Elbow Tendonitis

An interview with Dr. Eugene Wang

What exactly is tennis elbow?

Tennis elbow usually is a problem with the Common Extensor Tendon or the tendon that allows you to cock your wrist. Irritation to that specific tendon usually shows up as pain in the outer elbow with resisted wrist motion or strong gripping activities.

What is the difference between tendonitis and tendinosis?
Tendonitis involves active inflammation in a tendon vs. tendinosis where the normal healing process of a tendon is halted and the tendon sustains repeated "micro tears" resulting in the tendon losing elasticity and normal function. Tendinosis is not an inflammatory process and is generally more of a chronic issue.

Do the treatment strategies vary between tendonitis and tendinosis?
Yes. If a tendon is recently injured resulting in Tendonitis, we would use anti-inflammatory treatments to decrease the inflammation. In Tendinosis, the objective of treatment changes to trying to break down the damaged collagen tissue in the tendon and restart the bodies healing abilities to repair the damaged tendon.

What are some nonsurgical treatment options for tennis elbow?
If the injury is recent or "acute", there are 3 methods of delivering anti-inflammatory medicine to the injured area.
•    Over the counter NSAIDs like Ibuprofen, Naproxen or
•    Topical creams like Voltaren Gel.
•    Corticosteroid "Cortisone" injections around the tendon can provide quicker relief. It is important that the injection is done with ultrasound guidance to prevent the steroid from being injected in the tendon as this could increase the risk of tendon rupture.

When treating Tendinosis, the preferred nonsurgical treatment is Ultrasound-guided Percutaneous Tenotomy. This is a procedure where the damaged collagen tissue in the tendon is precisely "broken up" with a needle. Afterwards, Platelet Rich Plasma (PRP) or whole blood can be injected into the tendon to use the Growth Hormones in in the Platelets to speed up recovery.

With both Tendonitis and Tendinosis, Physical Therapy is a good treatment option to change the biomechanics that led to the problem in the first place. While the pain may be at the elbow, often there are muscular imbalances in other regions of the body that result in the elbow pain. A tennis player may be over utilizing their arm and wrist to produce power in their swing instead of driving the ball with their trunk or core strength. A Crossfitter may be inappropriately doing a reverse curl during a power clean movement instead of thrusting their pelvis to produce the momentum to get the bar into a front rack position. Other treatments like Iontophoresis, Theraputic Ultrasound, ice massage, and tennis elbow straps/bands can be helpful as well.

Holiday Pain: Travel

Frequent driving, flying, or bus trips can cause serious strain and stress to the spine and make for a very painful holiday season.The Harborside Spine & Sports Center staff is dedicated to helping all of our patients enjoy their holidays while avoiding holiday pain. Shopping and wrapping presents is just the tip of the iceberg.

Preventing back pain begins at square one: packing. For many of us, stuffing our carry-on luggage is standard for traveling procedures. However, it is best to distribute the weight into multiple checked suitcases. For more support, pack heavier items at the bottom of bags and lighter ones on top.

When lifting your luggage into the overhead bin, in and out of the car, and up the stairs, be sure to lift with your legs. Never bend over your waist to pick up items. Bend your knees and lift with your legs, not your back!

When traveling, especially for long flights and road trips, make sure you get up and move around on a regular basis. Walk around if you can so your muscles don’t become stiff.

Drink plenty of water while traveling. Your muscles need hydration to function at full capacity and keep from developing muscle stiffness or inflammation. Use over the counter medication including ibuprofen or acetaminophen if necessary.

Because the holidays are such a hectic time of year, we are often put to work right after travel. It is important that you get enough rest before you get involved in any strenuous activity. Avoid any rigorous work immediately after travel, and instead stay hydrated and stretch. Take time to enjoy your family and friends.

We wish everyone safe travels during the holiday season!