LATERAL EPICONDYLITIS AKA

TENNIS ELBOW, EXTENSOR TENDINOSIS, ELBOW TENDINOSIS

In my over two decades of practice, I have only seen one case of “Tennis Elbow” caused from playing too much tennis and yet I have literally seen hundreds of Tennis Elbow cases. Fact is we see many cases of elbow type pain every week. The proper name for Tennis Elbow is Elbow Extensor Tendinosis, or even more commonly, Lateral Epicondylitis. If you do not know the difference between Tendinitis and Tendinosis and are still referring to this problem as Elbow Tendinitis, it is critical for you to understand the distinction.

Tendinosis, sometimes called tendinitis, or tendinopathy, is damage to a tendon at a cellular level (the suffix “osis” implies a pathology of chronic degeneration without inflammation). It is thought to be caused by micro-tears in the connective tissue in and around the tendon, leading to an increased number of tendon repair cells. This may lead to reduced tensile strength, thus increasing the chance of repetitive injury or even tendon rupture. Tendinosis is often misdiagnosed as tendinitis due to the limited understanding of tendinopathies by the medical community.Tendon researcher and orthopedic surgeon, Dr. GA Murrell from an article called, Understanding Tendinopathiesin the December 2002 issue of The British Journal of Sports Medicine.

"Tendinitis such as that of the Achilles, lateral elbow, and rotator cuff tendons is a common presentation to family practitioners and various medical specialists. Most currently practicing general practitioners were taught, and many still believe, that patients who present with overuse tendinitis have a largely inflammatory condition and will benefit from anti-inflammatory medication. Unfortunately this dogma is deeply entrenched. Ten of 11 readily available sports medicine texts specifically recommend non-steroidal anti-inflammatory drugs for treating painful conditions like Achilles and patellar tendinitis despite the lack of a biological rationale or clinical evidence for this approach. Instead of adhering to the myths above, physicians should acknowledge that painful overuse tendon conditions have a non-inflammatory pathology." Karim Khan, MD, PhD, FACSP, FACSM, and his group of researchers at the Department of Family Medicine & School of Human Kinetics at the University of British Columbia, published this study (the quote is from the Abstract) in the March 2002 edition of BMJ (British Medical Journal).


If your doctor is still treating you for tendinitis and not tendinosis, he or she is probably caught in a time warp. According to what the American Academy of Orthopedic Surgeons said over 20 years ago, tendinosis is not an inflammatory condition (itis)! It is a degenerative condition (osis)! Not only is there some debate over whether or not tendinitis actually exists at all, but as you will see in a moment, the anti-inflammation medications and Corticosteroid Injections that your doctor has been prescribing you are actually creating more degeneration and scar tissue resulting in more long term chronic pain patterns. If you are not be aware that professional Track & Field athletes make it a point to keep up with the cutting edge diagnosis and treatment of tendinous sports injuries you might enjoy reading the following excerpt.

"The relatively new term 'Tendinopathy' has been adopted as a general clinical descriptor of tendon injuries in sports. In overuse clinical conditions in and around tendons, frank inflammation is infrequent and if seen, is associated mostly with tendon ruptures. Tendinosis implies tendon degeneration without clinical or histological signs of intratendinous inflammation, and is not necessarily symptomatic. The term 'Tendonitis' is used in a clinical context and does not refer to a specific histological entity. [The term] Tendonitis is commonly used for conditions that are truly Tendinosis, however, and leads athletes and coaches to underestimate that proven chronicity of this condition....... Most articles describing the surgical management of partial tears of a given tendon in reality deal with degenerative tendinopathies [Tendinosis]." From an official document found on the website of the International Association of Athletics Federations (IAAF) --- the official governing body of professional Track and Field

TENDINOSIS OVERVIEW

The truth is that I could go on and on with quotes from similar studies. Hopefully, you get the point! You should be starting to see that most of what you thought about chronic tendon problems needs to be flushed down the toilet or thrown out with the weekly trash. That's because there's a new model in town. Tendinosis is it's name; and if you want any hope of a solution to your tendon problem, you will have to step outside of the medical "box" and start thinking of your problem in terms of "osis" instead of "itis". Failure to grasp the new model leaves you vulnerable to treatments which, while possibly bringing some temporary relief, will ultimately make you worse --- possibly much worse! By the way, the following points are observations that you yourself will understand if you read the above quotes.

  • Tendinosis is a Degenerative Condition without inflammation.

  • Tendinosis is the proper model for understanding the majority of Tendinopathies. As a model for understanding Tendinopathies, Tendinitis has been retired for at least two and a half decades.

  • Tendinosis is both misunderstood and mismanaged by the majority of the Medical Community.

  • Traditional Therapies / Interventions for Tendinopathies significantly increase one's chance of Tendon Rupture.

  • Most Coaches and Athletes do not understand the difference between Tendinitis and Tendinosis.

  • If it does exist, Tendinitis (Inflammation of the Tendon) is rare, short lived, and mostly associated with Tendon Tears or Ruptures.

  • Tendinosis is caused by both overuse and under-use.

  • Tendinosis is often times Asymptomatic (no symptoms), until it becomes a painful and potentially debilitating problem.

  • Drugs; particularly NSAIDS and Corticosteroids, as well as certain antibiotics actually cause Tendinosis --- and Tendon Rupture. They also slow down (or reverse) the healing process.

Evaluation entails examining the wrist, elbow, shoulder joints and occasionally the neck as this problem can be caused somewhere along the kinetic chain. Most often the problem is specific to the elbow/lateral epicondyle and common tendons and quite often pain relief can begin after the first treatment and yes, it can be very effectively treated with non-surgical therapies in our office involving energy medicine such as elbow mobilizations, cold laser therapy and transverse soft tissue applications.

Before you opt in for medications, corticosteroid injections or surgery, explore your treatment options. I pride myself on results. Give us a call.