If this simple scan can tell how bad your Tennis Elbow injury is – Why won't your Doctor give you one – And when should you ask for it?
If you think you have Tennis Elbow or have been diagnosed by your Doctor, how do you know how severe your injury really is? (Not sure if that's even what you have? What is Tennis Elbow? )
Are there any tests that can tell you if the damage to your tendons is mild, moderate, severe – aside from an expensive, inconvenient MRI?
What if I told you, you might be able to cheaply and easily get a fairly accurate picture of how bad your tendon injury actually is, right in a Doctor's office? (A lot cheaper and easier than an MRI, anyway!)
But first you have to know about it – Then you'll probably have to ask for it – You may even have to demand it!
Why? Because of procedural rules and other strange “political” reasons, your Doctor probably won't even tell you this test exists and is an option. (Here in the U.S., it seems, anyway.)
Diagnosing Tennis Elbow is a simple matter with little margin of error – Even if you diagnose yourself, based on what you read here or elsewhere on the Internet.
If you get a diagnosis from a Doctor, it will be based on your description of your symptoms and two very simple physical tests.
- If there's pain or point tenderness at your Lateral Epicondyle, (the Tennis Elbow “spot”) when it's pressed on...
- And a muscle resistance test or two, which will be considered positive if you feel pain when resisting the specific movements.
But you won't have the slightest idea how severe it is, by any objective measure, anyway.
(Despite all common sense, the amount of pain you're in often has little to do with how severe the injury is – or whether there's really any measurable injury in your tendons at all.)
You'll tend to assume, at first, that if it doesn't hurt that badly the damage can't be that bad – And, conversely, if it hurts badly or continuously the damage must be severe.
But the reality is that the severity of your pain and other symptoms don't necessarily correlate with how severe your injury actually is.
And not knowing this may be perfectly fine at first if you're just starting to become aware you have a problem and haven't already been injured and in pain for months.
If you're just starting to have Tennis Elbow symptoms, there's no need to worry about or assume the worst.
Why not assume it's a mild injury and trust that you can heal and overcome it by being proactive.
(Being wise and proactive in how you treat it means rejection the common wisdom; ice, brace, pills, shots, etc, and taking a different approach based on a completely different model – which is what Tennis Elbow Classroom is all about, so stick around to learn more. There's a lot here!)
The real challenge is, what if you've been doing everything you were told to do by the purveyors of that so called “common wisdom” and “standard treatment approach” and you're still in pain 3 months, 6 months or even a year later!?
- How do you know how severe your injury is and if you have a tear in your tendon? (Again, not that that should be the first thing you should worry about)...
- How do you know what your prospects for a full recovery are?... And how long will your Tennis Elbow recovery take?
- When do you have to start thinking about quitting tennis or golf for a while? – Or face the possibility of cutting back your work hours?
- And at what point do you need to actually consider Tennis Elbow surgery – OR should you keep trying to heal and recover non surgically for the time being?
Wouldn't a test that offers some objective measure of your injury help, even if it's not perfect?
From all appearances, the medical protocol seems to be to wait and see – to rest, hope and wait – ice, brace and inject – rehab, restrict and repeat…
Sadly, especially here in the U.S., from what I've seen, you will probably be in the dark for at least 6 months to a year before you get access to a test that will give you any real, objective information.
Finally, if you're still not recovered in that time you're told that you “may be a candidate for surgery” – and NOW it's time for the MRI to see how bad your tendons look and make sure there's enough damage “in there” to justify surgery.
Unfortunately, the MRI is one of the most expensive, inconvenient and as I'm about to explain to you, unnecessary tests available – when it comes to the task at hand, which is determining how severe your Tennis Elbow is.
You may be facing a large co-pay, weeks of waiting to get a slot for the test, a separate visit to the hospital where the machine is and a lot of fuss and noise to actually have MRI administered.
Oh, let's not forget waiting days or weeks to hear what the results are and having to make another appointment later to find out.
The good news is, there's a cheaper, easier and completely non-invasive test that you could have instead – and in all likelihood, right in your Orthopedic Doctor's office.
The shocking thing is, it probably won't be offered to you – At least not as a stand-alone test.
I'm talking about a Sonogram.
What's A Sonogram And What Does It Have To Do With Tennis Elbow?
It's a machine that produces sound waves that harmlessly penetrate your body, bounce off your bones and tendons and are picked up by a transducer and converted into an image that can be seen in real time on a computer screen.
Doppler Ultrasound: A better, faster, cheaper way to see how severe your Tennis Elbow is - Or hopefully, isn't?
Sort of like an X-ray, except it uses sound waves instead of gamma rays and it's not a static picture, but a real time image like that from a camcorder.
The funny thing is, you've seen and heard of this technology being used for decades to see the developing fetus during pregnancy, where it's referred to as an Ultrasound or 'Obstetric Ultrasound,' technically.
