Elbow arthroscopy for stubborn lateral epicondylitis (tennis elbow)

Lateral epicondylitis (tennis elbow) can be one of the more frustrating conditions that patients come to see me for. It is the most common cause of lateral elbow pain and can lead to significant disability. Luckily, a vast majority of cases do improve without surgery within 3-4 months with rest, bracing, and stretching.

What can be done if the pain does not improve with the common treatment of rest, stretching, and bracing?

If the pain persists greater than 6 months, I generally offer elbow arthroscopy. This quick, outpatient surgery takes approximately 30 minutes and involves making two small skin incisions (approximately 1cm) around the elbow and using a camera and small instruments to remove the damaged portion of the tendon that is causing pain.

Most patients see very good results and have significant improvement in their pain and return of function within 4-6 weeks from surgery.

To learn more, you can schedule a consultation with me here or always feel free to contact the office with questions.

I am now a member of the American Shoulder and Elbow Surgeons! #ASESMembers

I am very happy to announce that I have been selected as a candidate member of the American Shoulder and Elbow Surgeons. The American Shoulder and Elbow Surgeons is a society made up of the leading national and international shoulder and elbow surgeons. As the premier organization of shoulder an elbow surgeons, it strives to serve patients and further research and education concerning shoulder and elbow issues. I couldn’t be happier and honored. Thank you #ASES.

Guest posts coming soon!

I will be introducing guests posts from upper extremity experts that I know and trust, discussing all things involving upper extremity injuries and treatment. As many of my patients also suffer from issues regarding the hand and wrist, I believe that this will be a great resource for patients going forward. Stay tuned!

AC Joint Separation Explained

Since the shoulder joint has the widest range of motion, it also is the most prone to injury from sports incidents, falls, or overuse.

What is an AC joint injury?

The acromioclavicular (AC) joint is formed between the collarbone (clavicle) and the tip of your shoulder blade (scapula). You can feel it by putting your hand on top of your shoulder and locating a bony bump.  You may sometimes hear an AC joint separation referred to as a shoulder separation, but it doesn’t actually involve the shoulder. Instead, it occurs when the collarbone separates from the shoulder blade.  AC joint injuries range in severity from a slight dislocation to a complete separation, and treatments can range from at-home treatments to AC joint surgery.  A slight dislocation is the most common type and causes the AC ligament to be stretched or partially torn. An AC joint may also be partially dislocated, with a completely torn AC ligament.

What are its symptoms?

The symptoms you may experience with an AC joint injury depend on the severity of your injury.

If you have a partial dislocation, you may have the following:

• Tenderness when you touch the joint

• Bruising

• Minor pain when you more your arm

If your AC joint is partially dislocated, you may experience the following:

• Moderate to severe pain

• Swelling

• Pain when you move your arm

• Clavicle moves when it’s pushed

• Painful to the touch

Finally, if you have a completely separated AC joint, you may have the following symptoms:

• Tendency to support your elbow and hold your arm close to your side

• Arm hurts with any type of movement

• Popping sound when you move your joint

• Swelling

• A bump on top of your shoulder, or the outer end of your collarbone may look out of place

• Unstable joint

Eat Well for Good Joint Health #Seattle #Health #Fitness

Since bones are living tissues that are constantly working to regenerate and produce new tissue material, the food that we ingest and how remain physically active is vitally important to the maximized production of healthy bone and tissue.

Below are some foods that help boost healthy bone and tissue:

Soy-Based Foods: Foods like tofu and edamame are low in fat and high in protein and fiber. They have anti-inflammatory properties that may relieve joint pain and help with bone and tissue regeneration.

Extra Virgin Olive Oil:  Extra virgin olive oil has been associated with increased levels of bone formation and regeneration. In its pure form, olive oil has a lot of anti-inflammatory and antioxidant properties.

Fish: Fatty fish such as tuna, salmon, herring, and mackerel are rich in omega-3 fatty acids. About 3-4 ounces twice a week will benefit those with rheumatoid arthritis.

Dairy Products: Low-fat milk products such as cheese and yogurt are packed with calcium and vitamin D,  which increases bone strength.

Sweet Potatoes:  a rich source of potassium and magnesium which can aid in boosting bone health.

Grapefruit: This fruit is high in vitamin C, an important vitamin that helps prevent bone loss.

Broccoli: Besides containing a high amount of vitamins C and K, broccoli also contains the compound sulforaphane, which helps slow down the progression of osteoarthritis.

Eating a diet full of these foods will aid in maximizing your bone and tissue regeneration, allowing for you to experience better range of motion and likely better quality of life.

