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Sever case of tendonitis in elbow. Took 3 injections, splints, braces and ice. Ultra sound shows abnormal echotexture and thickening. Suggest?

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General & Family Physician
Practicing since : 2007
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Since April, I have been dealing with a sever case of tendonitis in my left elbow. 3 injections, splints, braces, exer., ice have only slightly improved my symptoms. Ultra sound this week shows abnormal echotexture and thickening of the common extensor tendon at attachment site. Increase flow was also noted on Doppler. The cross section area of the ulnar nerve at the cubital tunnel is 9mm2. Diagnosis: sever common extensor tendon tendinosis. Findings consistant with mild cubital tunnel syndrome. I have tingling in my little and ring fingers, occasional shooting pain in my forearm, elbow aches all the time, there is a constant burning on the bottom of my elbow; any use of my arm makes my elbow very angry and painfull. Significant loss of grip due to the pain created. I have not had a full nights sleep since prior to this as the pain and/or tingling fingers wake me up. Past three weeks I have been in a full arm splint with a tens unit. As previously stated, I have endured 3 injections with only temporary results. My OT has thrown everything at it and we just aren't making headway. My reg ortho did the injections and then prescribed PT and I chose to see an OT at the university hospital where my husband works. My OT, after three weeks of getting nowhere suggested the ultrasound. My reg ortho wrote the order and the ultra sound was performed this past Tuesday. He has not had an opportunity to review the report. However, I did agree to see the arm/hand specialist there at the hospital just as an extra opinion. I have been doing some reading and from what I can gather is that even with mild cases of this syndrome, if left untreated, there is a significant risk of it getting worse and causing possible permanent damage. My question is, after treating the tendonitis conservatively for almost 6 mths with little results then discovering this other problem, is surgery at this point a reasonable approach? I am extremely frustrated at this point as this has totally ruined my summer and dealing with the discomfort for this long has just pushed me to the limit.
Posted Fri, 13 Sep 2013 in Bones, Muscles and Joints
Answered by Dr. David Okia 1 hour later
Brief Answer:
Yes surgery is reasonable option

Detailed Answer:
Thanks for your question.
Most of my patients with same condition who have not improved with conservative management have done well with surgical treatment(local decompression of the ulnar nerve) by orthopedic surgeons. As you wait for operation avoid aggravating factors like over extension and flexion of joint ,use elbow pads and NSAIDS drugs for pain. Hope I answered your question, will be happy to help you if you have more queries.
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Follow-up: Sever case of tendonitis in elbow. Took 3 injections, splints, braces and ice. Ultra sound shows abnormal echotexture and thickening. Suggest? 26 minutes later
thank you for the quick response. I do have one other question, well, actually two. What does echotexturing mean and is it safe to assume should I go the surgery route, that there will be two seperate proceedures done? One for the compressed nerve and one to clean up and/or repair the damaged tendon?
Answered by Dr. David Okia 47 minutes later
Brief Answer:
Ultrasonography imaging

Detailed Answer:

Thanks for your question.

Echo texturing is terminology used in ultrasound imaging to differentiate appearance and characteristics of tissues while doing imaging. Tissues that have problems appear different from normal tissues.
The orthopedic surgeon will explain the detailed procedure of operation and which operation to take based on physical findings he/she will get, they are experts in surgical management. Hope I answered your question, will be happy to help if you have other queries.
Above answer was peer-reviewed by
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