(Also known as Ultrasonography, Musculoskeletal Ultrasound, (MSKUS) Medical Ultrasound and Diagnostic Sonography. Whew!)
You WILL get one during (and probably before) a PRP therapy or an Autologous Blood injection treatment (full article)...
But that's only IF you've chosen to have one of these trendy, new procedures.
(Amazingly, none of the people I've ever treated – and that's a lot of Tennis and Golfer's Elbow sufferers over 10 years and counting – has ever been offered one by their Doctor simply as a diagnostic test, as far as I know.)
How A Musculoskeletal Ultrasound / Sonogram Test Is Conducted And What It Can Show
The Doctor or technician (Radiographer) simply smears some clear goop on your elbow, puts the 'transducer' on the area and looks at the screen while moving it around to see different areas.
Video of Ultrasound Diagnosis of the Lateral Epicondyle Area:
Here's a video where you can see what I'm referring to. The Doctor finds a dark area that is indicative of "diseased" tendon, (his words) which is likely degeneration.
The amazing thing is that it's possible to see whether there's any tendon degeneration (also known as Tendinosis, which is the most common tendon issue with Tennis Elbow)
And how severe that degeneration is, if it's present.
It's also possible to see if there are any significant tears in the tendons, or calcifications or bone spurs.
And this is all in real time as you sit there. Your Doctor or Sonographer can move the transducer around, look at the tendon and the joints in the area and interpret what he or she sees for you right then and there – not weeks later in a separate visit.
And there's no radiation or a huge electro-magnetic field that you'll be exposed to (which no one ever seems to be concerned about when getting an MRI. I certainly wouldn't be willing to subject myself to that enormous EMF just to look at a couple of tendons!)
Now, to be clear, IF you are at the point where you're ready to consider surgery, the MRI is the “gold standard” and you may want to have the best possible imaging and assessment / diagnosis before you make the decision about whether to go under the scalpel.
Although, you might still want to have a Sonogram / Ultrasound before you opt for the MRI – It might be conclusive enough.
Because there's always a possibility your tendons are no where near as damaged as you're worried they are, (symptoms are not dependable and often misleading) and may look quite good on the Sonogram…
Good enough that an MRI won't really make sense, and neither will surgery, hopefully!
Why Aren't Sonograms Routinely Offered To Tennis And Golfer's Elbow Sufferers?
So the ultimate question becomes: Why in the world aren't these tests being routinely offered to Tennis and Golfer's Elbow sufferers?
Are they reliable? This study suggests that:
"Ultrasound is considered a reliable, widely available, non-invasive and inexpensive imaging technique for assessing soft tissue involvement in Lateral Epicondylalgia. [Tennis Elbow]"
I can't say for certain, but I believe it has to do with the nature of modern managed care, with its protocols, segmentations and cost/benefit financial calculations (and perhaps even odd “political / medical turf” reasons.)
It seems that General Practitioners don't necessarily perfom Sonography or Musculoskeletal Ultrasonograhpy, either.
Orthopedists do, but you either need to know that and seek one out or be referred to one my your G.P. (Here in the U.S.)
And your General Practitioner Doctor isn't likely to refer you to an Orthopedist initially – Only months later when you haven't improved following the conventional treatment.
And that will probably be with the presumption that you'll be heading down the road to surgery, perhaps with PRP injections offered first, if you're lucky or Cortisone shots, if you're not so lucky – none of which you may be interested in.
Here's why you should avoid Cortisone Shots at all costs, by the way, if you'd even remotely consider them.
Even if you do go to an Orthopedist, you still might not be offered a Sonogram.
(At least here in the U.S. I get the impression it may be different in Europe. Let me know if you live there and you've had one.)
Perhaps the Orthopedists don't consider it worth their time to do Sonograms purely for diagnostic purposes.
You'll definitely get a Sonogram if you opt to have expensive Platelet-Rich Plasma therapy injections, however.
Your Doctor (again, likely an Orthopedist) will use the Sonogram image as feedback to guide the needle into the most damaged-looking areas of your tendons.
Read more about Platelet-Rich Plasma here if you'd like to know more about this relatively new therapy.
In that case, you will pay between several hundred and well over a thousand dollars for the privilege. (And that's for each treatment, of which several may be recommended.)
And, at this time, that cost won't be covered by insurance, (since it's still considered experimental, which is probably fair.)
