Elbow Pain


 

ELBOW AND FOREARM PAIN


There are many conditions affecting the elbow and forearm that may cause a range of symptoms ranging from mild discomfort to severe pain.  These can adversely affect the quality of your life including the ability to work, sleep and enjoy recreational activities.


At the Center for Integrated Pain Management a customized treatment plan is designed to give you optimal health and relief.  Below is a list of elbow, hand and wrist conditions that the Center treats.


  • Tennis Elbow/Lateral Epicondylitis
  • Golfer’s Elbow/Medial Epicondylitis
  • Elbow Sprain, Strain and Tears
  • Olecranon Bursitis
  • Cubital Tunnel Syndrome/Ulnar Neuropathy
  • Muscle Spasms
  • Radial Tunnel Syndrome/Radial Neuropathy
  • Nerve Entrapment/Radiculopathy
  • Ligamentous Joint Laxity

A diagnosis will be made once Dr. Kulick reviews your family history, completes a thorough physical examination and conducts an in-office ultrasound. If necessary, Dr. Kulick may request that you obtain an MRI, a CT Scan or additional X-rays in order for him to precisely determine the diagnosis and treatment plan.

To learn more about the treatment and relief of elbow and forearm conditions please contact our office at 212-867-1777.




Tennis Elbow/Lateral Epicondylitis


What is Tennis Elbow?

The medical term is Lateral Epicondylitis but this condition is typically called tennis elbow.  This sports injury is associated with the overuse of the wrist and elbow or repetitive movement particularly if the forearm muscles are weak. It results in tiny tendon tears on the outside or lateral side of the forearm. These tendons connect the muscles in the forearm to the lateral epicondyle, the small outer knob of the elbow bone. The forearm muscles extend from the elbow to the wrist and fingers and that is why tennis elbow causes both tenderness in the elbow and pain that may radiate to the wrist.


Tennis elbow was initially linked to the repetitive backhand movement of tennis players. However, it may be caused by any overuse of the forearm or the extension of the wrist away from the palm of your hand. Activities such as gardening, carpentry, painting, typing, butchering and even cooking can cause tennis elbow.  Weekend warriors and do-it-yourselfers are also at risk. It affects men and women equally.


Seek Treatment For These Symptoms:

Tennis elbow can produce a range of symptoms from mild discomfort to incapacitating pain.  It can be acute with a sudden onset of symptoms or chronic accompanied by a slow and gradual progression of debilitating symptoms.


  • Pain or weakness in the elbow or the outside of the forearm
  • Pain in the wrist or radiating from the elbow to the wrist
  • Difficulty shaking hands or turning a doorknob
  • Trouble gripping small objects such as a pen or a cup
  • Pain turning the steering wheel on a car or bicycle



Next Steps

Tennis elbow should not be left untreated as it can worsen. Seek a medical diagnosis and explore typical treatment choices such as rest, ultrasound-guided corticosteroid injections and anti-inflammatory medication to reduce tenderness and physical therapy to strengthen the muscles. Additional highly specialized and cutting edge options include ultrasound-guided tenotomy injections that destroy damaged tissue, followed by ultrasound-guided prolotherapy injections or ultrasound-guided injections of platelet rich plasma therapy (PRP) to accelerate the growth of healthy replacement tissue.

To learn more about the treatment and relief of tennis elbow please call 212-867-1777.


 

Golfer’s Elbow/Medial Epicondylitis


What is Golfer’s Elbow?

Also known medically as Medial Epicondylitis, golfer’s elbow is an overuse injury similar to tennis elbow.  It causes pain along the inside of the forearm and wrist because of minute tears in the tendon attached to the medial epicondyle, the small bony bump on the inside of the elbow.  The muscles that control the wrist and fingers are adversely affected.


Golfer’s elbow results from the repetitive motion of flexing the wrist against resistance, such as a golf club, for more than two hours a day.  Activities including golf, archery, football, baseball, weight training and racquet sports can lead to this condition, however any repetitive motions that involve bending the wrist or elbow such as painting, chopping wood, clicking a computer mouse or cooking may trigger golfer’s elbow.


Seek Treatment for These Symptoms:

  • Pain along the inner side of the forearm, wrist or elbow
  • Tingling or numbness in the fingers
  • Pain radiating to fingers
  • Difficulty shaking hands or turning a doorknob
  • Trouble grasping items with the hand facing downwards


Next Steps

Consult the Center for a diagnosis and for treatment options. These include rest, ultrasound-guided corticosteroid injections and physical therapy. Additional highly specialized and cutting edge options include ultrasound-guided tenotomy injections that destroy damaged tissue, followed by ultrasound-guided prolotherapy injections or ultrasound-guided injections of platelet rich plasma therapy (PRP) to accelerate the growth of healthy replacement tissue.

To learn more about the treatment and relief of golfer’s elbow please call our office at 212-867-1777.



Elbow Sprains, Strains and Tears


What are Elbow Sprains, Strains and Tears?

