Elbow Injuries

Elbow injuries often tend to occur more often in the elbow tendons rather than the ligaments. Consequently, proper diagnosis and treatment need to take into account the physiological differences between these two tissues.



Common Elbow Injuries:

  • Lateral epicondylosis (Tennis elbow)—lateral dysfunction and pain
  • Medial epicondylosis (Golfer elbow)—medial dysfunction and pain

Many elbow injuries are the result of repetitive occupational or sports activities, though specific symptoms vary from case to case.   Most often, these injuries are best characterized as a “tendinosis”—as opposed to a tendon”itis”.  The major distinction is that there is relatively little to no actual inflammation involved in the lesion; rather, it is more akin to a traumatic or degenerative disruption of the tendon’s attachment site (the “enthesis”) to the joint bone.

In some cases, elbow dysfunction may also be related to a shoulder injury—so a clear diagnosis is critical.

Causes

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  • Normal wear-and-tear, which may occasionally be associated with osteoarthritis
  • Repetitive occupational or sports joint strain and sprain
  • Direct sprain injury to the skeletal, muscle or ligament tissuesdue to a traumatic accident

Treatment

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Osteopathic Manual Therapy (OMT) can be helpful in mobilizing the elbow joint.

Elbow sprain injuries respond to Prolotherapy—especially if caught early. Prolotherapy is directed to specific elbow ligament or muscle tendon attachments—depending on clinical history and physical findings on examination and X-ray.

Particular care needs to be taken with treatment of tendinous injuries because tendons can be more sensitive to inflammatory irritation. Consequently, treatment of these injuries often requires gentler Prolotherapy over a longer course of treatments.

If the elbow injury resists standard Prolotherapy, Platelet-Rich Plasma (PRP) Therapy would be an appropriate next step.

References

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The following peer-reviewed journal articles have resulted in healthcare insurance reimbursement for lateral epicondylosis (tennis elbow):
The efficacy of prolotherapy for lateral epicondylosis: a pilot study. Scarpone, M, et. al. Clinical Journal of Sports Medicine 2008 May;18(3):248-54.
The systematic review of four injection therapies for lateral epicondylosis: prolotherapy, polidocanol, whole blood and platelet rich plasma. Rabago D, et al. British Journal of Sports Medicine 2008 Nov 21. [Epub ahead of print]

Gary B. Clark, MD, MPA | 1790 30th Street, Suite 230, Boulder, CO | (303) 444-5131