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Patient returned today after initial evaluation for lateral elbow pain.  She has a 5 year history of elbow pain, localized along the lateral aspect, constant in duration, progressive in nature without any radiations.  Pain was throbbing in character and aggravated by external rotation and her daily work responsibilities.  Therapies to date had included physical therapy, massage, chiropractic care, x-rays of elbow, evaluation by sports medicine physician, trial of anti-inflammatory medications and muscle relaxants. 

Physical examination demonstrated point tenderness along the lateral epicondyle and multiple trigger points in the extensor muscles.  Neurologic exam was normal.   Cervical spine had mild reduction in range of motion which was painful.  Specifically she had pain with extension and lateral rotation.

Lateral epicondyle 2

Given her poor response to conservative therapy, persistence of symptoms and neck pain and restriction motion, I was concerned that her pain was arising from a degenerate disc in her cervical spine.  That would make sense since the muscles in her arm which were painful receive their information from the C6 nerve.  If there is compression of the nerve root,  pain and muscle dysfunction can result.

Her cervical MRI demonstrated degeneration of the C5/6 disc and compression of the C6 nerve root.

A thorough examination is essential.  This is the standard at the Centeno-Schultz Clinic.  Regenerative options for this patient include prolotherapy, IMS, cervical injections with PRP and stem cell therapy.

Cervical_Spine_MRI