Dr Kanaan is an Duke Trained expert in NON-SURGICAL tendonitis treatments for tennis, golf, and pickleball elbow pain and injuries.
NON-SURGICAL Tennis, Golf, and Pickleball Elbow Treatment in Raleigh / Cary NC
Tennis + Pickleball elbow, or lateral epicondylitis, is a painful condition of the elbow caused by overuse. Not surprisingly, playing tennis or other racquet sports can cause this condition. However, several other sports and activities can also put you at risk. Tennis elbow is an inflammation of the tendons that join the forearm muscles on the outside of the elbow. The forearm muscles and tendons become damaged from overuse — repeating the same motions again and again. This leads to pain and tenderness on the outside of the elbow.
Golfers elbow or medial epicondylitis is a condition of the elbow on the inside of the elbow that sometimes can be made worse with golf, or an flexion of the wrist.
There are many treatment options for tennis and golfers elbow. In most cases, treatment involves a team approach.
Wake Nonsurgical Ortho is Triangle’s first private practice solely dedicated to Nonsurgical orthopedics. Duke-trained non-surgical orthopedic specialist, Dr. Matthew Kanaan, is dedicated to making sure that patients receive access to non-surgical treatments for tennis or golfers elbow. Dr. Kanaan will take the time to answer any questions you may have so that he can determine the best treatment option for you. For more information, contact our orthopedic clinic in Raleigh at (919) 719-2270 and schedule an appointment today!
Anatomy
Your elbow joint is a joint made up of three bones: your upper arm bone (humerus) and the two bones in your forearm (radius and ulna). There are bony bumps at the bottom of the humerus called epicondyles. The bony bump on the outside (lateral side) of the elbow is called the lateral epicondyle.
Muscles, ligaments, and tendons hold the elbow joint together.
Lateral epicondylitis, or tennis elbow, involves the muscles and tendons of your forearm. Your forearm muscles extend your wrist and fingers. Your forearm tendons — often called extensors — attach the muscles to bone. They attach on the lateral epicondyle. The tendon usually involved in tennis elbow is called the Extensor Carpi Radialis Brevis (ECRB). Golfers elbow involves the medial epicondyle and the Flexor tendons.
Cause
Recent studies show that tennis elbow is often due to damage to a specific forearm muscle. The extensor carpi radialis brevis (ECRB) muscle helps stabilize the wrist when the elbow is straight. This occurs during a tennis groundstroke, for example. When the ECRB is weakened from overuse, microscopic tears form in the tendon where it attaches to the lateral epicondyle. This leads to inflammation and pain.
The ECRB may also be at increased risk for damage because of its position. As the elbow bends and straightens, the muscle rubs against bony bumps. This can cause gradual wear and tear of the muscle over time.
Golfers elbow can be caused by trying to muscle the golf ball or an improper swing mechanic.
Activities
Athletes are not the only people who get tennis elbow. Many people with tennis and golfers elbow participate in work or recreational activities that require repetitive and vigorous use of the forearm muscle.
Painters, plumbers, and carpenters are particularly prone to developing tendonitis of the elbow. Studies have shown that auto workers, cooks, and even butchers get tennis elbow more often than the rest of the population. It is thought that the repetition and weight lifting required in these occupations leads to injury.
Age
Most people who get tennis and golfers elbow are between the ages of 30 and 50, although anyone can get it if they have the risk factors.
Doctor Examination
Your doctor will consider many factors in making a diagnosis. These include how your symptoms developed, any occupational risk factors, and recreational sports participation.
Your doctor will talk to you about what activities cause symptoms and where on your arm the symptoms occur. Be sure to tell your doctor if you have ever injured your elbow. If you have a history of rheumatoid arthritis or nerve disease, tell your doctor.
Tests
Your doctor may recommend additional tests to rule out other causes of your problem.
- X-rays. These tests provide clear images of dense structures like bone. They may be taken to rule out arthritis of the elbow.
- Ultrasound. Dr Kanaan can use the Ultrasound machine to look for damage or spurs.
Non- Surgical Treatment
Surgery is not the only option when it comes to treating tennis and golfers elbow. Approximately 80% to 95% of patients have success with nonsurgical treatment.
Physical therapy
Specific exercises are helpful for strengthening the muscles of the forearm. Your therapist may also perform ultrasound, ice massage, or muscle-stimulating techniques to improve muscle healing.
Brace
Using a WRIST/ SPICA brace can actually rest the elbow. This can reduce symptoms by resting the muscles and tendons. We like to use these at night as well.
Steroid injections
Steroids, such as cortisone, are very effective anti-inflammatory medicines. Your doctor may decide to inject the painful area around your lateral epicondyle with a steroid to relieve your symptoms.
NOTE: Dr Kanaan does not like to use repetitive steroid injections. This can actually make your tendon degrade in the long term ! There are other options.
Extracorporeal shock wave therapy
Shock wave therapy sends sound waves to the elbow. These sound waves create “microtrauma” that promote the body’s natural healing processes.
PRP Injections
Platelet-rich plasma (PRP) is currently being investigated for its effectiveness in speeding the healing of a variety of tendon injuries. PRP is a preparation developed from a patient’s own blood. It contains a high concentration of proteins called growth factors that are very important in the healing of injuries. Read more here : https://wakenonsurgicalortho.com/new-high-dose-prp-platelet-rich-plasma/
Needle Fenestration /Needle Tenotomy
What is needle tenotomy?
Percutaneous means “affected through the skin,” and tenotomy means cutting or removal of tendon tissue. Percutaneous needle tenotomy is a procedure to pierce the damaged parts of the tendon with a needle through the skin under ultrasound guidance. The goal is to promote the body’s healing response.
The doctor starts by numbing the area, which may cause mild discomfort. The entire procedure takes 15 to 20 minutes, and you can go home the same day. Any pain you have after the procedure should subside within a few days.
There’s a pinch and a burn when the numbing medication is injected. A small needle is moved through the affected tendon to disrupt and remove damaged tissue while leaving healthy tissue intact.
How does needle tenotomy work?
Tendons don’t get a lot of blood supply and they use less oxygen than muscles. The idea of this procedure is to produce inflammation, break up scar tissue and increase blood flow to the tendon by repeatedly piercing the damaged tissue with a needle. This allows the body’s own cells to begin the process of rebuilding the tendon.
The fresh, oxygenated blood produced by percutaneous needle tenotomy can trick the body into thinking that a decades-old nonhealing injury is a new injury. And the body sends its healing resources to the affected area to repair this injury.
The procedure can also break up calcium deposits in the tendon as well.
Who can benefit from needle tenotomy?
Percutaneous needle tenotomy is appropriate for people of all ages and activity levels. It can be especially helpful for people who may not be candidates for surgical tendon repair.
Patients that might benefit
- Tennis and Golfers Elbow
- Patellar Tendonitis
- Rotator cuff tendonitis
- Hip Tendonitis
- Plantar Fasciitis
Don’t wait! Contact us today to experience pain relief without the risk of surgery. Call (919) 719-2270, or schedule an appointment.