Elbow Pain

Your elbow is a complex joint formed by three long bones in your arm. Four sets of muscles help to move the joint and are attached to the bones by thick tendons. Damage to any of these structures or to the joint’s network of nerves, blood vessels and ligaments can lead to elbow pain.

Elbow pain can definitely affect your life since your elbow is used in so many ways. Most elbow pain results from over-use injuries. These may be sports-related or the result of activities and professions requiring repetitive hand, wrist or arm movements. Elbow pain can be due to arthritis, but in general, your elbow joint is much less prone to wear-and-tear damage than other joints. Although elbow conditions may be named after sports such as Golfer’s and Tennis elbow, they are very common whether one is engaged in sports or not.

Common causes of elbow pain include:

Golfer’s elbow: Also known as medial Epicondylitis,is similar to tennis elbow.Golfer’s elbow is pain and inflammation on the inner side of your elbow where the tendons of your forearm muscles attach to the bony bump on the inside of your elbow. The pain may spread into your forearm and wrist.

Tennis elbow: Also known as lateral Epicondylitis (see sonogram image) is on the outside of the elbow and is also associated with forearm pain. You feel the tenderness in the meat of the muscles above and below the elbow joint.

Bursitis: The bursa is a slippery sac between the loose skin and the bones of the elbow. It is located at the tip of the elbow. The bursa allows the skin to move freely over the underlying bone. Normally, the bursa is flat. If it becomes irritated or inflamed, a condition known as bursitis develops. Swelling is often the first symptom. The skin on the back of the elbow is loose, which means that a small amount of swelling may not be noticed right away. As the swelling continues, the bursa grows,causing pain as it is stretched, since it contains nerve endings. The swelling may grow large enough to restrict motion of the elbow.

Tendon and ligament tears: Tendons are the attachment of a muscle to a bone, and ligaments connect two bones together. When a ligament or tendon becomes overstretched due to an activity or overuse, the fibers that make up the tissues can fray and tear. The result can be chronicinstability in the joint.

Ulnar neuropathy: A disorder involving the ulnar nerve. Ulnar neuropathy may be caused by entrapment of the ulnar nerve as it passes through a tunnel on the inside of your elbow where your “funny bone” is located. The feeling you get when you hit your funny bone radiating into your ring and little finger is from the ulnar nerve.

The pain from elbow conditions does not have to keep you off the course or away from your favorite activities. With a proper diagnosis, rest and appropriate treatment, you can get back into the swing of things in no time!

Elbow symptoms include:

  • Pain and tenderness: On the inner or outer side of your elbow, and sometimes along your forearm.
  • StiffnessYour elbow may feel stiff, and it may hurt to make a fist.
  • Weakness: You may have weakness in your hands and wrists.
  • Numbness or tingling: Many people with golfer’s elbow experience numbness or a tingling sensation that radiates into one or more fingers — usually the ring and little fingers.

Pain can be increased when you:

  • Swing a golf club or racket
  • Squeeze or pitch a ball
  • Shake hands
  • Turn a doorknob
  • Pick up something with your palm down
  • Flex your wrist toward your forearm

How Is Elbow Pain Diagnosed?

History and Examination: A history of your complaints including duration, and what makes it better and worse is very important. Previous treatments and outcomes as well as an orthopedic examination to assess the muscles, joint, movement, strength and nerves are also used for diagnosis.

X-rays: X-rays can reveal arthritis and any abnormalities of the bone. In most cases an x-ray is not necessary.

Diagnostic Ultrasound Imaging: Unlike an x-ray, diagnostic ultrasound allows us to view the most common causes of your elbow pain with great accuracy. The bundles muscles and the tendons related to Golfer and Tennis Elbow, the bursa, joint capsule and the tunnel through which the ulnar nerve passes in the elbow can be readily examined for signs of swelling or inflammation. If the symptoms are only on one side, the symptomatic side can be compared with the non-symptomatic side.

With musculoskeletal ultrasound imaging (MSUS), the joint can be accurately examined at the time of your visit.

