successful Treatment

Our Regenerative Tennis Elbow Therapies

Damage to connective tissues is often slow to heal, because tendons and ligaments have low vascularity that limits the delivery of oxygen and nutrients to the cells. Our regenerative technologies stimulate the growth of new cells, to accelerate the repair of damaged tissues and reduce pain and inflammation. Your tennis elbow treatment plan may include a combination of regenerative therapies, along with physical therapy to restore pain-free functional movement.

Extracorporeal Shock Wave Therapy (ESWT)

ESWT is used to stimulate the growth and repair of tissues at the cellular level. It is particularly effective for healing connective tissues like elbow tendons and ligaments that have limited vascularity. ESWT plays an especially important role in athletic injury rehabilitation, to accelerate healing for the fastest possible return to sports.

Extracorporeal Magnetic Transduction Therapy (EMTT)

This non-invasive regenerative therapy is making headlines as the next big thing in sports medicine and rehabilitation. When combined with ESWT, EMTT helps to reduce inflammation, eliminate pain, and speed up the neogenesis of new cells in muscles, bones and connective tissues.

Ultrasound Guided Dry Needling

Dry needling is a safe and effective therapy for eliminating myofascial trigger points, tiny knots of overactive muscle fibers that cause pain and dysfunction. Guidance with ultrasound imaging dramatically increases the effectiveness of dry needling by enhancing precision, eliminating the need for repeated insertions.

Ultrasound Guided Injection Therapies

When appropriate, we use ultrasound guided injections to reduce pain and inflammation, and to promote the neogenesis of new cells. Corticosteroids, platelet rich plasma, hyaluronic acid and other injection therapies may be used in certain cases. Ultrasound guidance ensures that the injected substance reaches its target with precision and accuracy, for superior results with minimal patient discomfort.

Superior Microvascular Imaging (SMI)

SMI is one invaluable feature of our high resolution ultrasound equipment that enables us to detect microscopic vascular activity in soft tissues, indicating the advent of healing. SMI helps us to confirm that your tennis elbow treatment protocol is generating the desired outcomes, and to measure your healing progress.

Our Regenerative Tennis Elbow Therapies

Tips for Preventing Tennis Elbow Pain

The following tips will help you avoid lateral epicondylitis:

  • Seek professional guidance when choosing your racquet, to ensure you have the proper size racquet with the appropriate grip circumference.
  • Procure a coach or trainer to learn proper form for striking the ball.
  • If you use tools, take frequent breaks throughout the day to allow your arm muscles to rest.
  • Apply ice to your achy elbow at the first sign of pain, or submerge it in an ice bath.
  • Allow yourself adequate recovery time between sports or work sessions.
  • Get a biomechanical analysis from the sports medicine lab at NYDNRehab, to pinpoint mechanical errors and perfect your racquet skills.
Tips for Preventing Tennis Elbow Pain

Eliminate Elbow Pain for Good with Tennis Elbow Therapy in NYC

Without proper treatment, tennis elbow pain can take months to heal on its own, taking you away from the sports or activities that caused it. The sports medicine professionals at NYDNRehab are equipped to help speed up healing with accurate diagnosis, regenerative therapies, chiropractic care and physical therapy. You don’t have to live with tennis elbow pain. Contact NYDNRehab today, and start healing so you can get back out there!

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    Lateral Epicondylitis (Tennis Elbow)

    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 Symptoms

    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.

    Causes of Tennis Elbow

    • Tennis elbow is most commonly caused by repetitive wrist and arm movements, particularly in young and middle aged adults.
    • In older adults, tennis elbow may be associated with joint degeneration, cervical nerve compression, and a heightened sensitivity to pain stimuli.

    There are four subcategories of lateral epicondylitis:

    • Osteogenic, originating from the bony prominence of the lateral epicondyle
    • Myofascial, stemming from too tight or too lax muscle tension at the elbow
    • Tendinosis, caused by degeneration of the common extensor tendon that extends the wrist
    • Arthrogenic, hyperactivity of the elbow musculature secondary to cervical spine degeneration

    Diagnosis 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:

    • Impingement of the radial nerve
    • Arthritis of the elbow
    • Cervical nerve compression
    • Lateral epicondyle fracture
    • Posterior interosseous nerve impingement

    Case Study

    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.

    Risk Factors

    There are several risk factors that predispose a patient to tennis elbow:

    • Postural support: The distribution of forces along the elbow and forearm are directly affected by postural support of the spine, shoulder and neck. Inadequate support of the neck and shoulder blades contributes to muscle imbalances at the shoulder, elbow and wrists. Clinical evidence shows that recovery time for tennis elbow is shortened when shoulder blade stability is also addressed.
    • Wrist mobility: Wrist and finger mobility are key factors that contribute to lateral elbow strain.
    • Tissue texture quality: The quality of soft tissues can affect upper extremity musculoskeletal health. The presence of knots, adhesions and scar tissue can inhibit fluid joint movement. Weakened or tight tissues can cause muscle imbalances that increase injury risk.
    • Female gender: Women are at higher risk of painful wrist and elbow conditions due to a hormonal profile that affects the tensile quality of soft tissues.

    Treatment for Tennis Elbow Pain

    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.

    Tennis Elbow Treatment at NYDNRehab

    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:

    • DNS (Dynamic Neuromuscular Stabilization) to restore alignment, stability and mobility to upper body structures
    • Myofascial manipulation to improve motor control and lengthen myofascial tissue
    • Acupuncture to eliminate active trigger points in the forearm
    • ESWT (Extracorporeal Shock Wave Therapy) to enhance circulation and promote cellular regeneration

    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.

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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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