Elbow tendon tear

[9susan11]

I was diagnosed 2 years ago with tennis elbow in my right elbow.  I have been to 4 Orthopedic surgeons and got different answers each time.  The last specialist I saw said to just keep coming back when it hurts for another cortizone shot.  I don't have any idea what first caused the pain in the first place but every Dr. would just give me a shot until I said no more shots because I will only get relief now for a week or two at the most.  I have had at least 9 shots.  I take pain medication 3 times a day and now that isn't even helping with the pain.  I am up 4-5 times a night because if my arm is left in a certain position for two long or I need to move it the pain is so great my arm feels like it is going to break.  I insisted on getting an MRI from my regular Dr. and the results came back today showing that I have a tear in the tendon.  Now, I have an appointment with another Dr. next week to see what my options are.  I was told that since the injury has gone on for so long that surgery is my only option.  My question is:  Is surgery the only option I have for my problem??  Did having too many cortizone shots make it worse?  I am in so much pain and can't straighten my arm or move my wrist up or down.  Just brushing my teeth is a task in itself.  Does anyone have any answers on what I should do???   Thank you for your help.  

[9susan11]

Thank you for all your information.  I am going to ask the Dr. about PRP.  My primary Dr. warned about getting to many injections.  When I first started getting them they would take away the pain for about 6 weeks.  The last 2 injections did not relieve any pain and after the injection I was in so much pain for 3 days I couldn't move my arm and I was actually crying for 3 days because nothing relieved the pain.  I will let you know what the Dr. says on Friday.  Yes, this is a very frustrating injury considering it has gone on for 2 years and I have no idea what I did to injure it in the first place.  The only thing I can come up with is my chiropractor adjusted it one time and I did hear a pop and was in a lot of pain afterwards.  Not sure if that is what did it or not.  Thank you for your information..Susan

[Michael L Gross, MD]

This in a injury to the tendons that start on the outside of the elbow and travel down to extend the wrist and fingers. This can be a very frustrating injury to treat. Its not unusual to try one or two cortisone injections for lateral epicondylits (tennis elbow).  However, it is not entirely clear why the injections are effective since this is not really caused by inflammation, but rather by microtears within the tendon.  The MRI finding is not unusual, and is consistent with lateral epicondylitis.  
I have had very good success with platelet rich plasma injections (PRP) for this problem.  Platelets contain growth factors. In this therapy, your own blood is drawn, and spun to obtain a high concentration of platelets.  The concentrated platelets are injected into your tendon to deliver the concentrated growth factors and induce a healing response.  This treatment ihas had about 80% success rate.
I see about 200 patients with tennis elbow a year, and find surgery necessary on less than 5%.