What is “Golfer’s Elbow”? #Health #Seattle

Hitting the links on a beautiful day can be a relaxing and enjoyable experience.  However, many people experience what is called media epicondylitis or Golfer’s Elbow when playing a round.   Symptoms include tenderness and occasional sharp pains on the inside of the elbow, caused by inflammation or tiny tears in tendons near the elbow. The pain centers on the bony bump on the inside of the elbow and may radiate into the forearm.

Many professional players, including Tiger Woods, have battled golfer’s elbow severe enough to warrant withdrawal from major tournaments in the past.. Woods first experienced issues with his elbow at the U.S. Open in 2013 when he was hitting out of the rough, a stroke that is typically achieved with more force than others. That pain, along with tenderness, swelling and weakness on the inside of the elbow indicates a probable golfer’s elbow.

This condition is usually triggered by overuse of the muscles in the forearm that allow you to grip, rotate your arm, and flex your wrist. Repetitive flexing, gripping, or swinging (something that is of course very common in the game of golf) can cause inflammation or tiny tears in the tendons.  A similar condition, tennis elbow, is much more common and affects the lateral epicondyle, though the pain profiles of each of these are very similar.

When it comes to seeking treatment there is no benefit to early medical intervention. Playing through any discomfort is usually fine if the pain is tolerable and rest does not typically help elbow tendinitis.   Golfers should know, however, that it is not uncommon for low-grade symptoms to persist for many months before the condition resolves.

If you find that these symptoms are persisting for an extended period of time, it’s recommended that you visit your physician as there may be something that can be addressed medically happening. 

Can an “old” treatment find new life for rotator cuff repair treatment? #AAOS #Health #Seattle

A study that was presented at the American Academy of Orthopedic Surgeons has demonstrated that transcutaneous electrical nerve stimulation may reduce the pain scores and opioid use after rotator cuff repairs.  In this study, 37 patients were randomized to use either an active or a sham TENS unit during the first week after a rotator cuff repair.  
Electrical stimulation for pain control was first used in ancient Rome.  The first modern, patient wearable TENS unit was patented in the United States in 1974.  It was initially used for chronic pain patients but its use has expanded to other areas.

TENS unit

Following  arthroscopic rotator cuff repair, the use of a TENS unit during the first postoperative week was associated with significantly lower pain scores and opioid pain medication use when compared to patients who received the sham TENS unit.

I have used the this treatment  as part of my shoulder pain protocol after rotator cuff repair surgery with good results.  I continue to research ways to decrease postoperative pain and improve the overall outcomes of my patients after shoulder surgery.  The study is encouraging and may provide an inexpensive and safe way of improving pain control after surgery.
 

New tech may improve overall health #Seattle #Health #Fitness

A volunteer demonstrates Inspiratory Muscle Strength Training at the University of Colorado Boulder.

Credit: CU Boulder

As many of the know, I focus most my research time on shoulder and elbow conditions, space medicine, and reducing musculoskeletal pain, however, occasionally I will come across an article about general health that I find fascinating.  I read an article today about a 5 minute breathing treatment that was shown in a recent study to lower blood pressure, improve vascular health, boosts fitness and sharpen memory.  The treatment is called Inspiratory Muscle Strength Training.  Here is a link to the article if you would like more information.  This is a technology that I will research more as it may be a good treatment to recommend to my patients, especially those with high blood pressure or interested in increasing there fitness. 

What is elbow bursitis? #Seattle #health

Today, I’ll talk about a common condition that I see in clinic - elbow or olecranon bursitis.  Elbow bursitis, or olecranon bursitis, is inflammation of the fluid filled sac (bursa) at the tip of the elbow due to trauma, infection, or inflammation.   Some have referred to this condition as “Popeye elbow” because of the swelling and the bump that develops at the tip of the elbow.  The normal olecranon bursa provides protection and decreases friction to the elbow joint and contains only a small amount of fluid. 

Bursitis of the elbow can occur for a variety of reasons including:

• Trauma to the tip of the elbow causing swelling and fluid build up

• Repetitive stress to the elbow.

• Infection

• Gout

• Rheumatoid arthritis 

Treatment of the bursitis depends on the cause.

In general, most cases of elbow bursitis can be treated with time, prevention of repetitive stress to the elbow, and compressive ACE wraps.  There are certain conditions, however, that have specific treatment as seen below.

Infection

Bursa aspiration

Most infections can be treated with either oral or IV antibiotics.  Your doctor may also recommend aspirating (see Figure), or removing the fluid with a needle.  This can provide useful information, including the type of bacteria, but can also provide some pain relief.  Very rarely, I have to perform an arthroscopy to clean out the infected bursa.

