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Lateral Epicondylitis

Also known as Tennis Elbow

What is Tennis Elbow?

Lateral epicondylitis otherwise known as tennis elbow is an overuse injury involving the extensor muscles that originate on the bony prominence (epicondyle) on the outside (lateral) aspect of the elbow.  It is more properly termed tendinosis that specifically involves the origin of the extensor carpi radialis brevis muscle.  In a study, Nirschl and Pettrone attributed the cause of lateral epicondylitis to be tearing in the origin of the extensor carpi radialis brevis (ECRB) muscle (1).

The extensor carpi radialis brevis (ECRB) muscle originates from the lateral epicondyle. It functions to move the wrist so that the hand moves away from the palm and towards the thumb.

Symptoms of Lateral Epicondylitis

Symptoms typically include pain on the outside of the elbow and weakness in the wrist.

Arm Pain at Night

Arm pain at night can be miserable.  The pain can interrupt your sleep and erode your quality of life. Irritability becomes increasingly more common.  What are the causes?  When should I worry about it?  What are the treatment options for arm pain at night? The neck is composed of 7 boney building blocks numbered 1- 7. Sandwiched between the bones is a disc that functions as an important shock absorber. The cervical discs are susceptible to injury due to trauma, degeneration, repetitive motion, and surgery. Common disc injuries include disc bulges, and herniations. The injured disc can compress or irritate one or more nerves resulting in arm pain at night. It can…

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Arm Throbbing

In many patients, irritated neck nerves don’t present as a symptom in the neck. In fact, sometimes the only symptoms of irritated nerves in the neck occur in the arm muscles, as either tightness, throbbing, or both. While the arm throbbing might be frustrating as it’s happening, you might not think a whole lot about it, especially if it only happens on occasion. However, ignoring it is not a good idea since it is often a warning signal of a bigger problem in the neck. These body connections occur all the way back to when we were a fetus, like the neck, shoulder, and arm.

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Left Arm Numbness

Treatment depends upon the underlying cause of the arm numbness. Left-arm numbness is a warning sign that requires attention. As noted above unexplained numbness requires immediate attention. At the Centeno-Schultz Clinic, we are experts in the treatment of left-arm numbness due to cervical nerve irritation, cervical stenosis, thoracic outlet syndrome, and peripheral nerve injuries. When appropriate first-line treatment should involve conservative care including physical therapy and stretching. Steroid injections should be avoided as they are toxic to orthopedic tissue and can accelerate damage. Surgery for Cervical Stenosis and Thoracic Outlet Syndrome is major surgery and associated with significant risks. These risks…

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Pain on Outside of Elbow

Pain on the outside of the elbow which is referred to as lateral epicondylitis can be disabling. Typically seen in 30-60 year olds, patients complain of point tenderness over the outside aspect of the elbow ( lateral epicondyle) aggravated by gripping and activities that extend the wrist. The pain is thought to arise from degenerative changes in the muscles that attach to lateral epicondyle called the extensor muscles.

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Causes of Lateral Epicondylitis

The symptoms of lateral epicondylitis include pain and tenderness on the outside of the elbow, difficulty gripping objects, and weakness in the arm. Many cases of lateral epicondylitis are brought on by overuse, but the condition can also be caused by direct trauma to the elbow.

Many patients with tennis elbow are involved in work or recreational activities that require repetitive use of the forearm muscle. Pain can be severe and burning localized on the outside part of the elbow.   In most cases, the pain starts slowly and escalates over weeks or months.

Treatment Options for Tennis Elbow

Correct diagnosis is essential.   At the Centeno-Schultz Clinic, a complete evaluation is a standard.  Entrapment of the radial nerve and cervical degenerative disc disease with nerve root irritation is always evaluated.

Conservative treatment options include ice, resting the joint, and using a support brace.  Treating the dysfunctional muscle with myofascial release techniques (IMS) is critical to resolving the pain associated with tennis elbow.  In cases that are refractory to conservative care, a novel technique is now available in which a patient utilizes their own bone marrow concentrate (BMC) containing mesenchymal stem cells.  It is a needle-in, needle-out procedure which allows one’s own BMC to repair the damaged tissue.

NSAIDs

The other day I was evaluating a patient and reviewing the treatment options for their spine condition.  After discussing prior treatments, we got to the topic of medications taken for pain relief. She explained that she mainly utilized anti-inflammatory (NSAID) medications and then she told me to hold much she takes and has been for many years…..she takes close to 2 grams (2000 milligrams) on a daily basis which equated to about 9-10 capsules of medication per day.  I was shocked, considering she was pre-diabetic and with high blood pressure plus the kicker of it is that her PCP (primary care physician) is ok with this…

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PRP for Tennis Elbow

PRP, which stands for platelet-rich plasma, is a concentration of platelets and growth factors derived from whole blood. Plasma is the fluid portion of blood. Blood is drawn from a peripheral site most commonly in the arm and then placed into a centrifuge where the platelets are concentrated. Platelets contain important growth factors that are critical to tissue healing and repair which include vascular endothelial growth factor and platelet-derived growth factor. PRP has been compared with steroids in the treatment of lateral epicondylitis. In a 2015 study, 65 patients with lateral epicondylitis were randomized to receive PRP or steroid injections. Pain, grip strength…

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Our Doctors That Can Assist with Tennis Elbow

Christopher J. Centeno, MD

Christopher J. Centeno, M.D. is an international expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate in orthopedics. He is board-certified in physical medicine and rehabilitation with a subspecialty of pain medicine through The American Board of Physical Medicine and Rehabilitation. Dr. Centeno is one of the few physicians in the world with extensive experience in the culture expansion of and clinical use of adult bone marrow concentrate to treat orthopedic injuries. His clinic incorporates a variety of revolutionary pain management techniques to bring its broad patient base relief and results. Dr. Centeno treats patients from all over the US who…

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John Schultz, MD

My passion and specialization are in the evaluation and treatment of cervical disc, facet, ligament and nerve pain, including the non-surgical treatment of Craniocervical instability (CCI). I quit a successful career in anesthesia and traditional pain management to pursue and advance the use of PRP and bone marrow concentrate for common orthopedic conditions. I have been a patient with severe pain and know firsthand the limitations of traditional orthopedic surgery. I am a co-founder of the Centeno-Schultz Clinic which was established in 2005. Being active is a central part of my life as I enjoy time skiing, biking, hiking, sailing with my family and 9 grandchildren.

