01 Apr Facebook Live: Todd Wurth, M.D. on Elbow & Wrist Tendonitis
Dr. Wurth, can you tell me a little bit about yourself and explain your specialty?
I’m an orthopaedic surgeon here at the Bone and Joint Institute. By and large, all of us here at Bone and Joint Institute cover general orthopaedics, but in addition to that, a great number of us have done fellowships in a subspecialty. I did a fellowship in upper extremity surgeries. I basically handle anything, from a specialty standpoint, from the shoulder to fingertips.
Can you talk a little bit about elbow and wrist tendonitis?
Elbow and wrist tendinitis are different in the sense that elbow tendinitis tends to be an insertional tendinitis, where a tendon attaches muscle to bone. Around the elbow you see problems where the tendon attaches to the bone, whereas around the wrist, tendon problems tend to be sheath problems. This would be where the tendon runs through the sheath, and the sheath gets inflamed, then you get symptoms associated with that. The treatment for both can be similar, but still a bit different. For tendonitis around the elbow, the most common ones that you hear about are tennis elbow and golfer’s elbow. Golfer’s elbow being on the inside, tennis elbow being on the outside. What causes that is where there’s inflammation where the tendon is inserting to the bone. You can get inflammation and you can also get microtearing. You’ll get people who will come in and get an MRI and are really worried because they’ll say, “I have a tear in my tendon”, when in reality that’s not really something huge to worry about, it’s unfortunately just part of the disease process. The good thing about tennis elbow and golfer’s elbow, is that in upwards of 95% of cases, it will just burn itself out and may take someone a year for it to go away. It can be very similar to plantar fasciitis which can give you misery for just months and months, but then one day it seems like it just goes away. You can treat it with some degree of rest, but we don’t immobilize these conditions. You don’t put people in long arm casts who have chronic tennis elbow or golfer’s elbow. That’s the last thing you would want to do because you want to focus on working it, you want to focus on stretching. So when I say rest, it’s usually rest from repetitive activities that are inflaming the issue. From a physical therapy standpoint, the key there is going to be stretching and gentle strengthening. It’s very controlled strengthening, it’s something that a therapist will guide you on. Anti-inflammatories are also helpful, sometimes orally or sometimes via injection. Usually by the time that people see me about it, they’ve been dealing with it for months – they’re over it. It is affecting their life to a big degree, so I’ll give them a steroid injection, which can really help, because steroids are just an anti-inflammatory. It’s a small dose, but it’s potent and it goes very deep inside. That can really settle down the acute symptoms of it.
What is the best way to prevent elbow and wrist tendinitis?
The biggest thing is making sure that you stretch appropriately before activities, even trying to maintain appropriate strengthening exercises, and I always tell people to incorporate those into your life. That will help prevent these conditions from coming back. One other specific kind of tendinitis that I should mention is distal biceps tendonitis. That’s going to be tendinitis more on the mid portion of the front side of the elbow. That can be a precursor to a distal biceps rupture. Particularly I see a lot of men in their 30s and 40s, who have pre-existing biceps tendinitis and will be hurting for a couple of months, and they go do one simple thing that ruptures it. That’s something that when that happens that’s a surgery that you want to get done within a couple of weeks. I always tell people if you’re experiencing pain, be careful with your activities, go easy with it, take anti-inflammatories, gently strengthen it, and try to warm up before you do anything, because you could acutely rupture that tendon.
Is there any kind of specific technology that you use for diagnosis and/or treatment of tendonitis?
For initial treatment, I would do therapy with stretching and strengthening, as well as anti-inflammatories or a steroid injection. If I have a patient who has already had a steroid injection, and they’ve gotten partial relief, we can consider a PRP injection if they still have less than a year of symptoms. PRP is platelet rich plasma. That is essentially where we draw a patient’s blood, spin it down, centrifuge it, and take the platelets from the plasma. Plasma is the yellow portion of blood. Once we have those platelets, we re-inject those into the side where they’re having that tendinitis. That plasma has growth factors that can, to some degree, heal the tendon and settle down the inflammation. I will use that as a go-between for someone who has failed other conservative measures, but prior to surgery.
As far as the timeline for that, how long does it take for a PRP injection to take effect?
It will take a couple of weeks. People who get a cortisone injection will notice within 10 minutes a difference because of the marcaine in the shot. That always lasts for about 8 to 10 hours, and then that will wear off. The cortisone takes about 48 to 72 hours to really kick in. The PRP though, is something that will take a couple of weeks for that to hopefully settle things down.
Can you briefly describe what you would do surgically for tendinitis?
It’s not recommended to have surgery for golfer’s elbow or tennis elbow unless you had symptoms for at least 6 to 12 months. With surgery, you go in and you debride the chronically inflamed tissue, and oftentimes, at that point you’ve got chronic tearing of it. I’ll debride the chronically inflamed tissue and then reattach the healthy tendon above it. Even with arthroscopic treatments for tennis elbow, you’re just debriding, not repairing it.
How does the comprehensiveness of Bone and Joint Institute help the patient experience?
I think that we offer a unique experience for patients that come here in the sense that you can come here if you have a problem, you’re worked up, and you’re evaluated clinically, but then you’re also evaluated diagnostically. You can have your therapy here – we have an excellent therapy department- and you can have your surgery here as well. It provides a one stop patient experience where everything is under one roof. It allows for not only communication between all the providers, but also communication between therapists and physicians. It also allows us to create an environment of excellence across all service lines. From your first experience with our front desk team, to our physicians, to our nursing staff, to therapists, to anesthesiologists – we want to maintain that environment of excellence. We take pride in that. The collaborative nature between all of our different specialties and departments makes us unique.
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For more information about elbow and wrist pain, call Bone and Joint Institute of Tennessee at (615) 791-2630. You can also schedule an appointment online.