Posts Tagged ‘elbow pain’

Innovative Treatments for Chronic Tendon Pain

Do you have chronic tendon pain? Learn about the different innovative treatment options for Chronic Tendinopathy at Emory Healthcare.Chronic tendinopathy (tendon pain) can limit your activities and take months to years to heal. You don’t have to live with the pain. Learn about new innovative treatment options that can get you back to your sporting activities.

What Is Chronic Tendinopathy?

Tendinopathy is a broad term used to describe pain in and around your tendons. It happens when tendon tissue (which attaches muscle to bone) is damaged and can be caused by:

  • Overuse
  • Trauma, such as a direct impact or fall
  • Age-related wear and tear
  • Arthritis or other inflammatory disease

Overuse of your tendons from activities that require repetitive motions, such as working on a computer or playing sports, is the most common cause of chronic tendinopathy (tendon pain that lasts longer than six months.)

Chronic Tendinopathy Symptoms

With overuse, your injuries are often small and can’t be felt right away. And often a person will continue the motion without knowing they’re causing further damage. Over time, your body will begin to give you signals including:

  • Pain when exercising, moving or touching the area
  • Dull ache when you are at rest or sleeping
  • Weakness
  • Stiffness
  • Limited range of motion

If your chronic tendinopathy is caused by a trauma, you’ll experience more immediate symptoms.

How Is Chronic Tendinopathy Treated?

Depending on your circumstance, your doctor may recommend at-home remedies such as rest, applying ice or heat to the injured area, or analgesic medications. Physical therapy may also be considered to help improve functionality.

If these methods don’t provide you enough relief, arthroscopic or traditional open surgery on your injured tissue would have been the next steps. But, thanks to newly developed technologies and procedures, you now have alternatives to surgery that are equally or more effective.

Platelet-Rich Plasma Therapy for Chronic Tendinopathy

Platelet-Rich Plasma Therapy is an outpatient, nonsurgical procedure. During the therapy, your blood is drawn and placed in a machine that separates out the platelets. Guided by an ultrasound machine your doctor will then inject the platelet-rich plasma directly into your tendon.

Tenex Health TX® System for Chronic Tendinopathy

Tenex Health TX® System is a non-surgical tool that uses ultrasound imaging to help your doctor pinpoint your damaged tissue and remove it, leaving your healthy tissue intact. It requires only local anesthesia, no stiches and a fraction of the recovery time compared to surgery.

Learn More

Emory Sports Medicine Center can offer you these innovative procedures and decide which one is right for you if more conservative treatments aren’t working. Would you like to learn more?


About Dr. Maturner

Dr. Kenneth Mautner helped this patient with foot pain.Dr. Ken Mautner is Assistant Professor in the Department of Physical Medicine and Rehabilitation and the Department of Orthopedic Surgery At Emory University in Atlanta, GA. He is board certified in PM&R with a subspecialty certification in Sports Medicine. He is the Director of Primary Care Sports Medicine at Emory and Fellowship Director for the ACGME accredited Primary Care Sports Medicine Fellowship. Dr. Mautner is co-editor of the Atlas of Interventional Musculoskeletal Ultrasound. He has been using Musculoskeletal U/S in his practice since 2007 for and has been teaching courses around the country since 2009. In addition, He is considered a leader in the field of Orthobiologics treatment for chronic soft tissue and joint disorders. Dr. Mautner also serves as Team Physician for Emory University, Agnes Scott College, Pace Academy, and a Consulting Physician for Georgia Tech Athletes.

Takeaways from the Hand, Wrist & Elbow Live Chat

hand-wrist-elbow-emailThanks to everyone who joined us Tuesday, April 26, for our live online chat on “Hand, Wrist & Elbow Pain and Treatment” hosted by Emory orthopaedic surgeon, Dr. Michael Gottschalk.

We had an awesome turnout for the chat, and we were able to answer a lot of really great questions that were submitted prior to and during the chat. Below you can find some of the highlights. You can view the full chat transcript here.

Question:I have carpal tunnel and arthritis in my hands and my wrist is very painful I can’t use my hands. What can I do for this?

Dr. Gottschalk: Currently there are several suggestions and recommendations for carpal tunnel syndrome. I always like to first make sure that this is indeed what you have. Carpal tunnel syndrome is a pinching of the median nerve at the wrist. It can cause pain, numbness and tingling to the hand and especially the thumb, index, middle, and half of the ring finger. If your carpal tunnel is severe or has been going on for a long time it can also cause weakness or wasting of the muscles to the thumb. Often times we might order an electrical test to confirm you have carpal tunnel syndrome or perform certain physical maneuvers to confirm this in the office. Once we have confirmed you have carpal tunnel syndrome I will normally make the following suggestions.