Treatment Options We Offer

Why are ultrasound-guided injections better and more accurate?

When using an injection to deliver treatment into painful joints, it is necessary to be exact and precise. Dr. Isidro and his team are highly trained in ultrasound-guided injections. These procedures are performed in the office, at the time of your visit. Some of the common structures involved in joint pain may be as little as 2-3mm wide and therefore require a high level of precision to be accurate. In addition, when performing an injection, there are also structures that you want to avoid so you don’t knick or damage them on your way into the joint. The ultrasound machine provides live imaging in real time, to safely place injectable medications or treatments into or around the joint with laser-like precision.

Consider trying to hit a target blindfolded¾you may know the general direction but would not be certain if you have actually hit your target. With live ultrasound imaging, the targeted areas of pain are viewed in real time while the injection is taking place, guiding the needle with pin-point accuracy!

Cortisone Injection:

Painful arthritic joints, chronic tendinitis, bursitis and inflammation respond quickly to cortisone. In many cases this is the head start patients need to allow for gains with more conservative care and no further treatment is required. Many patients think that cortisone is bad for you. Too much of anything is not good. Using cortisone infrequently, as much as several times per year will not do any harm. If the pain continues to return, other treatment options should be considered.

Cortisone is injected using continuous live ultrasound guidance exactly where it is needed to quickly reduce inflammation and pain.

Platelet Rich Plasma Therapy (PRP): Jump starting the healing signals:

Why use PRP?

When there is damage, tissue tears or arthritis, this exciting new procedure (made popular by professional athletes) that heals damaged structures in a joint such as the labrum, tendons, muscle, ligament or cartilage is showing exciting results!

How does PRP work?

When you cut your skin and it bleeds, platelets collect and gather at the wound site. Once there, platelets act like a conductor in an orchestra. They release growth factors that signal the healing activities to begin, resulting in a cascade of events that restore the damaged tissue.

Joints, however, do not have a direct blood supply. Therefore, when a joint structure is damaged or torn, platelets do not gather and orchestrate the necessary events for that damage to be restored. Joint damage either heals slowly or not at all. That is where Platelet Rich Plasma Therapy (PRP) proves valuable!

New Treatment Using LIPOGEMS® Could Be the Answer for Arthritis Pain

LIPOGEMS® is a new treatment option for arthritis pain now offered by Dr. Norma Bilbool, M.D., a double board certified physician specializing in Physical Medicine and Rehabilitation and Pain Medicine and Richard D. Striano D.C., RMSK Registered in Diagnostic Medical Musculoskeletal Sonography. The combination of advanced imaging techniques with ultrasound to diagnose and precisely guide treatment, and physician experience with treating all joints with minimally invasiveLIPOGEMS® has led to the majority of patients treated having significant improvement with less pan, improved function and quality of life.

LIPOGEMS® could be the solution to those who suffer from pain in the shoulder, lower back, hip, knee, ankle and other joints including the rotator. Optimum Joint, is equipped and has been performing ongoing clinical studies on the shoulder, rotator cuff, lower back, hip and ankle pain where a patient’s own fat is used to alleviate arthritis related conditions many of which have failed to respond to other treatment methods including bone-on-bone joints. Optimum was among the first practices in the USA trained in the state-of-the-art treatment through LIPOGEMS® technology that is a minimally invasive same day procedure, performed in about an hour, using local anesthetic with no sedation required and no down time. This could be the answer for many of those looking to avoid surgery.

The Autologous (fat from you and put back into you) Micro-Fragmented Adipose Tissue (LIPOGEMS®) is a NEW technology where fat is taken from the patient, using a local anesthetic, washed, and micro-fragmented, using the LIPOGEMS® system. Micro-fragmented fat using the LIPOGEMS® system mechanically supports and cushions joints, and holds regenerative capabilities and when re-injected can decrease inflammation, cushion, repair or replace defects in damaged tendons and cartilage, or other tissue.