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John Pitts, M.D.

Dr. Pitts is originally from Chicago, IL but is a medical graduate of Vanderbilt School of Medicine in Nashville, TN. After Vanderbilt, he completed a residency in Physical Medicine and Rehabilitation (PM&R) at Emory University in Atlanta, GA. The focus of PM&R is the restoration of function and quality of life. In residency, he gained much experience in musculoskeletal medicine, rehabilitation, spine, and sports medicine along with some regenerative medicine. He also gained significant experience in fluoroscopically guided spinal procedures and peripheral injections. However, Dr. Pitts wanted to broaden his skills and treatment options beyond the current typical standards of care.

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Jason Markle, D.O.

Post-residency, Dr. Markle was selected to the Interventional Orthopedic Fellowship program at the Centeno-Schultz Clinic. During his fellowship, he gained significant experience in the new field of Interventional Orthopedics and regenerative medicine, honing his skills in advanced injection techniques into the spine and joints treating patients with autologous, bone marrow concentrate and platelet solutions. Dr. Markle then accepted a full-time attending physician position at the Centeno-Schultz Clinic, where he both treats patients and trains Interventional Orthopedics fellows. Dr. Markle is an active member of the Interventional Orthopedic Foundation and serves as a course instructor, where he trains physicians from around the world.

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Matthew William Hyzy, D.O.

Doctor Hyzy is Board Certified in Physical Medicine and Rehabilitation (Physiatry) and fellowship-trained in Interventional Orthopedics and Spine. Dr. Hyzy is also clinical faculty at the University of Colorado School of Medicine in the Department of Physical Medicine and Rehabilitation; In addition, Dr. Hyzy is an Adjunct Clinical Assistant Professor at The Rocky Vista University College of Osteopathic Medicine. Dr. Hyzy also maintains an active hospital-based practice at Swedish Medical Center and Sky Ridge Medical Center. He is also recognized and qualified as an expert physician witness for medical-legal cases and Life Care Planning. He is published in the use of autologous solutions including…

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Brandon T. Money, D.O., M.S.

Dr. Money is an Indiana native who now proudly calls Colorado home. He attended medical school at Kansas City University and then returned to Indiana to complete a Physical Medicine and Rehabilitation residency program at Indiana University, where he was trained on non-surgical methods to improve health and function as well as rehabilitative care following trauma, stroke, spinal cord injury, brain injury, etc. Dr. Money has been following the ideology behind Centeno-Schultz Clinic and Regenexx since he was in medical school, as he believed there had to be a better way to care for patients than the status quo. The human body has incredible healing capabilities…

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Other Resources on Tennis Elbow

  • PRP for UCL Injury – PRP Injections for UCL Tear

    Dr. Pitts Talks About PRP for UCL Injury as an Alternative to Tommy John Surgery Transcript Hi everybody. This is Dr. John Pitts with the Centeno-Schultz Clinic, where we lead and invented much of the field of Interventional Orthopedics and regenerative medicine. Mainly we treat most musculoskeletal and orthopedic problems with injections of your own … Continued


  • Tennis Elbow vs Golfer’s Elbow: Things You Must Know

    Elbow pain can be debilitating. Dr. Schutlz discusses the differences between Tennis elbow and Golfers elbow and successful treatment options that do NOT include steroids, NSAIDs or surgery.


  • Ulnar Shortening Surgery: What You Need to Know

    Ulnar shortening surgery, also known as ulnar osteotomy, is cutting out a portion of the ulna bone which is thought to be causing excessive force, injury, and pain in the wrist. Dr. Schultz discusses the indications, complications and non surgical alternatives in the treatment of ulnar sided wrist pain.


  • Tommy John Surgery Success Rate

    Injury to the ulnar collateral ligament in the arm and the surgical procedure commonly used to “repair” it is called the Tommy John Surgery. Dr. Schultz discusses complications, return to play and decline in performance, shorter career, and re-injury.


  • Centeno-Schultz Clinic Proudly Sponsors United States Tennis Association

    The Centeno-Schultz Clinic was excited to announce their sponsorship of the United States Tennis Association this week and get involved in the tennis community. It was a very exciting weekend. On Saturday morning we sponsored a coaches workshop at the Denver Tennis Park led by Wayne Bryan. Wayne is a former tennis club owner and … Continued


  • Dumb Surgery Alert: Biceps Tenodesis

    We’ve added yet another surgery to our dumb-surgeries list here at the clinic. You’d think after all these years, the crazy surgeries patients come to us after having endured wouldn’t still shock us. Unfortunately, however, we still seem to be thinking, They did what to you? a bit too often when these patients are explaining … Continued


References:

Nirschl RP, Pettrone FA. Tennis elbow. The surgical treatment of lateral epicondylitis. J Bone Joint Surg Am. 1979 Sep;61(6A):832-9. PMID: 479229.

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