1) Wear a wrist brace at night that keeps the wrist straight (the brace does not need to be tight)

2) Try anti-inflammatory medications such as Ibuprofen or Aleve, make sure to check with your primary care doctor first as these medications can have side effects and cause kidney/stomach issues

3) Injections: I normally reserve injections for patients I am either confirming the diagnosis or for a patient that has a temporary reason for carpal tunnel (e.g. pregnant women)

4) Surgery: This is normally a last resort and I often recommend this for patients who have failed 1 and 2.


Question: My wrist hurts when I bend it backwards (as if I were telling someone to stop) and if it bears any weight (like shifting my weight in a chair). If I make a fist and keep my wrist straight it doesn’t hurt at all to bear weight on it. There’s also a slightly tender knot on the ulna side of my wrist). This has been happening for approximately 3 weeks. Any thoughts?

Dr. Gottschalk: This can be a common problem. Hyperextension or bending the wrist backwards (e.g. like for pushups) can cause significant stress on the wrist joint. There are several possibilities as to why this may be painful. One possibility is a wrist sprain where the ligaments are injured but not torn. Other possibilities include inflammation within the wrist joint (synovitis), ligament tears (more severe than a sprain), and possibly even a broken bone.

If these symptoms do not subside I would recommend seeing a physician for x-rays. It is possible that they may recommend NSAIDs, bracing, or an injection. I would also recommend cessation of activities that make it worse at least until it improves.


Question: Tell me a bit about golfers elbow.

Dr. Gottschalk: Golfer’s and Tennis elbow are very similarly related. They’re often repetitive overuse injuries. They normally occur where the tendon attaches to the bone near the elbow. Treatments often start with stretching exercises, inflammatory medication and sometimes bracing. If these are ineffective, I would normally recommend injection or other advanced therapies. Surgery would be the last resort option.

If you missed out on this live chat, be sure to check out the full list of questions and answers on the chat transcript. You can also visit Emory Sports Medicine Center for more information.

Also, if you have additional questions for Dr. Gottschalk, please feel free to leave a comment in our comments area below.

About Dr. Gottschalk

gottschalk-michaelDr. Gottschalk grew up in Dallas, Texas as the youngest of three boys. He went on to graduate from JJ Pierce High School in the top 10% of his class and as an AP Scholar with Distinction. Dr. Gottschalk received an academic scholarship to attend the Business Honors Program at the University of Texas at Austin. After graduating from UT Austin, he then went to complete medical school at the University of Texas Health Science at San Antonio. Upon completion of medical school, Dr. Gottschalk completed his Orthopaedic Surgery Internship and Residency at Emory University. While in his training, Dr. Gottschalk received multiple accolades and awards for his outstanding research and was elected as a resident leader to the esteemed American Orthopaedic Association.

Hand, Wrist & Elbow Live Chat on April 26, 2016

hand-wrist-elbow-emailWhether for work or play, we use our hands, wrists & elbows during almost every activity throughout the day. Overuse can sometimes lead to the development of painful conditions, such as carpal tunnel syndrome or arthritis. When upper extremity pain begins to interfere with your daily activities, it is time to see a hand specialist.

Join Emory orthopaedic surgeon, Dr. Michael Gottschalk, on Tuesday, April 26, 2016 at 12 pm EST, for a live web chat. Dr. Gottschalk will be available to answer your questions about the diagnosis and treatment – both surgical and non surgical – for a wide range of hand and upper extremity issues. Register for this live chat here.


What is Tommy John Surgery and why are so Many MLB Baseball Players Getting it Now?

Elbow PainA number of major League baseball pitchers have recently had to undergo “Tommy John Surgery”, a procedure used to reconstruct a torn ulnar (medial) collateral ligament (UCL) in the elbow. An injury to the UCL in the elbow is typically caused by repetitive overhead throwing motions, such as pitching a baseball. Collegiate and professional athletes in several sports such as tennis, gymnastics, wrestling, softball, football and track&field have also undergone the procedure, but baseball pitchers are the most prevalent group.

The increased incidence of UCL injuries and tears in MLB pitchers is multifactorial, but is mostly related to the increased stress that these athletes place on the inner aspect of their elbow through pitching, in order to compete at the level of a professional player.