A sprain is an injury to a ligament, the connective tissue that attaches bone to bone.  The elbow has three ligaments that meet at the joint to connect the upper arm bone to the lower arm bone.  They are the radial, ulnar and annular ligaments. Elbow sprains may result from a direct blow to the elbow or twisting it in an unnatural position.  It can occur from a fall, collision or contact sports. A strain is an injury to the muscles or the tendons that attach muscles to the bone. These typically result from overuse of the joint, particularly repetitive motions, and may occur while playing racquet or contact sports. Both sprains and strains have varying levels of severity.  They may range from a mild over stretching of the ligament, muscles or tendons to a slight rip or a complete tear. Tennis Elbow and Golfer’s Elbow are common examples.


Seek Treatment for these Symptoms:

  • Elbow pain or stiffness
  • Swelling, warmth or redness at the elbow
  • Weakness when trying to move the arm


Next Steps

Consult the Center for a diagnosis and for treatment options. These include rest, ice, ultrasound-guided corticosteroid injections and physical therapy. Additional highly specialized and cutting edge options for strains, if there is evidence of tendinosis, are ultrasound-guided tenotomy injections that destroy damaged tissue, followed by ultrasound-guided prolotherapy or ultrasound-guided injections of platelet rich plasma therapy (PRP) to accelerate the growth of healthy replacement tissue.

To learn more about the treatment and relief of elbow sprains, strains and tears please call our office at 212-867-1777.



Olecranon Bursitis


What is Olecranon Bursitis?

A bursa is a fluid filled sac that minimizes friction between soft tissue such as skin, muscles, tendons, and bones. The olecranon bursa is located between the skin and the olecranon, the pointy bone at the back of the elbow. The bursa fills with fluid and becomes inflamed and painful. It can swell to the size of a golf ball. Nicknamed “student’s elbow,” it may be caused by prolonged leaning on the elbow.  It can also be caused by a trauma to the elbow or an infection in the bursa.


Seek treatment for these symptoms:

  • Swelling at the tip of the elbow
  • Elbow pain
  • Redness or warmth to the touch at the elbow


Next Steps

Consult the Center for a diagnosis and for treatment options. The bursa may need to be aspirated which means that the excess fluid is removed with a needle. Ultrasound-guided prolotherapy injections, ultrasound-guided corticosteroid injections and anti-inflammatory medications may also provide relief.

To learn more about the treatment and relief of Olecranon Bursitis please call 212-867-1777.


 

Cubital Tunnel Syndrome/Ulnar Neuropathy


What is Ulnar Neuropathy?

The ulnar nerve passes through the cubital tunnel, a narrow space in the elbow, passing the “funny bone” of the elbow and traveling down through the forearm to the hand.  This nerve controls many of the hand muscles that support fine motor skills. The syndrome is caused by pressure on this nerve that generates elbow pain, tingling and numbness, particularly in the ring and little fingers of the hand. It may be caused by excessive leaning on the elbow or keeping the elbow bent for long periods of time.


Seek Treatment for these Symptoms:

  • Numbness or tingling in the ring or little fingers
  • Elbow pain or numbness
  • Inability to pinch thumb and little finger together


Next Steps

Consult the Center for a diagnosis and for treatment options. These may include rest, an ultrasound-guided nerve block injection and a steroid-free ultrasound-guided hydrodissection that frees the ulnar nerve from compression.

To learn more about the treatment and relief of Ulnar Neuropathy please contact our office at  212-867-1777.



Muscle Spasms

 

What Are Muscle Spasms?

Muscle spasms are very common and can happen without warning. Perhaps you pick up a heavy box, reach for an item or even sleep in an awkward position. This suddenly triggers a muscle spasm in your forearm and you cannot straighten or move it without pain. Muscle spasms are the involuntary contraction or tensing of one or more muscles. They may in the forearm, hand, wrist, neck, upper or lower back, and legs.  Muscle spasms may be caused by heavy lifting, muscle overuse, weak muscles, nerve compression, spinal conditions such as degenerative disc disease or a herniated disc, and many sports injuries. Some sports including golf, football, weightlifting and basketball that require the constant twisting of the spine may lead to back spasms. Spasms may seem to appear out of thin air, however, typically small tears in the muscle may have developed over time. These tears may lead to swelling that compresses the nerves surrounding the muscle. This in turn triggers a muscle spasm that can cause pain, cramping or twitching.


Seek Treatment for these Symptoms:

  • Muscle pain that does not dissipate on its own
  • Constant muscle cramps
  • Difficulty walking or moving
  • Muscle appears hard or distorted


Next Steps

If the muscle spasm does not resolve by itself after a few days of rest, icing the area for short periods of 10 to 20 minutes every two hours or using a heated pad, and taking non-steroidal anti-inflammatory medication, then seek treatment. Consult the Center for a diagnosis and for options.  The spasm may be the result of an underlying condition that can be treated. Once identified, treatment options may include ultrasound-guided corticosteroid injections, trigger point therapy, ultrasound guided prolotherapy injections or anti-inflammatory or muscle relaxant medication. Ultrasound guided injections of platelet rich plasma (PRP), or stem cell therapy may be advised. If nerve entrapment is indicated then a steroid-free hydrodissection to release the nerve or ultrasound-guided nerve block injections will be recommended.

