Member Case Study: Chronic Epicondylitis

author : AMSSM

comments : 0

The diagnosis was epicondylitis medial and tendinopathy in both elbows with partial rupture of the common flexor tendon. Are there any more treatments available that I haven't tried?

Member Question from Spider
I have been suffering with an injury for 28 months now, without any relief. The symptoms are: edema in both elbows, extreme pain while moving joints, weakness in wrists and fingers, pain that moves from shoulders to fingers, inability to open jars, lift, or carry anything.

I injured my elbows overdoing my weight sessions. When the pain first started, I just ignored it and continued to train until it became unbearable. I had a consultation with a sports specialist and got a scan done. The diagnosis was epicondylitis medial and tendinopathy in both elbows with partial rupture of the common flexor tendon (right arm).

I had many treatments including three cortisone injections in the locale of injury, four months of assorted physical therapy including stretches, and short wave and electric pulse treatments. My doctor advised on alternative medicine so I had 22 acupuncture sessions and Reiki. I also had high doses of anti-inflammatory drugs for a short period of time alternated with lower doses for longer period of times. I had two types of opioid medication for the pain and they didn't work. Now I am being treated with homeopathy for about two months with a very slight improvement in pain relief.

Are there any more treatments available that I haven't tried? I am desperate and in lots of pain.
 

Answer from Doug McDonald, MD

Member AMSSM

Two and a half years with a condition without much relief despite multiple and various treatments first makes me wonder if the problem is coming from somewhere other than the elbows, such as a cervical radiculopathy, a systemic rheumatological condition, or carpal tunnel syndrome. The symptoms listed could be describing these, and the treatments undertaken so far would not likely have much impact on any of these. However, if we assume that the "scan" (I am guessing an MRI) is accurate and that there is medial epicondylitis and tendinopathy with a partial common flexor tendon rupture, and that these occurred from overuse as described, then there are a few other treatments to consider.

First, and possibly most important, is a true rest period of 4-6 weeks to see if any healing could occur. I would at least relatively rest both to see if it helps. I would probably choose only one side to begin with, but a sling and good patient compliance may suffice to more completely rest one side. This should be followed by aggressive physical therapy and massage therapy.

Anti-inflammatories have been tried but may be considered if needed for some pain relief. Perhaps, with great caution, a short course of an oral steroid anti-inflammatory could be tried to see if it helps symptomatically. Other non-surgical methods that could be tried include prolotherapy, platelet rich plasma injections, or even lithotripsy shockwave treatments. Each of these should only be done with experienced providers. If the MRI is more than six months old, then I would likely to repeat it to see if there is any interval change and to better quantify the tear of the flexor tendon.

Certainly pursuing some rheumatological labs might be considered, and possibly an EMG to evaluate the weakness. If none of the above were successful, then a surgical consultation with an Orthopedic Hand surgeon should be considered for debridement of adhesions or scar tissue, or for consideration of surgical exploration.

Doug McDonald, MD
Denver, Colorado
Member AMSSM

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date: August 12, 2008