What are the Symptoms of Ulnar Collateral Ligament (UCL) injuries?

  • “Pop” and pain in the inner elbow
  • Inability to throw, or decreased ability to throw a ball at the same velocity
  • Continuous pain on the inside of elbow
  • Instability, or feelings of looseness in the elbow
  • Numbness in the small finger and ring finger

If you have any of the above symptoms, it is important to be evaluated by a sports medicine physician right away to determine if you can prevent further damage to your UCL, or the cartilage in your elbow. Continuing to play can cause further damage to the elbow and eventually lead to the need for Tommy John Surgery.

What is Tommy John Surgery?

Tommy John Surgery is a surgical procedure where the ulnar collateral ligament in the elbow is replaced with a tendon from another part of the body, or from a donor. An orthopaedic surgeon typically performs this procedure by drilling holes into the bones above and below the elbow where the UCL normally attaches. Typically, a graft from a tendon in the forearm is used to reconstruct the ulnar collateral ligament. An athlete is advised to enter into an intensive rehab program after the surgery and typically do not return to sports for 12 – 18 months after the surgery, in order to let the area fully heal.

How can you prevent your child from having to have Tommy John surgery in the future?

Unfortunately many high school baseball players complain of elbow problems, each year. Injuries and predispositions that result in Tommy John Surgery, typically start developing from an early age. A young baseball player who pitches too much before maturing has a much higher likelihood of getting hurt than one whose pitch count is closely monitored. In addition, a young player who has improper throwing mechanics, or shoulder strength and motion can also increase their chances of having elbow troubles.

UCL Injury Prevention Tips:

  • It is important for coaches and parents to understand the importance of “pitch counts” and limiting a student athlete’s use of his arm.
  • Also, we encourage parents to get a full sports medicine physical in the off season to evaluate if the student athlete has physical findings that might predispose them to injury.
  • There are exercises an athlete can do to strengthen the muscles in the right places so that the student athlete can avoid potential injury.
    • Hip, legs & core strengthening and flexibility are an important foundation for the throwing athlete.
    • Rotator cuff strengthening exercises are a mainstay, but the other muscles surrounding the shoulder blade (peri-scapular) can play a vital role in stabilizing the throwing shoulder.
    • Upper & lower extremity stretches are also critical to preventing injury.
  • Working with a pitching coach who understands proper throwing mechanics is essential. Video tape the athletes pitching to make sure he or she is not putting too much pressure on the elbow joint with poor mechanics.

It is important for parents, coaches and athletes to understand the risks of pushing too hard in an athletic arena. Tommy John Surgery is a serious procedure and it takes a long time to recover after the surgery. Although, through our surgical technique a high percentage of athletes are returning to their sports, there are still athletes who are not able to return. In addition, when an athlete has to have the procedure a second time, they have a drastically lower chance of returning to their sport. Practice caution so that you can have a long, successful athletic career.

Related Resources

Other blogs by Dr. Kyle Hammond

About Dr. Kyle Hammond
Dr. Kyle HammondDr. Hammond is an orthopaedic surgeon new to the Emory Orthopaedics faculty. He recently completed his fellowship at the University of Pittsburgh Medical Center. While at the University of Pittsburgh he was the Associate Head Team Orthopaedic Surgeon for both the Duquesne University Football team and the University of Pittsburgh Men’s Basketball team. He also worked as a Team Physician for the Pittsburgh Steelers, the Pittsburgh Penguins, the University of Pittsburgh athletics, Robert Morris College athletics, as well as the Pittsburgh Ballet.

Dr. Hammond sees patients at Emory Johns Creek Hospital, as well as Emory Orthopaedics & Spine Center in Atlanta. Dr. Hammond has a special interest in the overhead/throwing athlete, ligament injuries to the knee, Tommy John surgery, joint preservation surgery, and is one of the few fellowship trained hip arthroscopists and concussion specialists in Georgia.

About Emory Ortho, Sports and Spine in Johns Creek and Duluth
Emory Orthopaedics, Sports & Spine has recently opened two new clinics, one in Johns Creek and one in Duluth. Emory physicians, Kyle Hammond, MD, and Oluseun A. Olufade, MD see patients in Johns Creek. Mathew Pombo, MD and T. Scott Maughon see patients in Duluth. Our new clinic locations care for a full range of orthopedic conditions including: sports medicine, hand/wrist/elbow, foot/ankle, joint replacement, shoulder, knee/hip, concussions, and spine. To schedule an appointment call 404-778-3350