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Tennis Elbow May Not Be Tendinitis

The path to pain relief may be surprising

Fortunately for today's tendinosis sufferers, innovative treatments designed to rally the body's innate healing response are now becoming available at specialized orthopedic clinics and sports medicine centers. These include:

Shock-wave therapy. Shock waves are delivered via a handheld device placed directly against the injured body part. "It literally feels and sounds as if you're getting hit by a jackhammer," says Alfred Cianflocco, M.D., director of Primary Care Sports Health at the Cleveland Clinic. Cianflocco underwent the procedure after a bad case of golfer's elbow failed to respond to ice, anti-inflammatory drugs, wrist splints and elbow straps. A typical session can last about five minutes; the more discomfort you endure in that time, says Cianflocco, the better your long-term results. Within weeks of his own treatment, Cianflocco threw away his elbow straps and returned to golf and gardening pain-free.

Needling. In a procedure called prolotherapy, a doctor uses a hypodermic needle to inject a known irritant, from talc to dextrose, into the injury site. This therapy stems from the realization that one longtime orthopedic staple — cortisone shots — works not so much because of the cortisone, but because of the micro-trauma caused by the needle itself. Cortisone, it turns out, may help relieve your pain in the short term, but it often weakens tendon tissues in the process, making tendinosis worse. Researchers have reported better long-term results by simply poking around with the needle. "This is called dry needling," explains Dimeff, "and it's another technique that causes a little bit of tissue damage so the body will wake up and respond to the injury." Adding safe but irritating compounds, he says, increases the volume of the wake-up call.

Nitroglycerin patches. Nitroglycerin has long been given in pill form to treat the heart pain known as angina. It does this by expanding blood vessels that supply the heart, allowing more oxygen and nutrients to reach starved heart muscle. Over the past few years, doctors have found that when it's applied via skin patches over painful tendons, nitroglycerin significantly increases tendon strength and function in patients suffering tennis elbow, swimmer's shoulder and Achilles' heel.

Platelet injection. Although platelets are best known as clotting agents that seal cuts and stop bleeding, they also contain powerful tendon-healing growth factors. To better concentrate these growth factors in a region of tendinosis, doctors remove a small amount of the patient's blood, spin it in a centrifuge, separate out the platelets and then re-inject these at the injury site. Another similar procedure called autologous blood injection (ABI) skips the platelet separation and simply injects the patient's whole blood back into the damaged area. Though research has yet to prove one approach works better than the other, both work for many patients: Reported success rates range from 80 to 95 percent.

In the pipeline. Stay tuned for a host of other promising treatments. For instance, researchers recently reported positive results for tennis elbow following injections of joint-lubricating hyaluronic acid (HA). Other studies have found that certain blood pressure meds have a serendipitous side effect: They reduce scar-tissue formation, promoting a more natural, youthful healing response in older adults. Still other investigators are using vessel-choking "sclerosing agents" and minimally invasive surgery to put the kibosh on tendinotic pain.  

Next: Visit a physical therapist for rehab exercises. »

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