The fat is injected using continuous ultrasound guidance to ensure pin point accuracy in treating the joint and surrounding damaged tendons to repair and restructure damaged tissue with pin-point accuracy. Research has shown non-guided “blind” injections are accurate 36% – 60% of the time while ultrasound guided injections are 100% accurate. Accuracy in delivering regenerative treatments is essential. We are evaluating the LIPOGEMS®, made with an FDA cleared device, for their ability to cushion, repair, or replace damaged tissue and the regenerative effects of the fat it contains, to jump-start repair and decrease inflammation.

“This is an extraordinary study because of its use of micro-fragmented fat tissue, which makes it more bioavailable to the area we inject, and by using the precision of ultrasound guidance the treatment is visualized being delivered to each area of the joint and tissues in need of repair. This combination of support and regenerative regenerative elements with the precision of advanced ultrasound guidance is contributing to the long term impressive results.

 NEW STUDY: Adipose tissue contains Adipose Derived Stem Cells “ADSC’s” and more than 600 secreted proteins and included key molecules involved in tissue regeneration. Stem Cell Res Ther. 2015; 6: 221.

NEW STUDY: Lipogems Product Treatment Increases the Proliferation Rate of Human Tendon Stem Cells without Affecting Their Stemness and Differentiation Capability. Results showed that the Lipogems product significantly increases the proliferation rate of hTSCs (human tendon stem cells). Moreover, treated cells increase the expression of VEGF, which is crucial for tissue healing. Stem Cells International Volume 2016 (2016), Article ID 4373410, 11 pages

Dr’s Bilbool and Striano are among few doctors in the country offering IRB- approved regenerative treatment options, with a focus on minimally invasive alternatives to surgery. Their work has been recognized and new studies are being published this year.

Have you tried Physical Therapy in the past and it hasn’t worked for you?

A Different Approach Other Than Routine Painful Exercises:

We see many patients who come to us in chronic pain. Many have also had experience with physical therapy where they spent much of their sessions doing exercises and it hasn’t helped. Think of being in pain, having joint stiffness, loss of range of motion or chronic inflammation and then doing exercises to get rid of it. In most cases, you’ll feel worse not better.

Exercise is critical to maintain proper joint strength, but done at the wrong time and your pain often becomes worse. That is why we take an entirely different approach with treatment plans using three phases:

  • Therapeutic Modalities:

Our physical therapy team specializes in using certain modalities like electrical stimulation or ultrasound to reduce swelling and inflammation and increases local circulation to help the healing process. Different modalities can be applied to successfully address spasm, trigger points, inflammation, edema, swelling and damage from tendonitis and tears.

  • Joint Release Techniques:

Techniques are done by hand to gently stretch, massage and release the pressure in each of the muscles, tendons and ligaments surrounding the joint. The result is a soothing improvement in joint pain.

  • The Selective Functional Movement Assessment:

Our physical therapy team is certified in the Selective Functional Movement Assessment (SFMA), which is a series of 7 full body movement tests designed to assess fundamental patterns of movement such as bending and squatting in those with known joint pain. When the clinical assessment is initiated from the perspective of the movement pattern, our therapy team has the opportunity to identify meaningful impairments that may be seemingly unrelated to the main joint pain complaint, but contribute to the pain.

Think of having a painful right knee and favoring that side for an extended period of time. Following a period of uneven gait you may develop pain on the opposite unrelated side. This concept, known as Regional Interdependence, is the hallmark of the SFMA.

The assessment guides our clinical physical therapist to the most dysfunctional non-painful movement pattern, which is then assessed in detail. By addressing the most dysfunctional non-painful pattern, the application of targeted interventions (manual therapy and therapeutic exercise) is not adversely affected by pain.

When to see a doctor

  • Your activity is being restricted by pain
  • Before you pain becomes severe
  • Pain is getting worse or not improving in two weeks
  • Sharp or shooting pain, especially when you squeeze, grasp or twist your hand
  • Swelling around the elbow
  • Tingling into the ring and fifth finger
  • Weakness in your fingers



Can an OptimumJoint traditional or regenerative medical procedure help me? To find out if you might be a candidate for an OptimumJoint medical treatment procedure, complete our Optimum Joint Procedure Candidate Form online.