To learn more about the treatment and relief of Muscle Spasms please call our office at 212-867-1777.

 

Radial Tunnel Syndrome/Radial Neuropathy


What is Radial Tunnel Syndrome or Radial Neuropathy?

Throbbing aches below the elbow? Stabbing pain when lifting or throwing a ball? You may suffer from Radial Tunnel Syndrome also called Radial Neuropathy. This syndrome  affects the muscles in the forearm and is characterized by increased pain when turning your arm or lifting an object. It is often the result of repetitive movements. The radial nerve is one of three major nerves in the arm.  It travels from the upper arm around the elbow through the radial tunnel, a narrow passageway made up of bone, muscle and tendon and on through the forearm and hand. This tunnel is responsible for your ability to rotate your forearm. The radial nerve maybe pinched in this narrow passageway resulting in pain and muscle fatigue.


Seek Treatment for These Symptoms:

  • Pain below the elbow
  • Pain increases with activity or rotating the arm during sports or lifting
  • Pain may increase during the night
  • Constant aching pain or a sharp stabbing pain when using the forearm


Next Steps:

Consult the Center for a diagnosis and for treatment options. These may include rest, an ultrasound-guided nerve block injection and a steroid-free ultrasound-guided hydrodissection that frees the radial nerve from compression.

To learn more about the treatment and relief of Radial Tunnel Syndrome or Radial  Neuropathy please contact our office at 212-867-1777.




Ligamentous Laxity of the Joint


What is Ligamentous Laxity?


Stretch, snap, crackle, and pop. These may be telling signs of an underlying condition called Ligamentous Laxity. Flexibility, in this instance, is not all it is cracked up to be. Joints are held in place by surrounding muscles, tendons and ligaments. If the ligaments, the soft tissue that connects bones to bones, are loose, the result may be joints that extend beyond the normal range of motion leading to chronic pain and joint instability. Since the ligaments do not support the joint properly, the condition can lead to a higher risk of joint injury, cartilage deterioration and muscle spasms as the surrounding tissue tries to correct the loose joint. Partial joint dislocation, when the bone pops in and out of the joint, is also a common symptom. Also known as hypermobility or double jointedness, this condition typically affects the joints of the shoulder, elbows, wrist, fingers and knees. It may be the result of a sports injury, bone structure or a genetic predisposition.


Seek Treatment for these Symptoms:


  • Ability to move joints beyond the normal range of motion
  • Chronic joint pain
  • Repeated partial dislocation of a joint
  • Cracking or popping sounds when flexing or straightening the joint
  • Muscle spasms near the afflicted joint


Next Steps

Consult the Center for a diagnosis and for treatment options. These may. include ultrasound-guided corticosteroid injections, prolotherapy injections and physical therapy. Additional highly specialized and cutting edge options


To learn more about the treatment and relief of Ligamentous Laxity of the Joint please call 212-867-1777.


Nerve Entrapment/Radculopathy


What Is Radiculopathy?

Radiculopathy is a group of conditions affecting one or more nerves in the spine. These nerves may become pinched or compressed, causing pain, numbness or tingling in the arms or legs. The sciatic nerve, the large nerve that runs down the lower back, hip, buttocks, and back of leg to the foot may be compressed in the lower back as a result of a herniated disc or other spinal damage.

Radiculopathy commonly occurs in the cervical spine (neck), the thoracic spine (mid back)or the lumbar spine (lower back).

Cervical, thoracic, and lumbar radiculopathy are often caused by herniated discs in the vertebrae (bones of the spine) and spinal stenosis, a narrowing of the hole in the vertebrae through which spinal nerves exit.  This places pressure on the nerves as they branch out from the spine. The compression may also be caused by an injury, overuse of muscles and tendons, poor posture, bone spurs, and arthritis.


Seek Treatment for these Symptoms:

  • Pain that radiates outward from the injured nerve
  • Numbness, tingling, burning sensation
  • Muscle weakness
  • Cervical radiculopathy affects the neck, upper back, shoulder, chest, arm,or hand.
  • Thoracic radiculopathy affects the chest, ribs, shoulders, mid back or stomach area
  • Lumbar radiculopathy causes sciatica which is an irritation of the large sciatic nerve located in the lower back.  This causes pain to radiate down the back of the leg to the calf or foot called sciatica
  • Pain may be aggravated by activities such as walking, climbing stairs or sitting


Next Steps

Consult the Center for a diagnosis and for treatment choices.  Depending on the diagnosis, treatment options may include ultrasound-guided corticosteroid injections, ultrasound -guided injections of platelet rich plasma (PRP), ultrasound-guided prolotherapy injections, physical therapy and anti-inflammatory medication. If nerve entrapment is indicated then a steroid-free hydrodissection to release the nerve and ultrasound-guided nerve block injections will be recommended.

To learn more about cervical radiculopathy and its treatment please call our office at 212-867-1777.




Location
Alexander Kulick, MD
112 East 61st Street
Upper East Side

New York, NY 10065
Phone: 917-810-4139
Fax: (646) 585-0042
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917-810-4139