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.