Elbow pain is one of those conditions that once you have it you realize how difficult it is to function around it. The two most common sources of elbow pain seen in our office are “Medial Epicondylitis” and “Lateral Epicondylitis”. These are commonly also known as “Golfers Elbow” and “Tennis Elbow”, respectively. Both conditions are usually related to tendon overuse at the elbow.
Tendons are the ends of muscles, where they attach to bone. They are rope-like structures that allow muscles to move bones when contracted. Tendons are also structures that have very poor blood flow and are susceptible to high-stress loads and repetitive stress injuries. The result is that we tend to see tendon problems in activities such as tennis or golf where there's a high degree of repeatability. Once tendon damage accumulates it usually creates either an inflammatory reaction parenthesis (tendonitis) or eventually tendon breakdown (tendinopathy). In the case of Tennis Elbow or Golfer’s Elbow, the only real difference is whether or not the tendon pain is on the outside of the elbow or the inside of the elbow.
With elbow tendon pain the damage can become so severe that it is difficult to hold up a glass of water or even do the normal activities of daily life such as buttoning your coat or lifting your purse or briefcase. The good news is there are some excellent treatments, that don't require surgery and can resolve the problem fairly quickly.
What makes our elbow treatment so successful?
One of the favorable aspects of elbow tendon injuries is they image very well in the office with high-resolution ultrasound. With high-resolution ultrasound, we can define the extent of the problem usually on the very first visit, without the need for more expensive and time-consuming tests like an MRI. Ultrasound helps us determine helps us make an important determination if we have simple tendonitis or an actual tendon tear.
Without this step, we have seen many patients fail to get better and get worse with treatments that inadvertently hurt the tendon, not helping it.
Note: We find patients who have been told to stretch, massage, and exercise their “tendonitis” only to complain that they feel worse after treatment. Why? If you have a small tear not just inflammation (tendonitis) then pulling on the tear either through stretching or exercise can cause make it larger. We avoid these mistakes by imaging the tendon first before we start therapy. Tears are more common than you'd think with elbow tendon pain which may be one of the reasons why so many people fail to get better even with treatment like Physical Therapy.
One of our favorite tools for treating Golfer’s or Tennis Elbow is “PRP”, which stands for Platelet Rich Plasma injection. This is a non-invasive, in-office treatment, where we take small quantities of blood through a simple blood draw technique and concentrate the number of naturally occurring platelet cells. We then inject the “Platelet Rich Plasma” directly into the tear under ultrasound imaging guidance, in essence using the power of these healing cells to “seal” the tendon injury without surgery. (Platelets produce growth factors and other compounds that stimulate repair when they are placed in an area of tissue injury. They are the same lifesaving cells that stop the bleeding and repair a cut in your skin when you hurt yourself).
Thankfully PRP does not generally require many visits either, usually, 1 - 3 to three treatments are enough to manage most elbow tendon issues that we see. The result is that our patients can get back to the things to things they love quickly, even when they have been in pain for long periods of time and failed other forms of treatments.