Trauma

Most bursitis related to trauma resolves on its own once the injury has been treated.

Repetitive stress

This is the most common cause of bursitis that I see.  The key to preventing olecranon bursitis due to repetitive stress is to stop the repetitive trauma.  This can be as simple as not resting your elbow on hard surfaces, but may include placing pads on your table or desk, or in extreme cases - wearing an elbow pad for a period of time.

Gout and rheumatoid arthritis

Treatment of the underlying disease, normally improves the symptoms of the bursitis.  On occasion, the bursa will become chronically scarred or will have abnormal material due to gout that may have to be surgically removed.

Conclusion

Elbow bursitis is very common and is generally easy to treat.  It can be frustrating, however, due to the high rate of recurrence.  Please reach out to me or your primary care provider if you think that you have elbow bursitis and would like treatment. 

Thank you,

Andrew Pastor

Is "selfie elbow" real?

A new, catchy, condition has been making headlines: "selfie elbow".  The question is, is this a real condition?  Although the name sounds ridiculous, this condition is nothing new.  As an elbow specialist who takes care of a variety of elbow conditions, I see this type of injury routinely.  "Selfie elbow" is similar to other repetitive strain conditions that happen around the elbow.  I'm sure many of you have heard of tennis elbow or golfer's elbow.  "Selfie elbow", like those seen with tennis and golf, is an overuse injury.  Extending your elbow while keeping a firm grip on your phone puts excess stress on the tendons that attach to your elbow and control function in your hand and wrist.  Many who suffer from this type of condition have significant difficulties with use of the hand, especially with lifting and grasping activities.

Luckily, this condition almost always improves without surgery.  They key to healing this type of condition is refraining from any activities that cause pain and performing specific physical therapy.  Overall resolution of the symptoms can take weeks to months to improve.  Rarely, this condition lasts so long that I would recommend surgery.  If needed, the condition is easily treated with simple, minimally invasive, arthroscopic surgery of the elbow.

Arthroscopic surgical treatment of medial epicondylitis

Medial epicondylitis, also known as golfer’s elbow, is a painful condition on the inside of the elbow that is usually treated with nonoperative treatments such as refraining from doing activities that cause pain, physical therapy, and bracing.  On occasion, these treatments fail to completely relieve the elbow pain and surgical treatment is recommended.  Historically, the surgical treatment for medial epicondylitis has been open surgical debridement.  Over the last few years, however, a push has been made to determine if minimally invasive, arthroscopic treatment is safe and effective.  I recently reviewed a new article in the Journal of Shoulder and Elbow Surgery discussing the arthroscopic treatment of medial epicondylitis.   In this small study of seven patients, the functional outcome scores and pain were noted to be significantly less after arthroscopic surgical treatment with no significant complications.  Although a small study, I believe that this study does provide some indication that when done properly, arthroscopic surgical treatment may be an option for certain patients with medial epicondylitis that have failed to improve with nonoperative treatment.  As someone who does a lot of elbow arthroscopy, this article is encouraging and may help me better treat my patients with this painful condition.

Tennis Elbow pain - What are my options?

If you’re like 50 percent of American adults, you’ve experienced elbow pain. For some, it’s a dull ache on the outside of the elbow, but for others, it makes everyday tasks into ordeals. When you have severe elbow pain, even lifting your arm to drink coffee or gripping a shopping bag can be incredibly painful.

More likely than not, you’re suffering from a condition called tennis elbow. You’re not alone. In fact, tennis elbow is so common that it is sometimes referred to as a rite of passage to middle age. Don’t be misled by the name—only a small percentage of people diagnosed with tennis elbow actually get it from playing tennis. Instead, tennis elbow is an overuse injury caused by repetitive stresses to the elbow, which can come from any number of activities, from hammering to lifting heavy boxes.

In more than 90 percent of cases, tennis elbow can be treated with a structured home therapy program or physical therapy. However, for a small percentage of people, the pain will persist. If your pain lasts more than six months, it’s time to consider other options. Luckily, there are a variety of treatments available, both surgical and nonsurgical. Of these options, minimally invasive arthroscopic surgery is one of the most effective.

Arthroscopic surgery involves less damage to the healthy tissue and a faster return to your everyday activities.

You can go home the same day, and you can go back to using your elbow again within days in some cases.

Not all surgeons are trained to treat tennis elbow through arthroscopic surgery. If you are struggling with elbow pain, please reach out to us! We will discuss your treatment options, both surgical and nonsurgical. Relief is closer than you might think.