Apparently Sonography is fairly tricky, difficult-to-master technique:
“the technique... is instrument and operator dependent and [has] a steep learning curve” http://www.jultrasoundmed.org/content/29/12/1717.full
And there are a lot of other variables, including different types of ultrasound equipment, different settings on that equipment, and no single, uniform standard when it comes to interpreting and diagnosing the abnormalities and apparent abnormalities seen in the scan:
"The use of ultrasound in the detection of Lateral Epicondylitis [Tennis Elbow] is recommended with caution since its accuracy appears to be highly dependent on numerous variables." S.K. Lathama, , T.O. Smithb - doi:10.1016/j.otsr.2014.01.006 (Link below)
As far as the political turf aspect is concerned, Sonography is a distinct technique within Radiography.
Radiographers specialize in the taking of the image of the patient, but not necessarily the interpretation of it.
Whereas Radiologists may be qualified to do both but definitely seem to specialize in the interpretation of images (X-rays, CT scans, MRIs and other scans) and the diagnosing of pathologies seen in those images, which are often taken by Radiographers.
Radiologists are the specialists who look at and interpret X-rays, CAT scans, MRIs and other scans – But they don't do Sonograms, apparently.
The only significant difference I can see, is that the scans that Radiologists “read” are static pictures, usually sent to them after the scan is taken for their expert assessment and interpretation.
And a Sonogram, if it's recorded, is like a video.
The problem may be that your average General Practitioner Doctor doesn't have the training to read the image. It's definitely a distinct skill that's very dependent on making the correct interpretation.
(And, although the Ob/gyn Doctors have Sonogram / Ultrasound equipment, they are clearly focused on Womens' health and not using their Ultrasounds for assessing tendon injuries.)
When Should You Get A Sonogram If You Have A Tennis Or Golfer's Elbow Injury?
When do you really need a Sonogram, though?...
Should you try and get one the minute you suspect you have Golfer's or Tennis Elbow? – (It may not be necessarly)...
It may not be necessary in most cases, if symptoms are just beginning to gradually appear, and as we established in the beginning of this article, you don't need one for the diagnosis, since that's a very straightforward thing to determine.
If you have a case of Tennis Elbow that happened forcefully and suddenly, however (most cases of Tennis and Golfer's Elbow are of a slow, gradual onset, by definition) – Especially if there was a clear acute trauma; a sudden, forceful injury – then it might be very helpful to see if there's evidence of a significant tear.
Should you seek out a Sonogram after several months of struggling to recover from your injury without success? – (Probably the best time)...
This is probably the point where it makes the most sense to get one; if you've made absolutely NO progress – keeping in mind that Tennis Elbow is often a challenging, slow-healing chronic injury that doesn't get better quickly or easily.
At this point it may be helpful to see if there's evidence of moderate to severe damage in your tendons with a Sonogram, and hopefully you'll get a better sense about whether you just need to be more patient, redouble your current treatment efforts or come up with another, hopefully better, approach.
Is it time to get one when you're starting to wonder if you might have a severe injury that may warrant surgery, after a year or more of pain and little to no improvement? – (Maybe. Might be time for MRI, though)...
The conventional medical thinking seems to see the “cutoff point” when surgery is often suggested is after the 1-year mark and this would probably be a good time to “get a better look” via a Sonogram, but if you are already seriously considering surgery, it may be time for an MRI, which gives the clearest picture.
If you want to first see if you're a good candidate for PRP or Autologous Blood Injection Therapy, (before considering surgery) then it makes sense to have a Sonogram, since it's probably a prerequisite and it's less serious and invasive, so the best possible scan (MRI) isn't necessary.
Ultimately, it's really going to depend on your mindset, needs and priorities.
If there's a lot riding on whether your injury is mild, moderate or severe, you may want to get one as soon as you can.
If there's not a lot riding on how bad your injury is (like your pro tennis career or other work) but you worry a lot and it would really help you to know, then it may be worth it for that reason.
From my perspective, though, the most important thing is understanding the likely nature of the injury (Tendinosis) in the first place!
And how to treat it the right way – As in doing everything you can to support your tendon healing…
And avoiding treating it the “conventional” way – Which is the wrong way (dead wrong, opposite way) And this entire site is dedicated to revealing why that is the case.
I see altogether too much time and energy being wasted worrying about how bad ones injury is, (when I believe the course of action should be the same, regardless of the severity – barring a large, full-thickness tear, which is not very common)...
Resting, hoping and waiting for it to get better (which doesn't work if there is any real damage, from what I've seen)
And pointless inflammation fighting and other “symptom chasing” with pills, ice and shots, which may offer some pain relief – but have no effect on healing the injury.
When it comes to supporting tendon healing that's what I teach my members inside the private members area.
Learn To Treat And Heal Your Own Golfer's And Tennis Elbow Right Here:
I'll be your personal tutor guiding you through easy-to-follow lessons, where you'll get the therapy techniques, key stretches and essential exercises you need to treat and recover from your injury at home.
Just watch the videos, follow along and start putting an end to your elbow pain today.
Learn more, and get started here: Tennis Elbow Self-Help Program