New Ultrasound Therapy for Tennis Elbow

Works for Other Ligament, Tendon Injuries, Too

From the WebMD Archives

Dec. 6, 2002 (Chicago) -- From tennis elbow to jumper's knee, a new ultrasound needle treatment reduced pain and restored function in 65% of patients treated, according to researchers at a meeting of specialists. And the best part is that it worked in patients who had already failed treatment with traditional measures.

For years doctors have been injecting injured elbows and knees with pain-numbing drugs or anti-inflammatory steroids to treat minor tears, says Levon N. Nazarian, MD, professor of radiology, Jefferson Medical College of Thomas Jefferson University, Philadelphia.

"But we are combining ultrasound with needle therapy so that the needle is carefully guided to the point of injury," he says. He presented the study at the 88th Scientific Assembly and Annual Meeting of the Radiological Society of North America.

Standard "needle therapy" either draws fluid out of a joint or injects something into the injured joint. But the ultrasound-guided needle therapy allows the doctor to use the needle as a very tiny surgical instrument to break up scars. In addition, the needle can poke holes in an injured ligament -- this allows collagen to build in the area to replace the damaged tissue, Nazarian says.

All patients are initially injected with a pain-numbing drug into the injured area. This allows the doctor to determine by ultrasound if the perceived abnormality is the actual cause of the patient's pain.

If the pain disappears after numbing the area, "we know we are on the right track," says Nazarian. After the anesthesia is injected, the patient may be treated with just "needle surgery" or may receive anti-inflammatory steroid injections or additional pain-numbing medication.

"The advantage to this procedure is that it is so minimally invasive that restoration of function is very rapid, much more so than even arthroscopic surgery," says Nazarian.

This also offers a surgical option for patients who have "tears or abnormalities that are so small that they cannot be fixed by surgeons and yet they are not responding to conservative treatment of rest, ice, and support."

The 273 patients in Nazarian's study ranged in age from 13 to 82. Patients had a variety of conditions, including tendon tear, muscle tear, bursitis, tenosynovitis, ligament injury, and plantar fasciitis -- all had failed conservative treatment.


The procedure takes about one hour. Patients were instructed to perform only light stretching for the first two weeks, strengthening exercises from weeks two through six, and then a gradual return to higher level activities.

While 65% of patients reported symptom relief in two to 12 weeks, Nazarian said 35% were unchanged. "But these patients still had all options open to them. Since we didn't treat with traditional surgery, no bridges were burned," he says. Moreover, even patients who didn't improve did not get worse.

Michael A. Sullivan, MD, associate chairman, department of radiology, Ochsner Clinic Foundation, New Orleans, says using ultrasound to guide needle therapy is a major advance. "For years people have been injecting joints blindly: If it hurts here, inject here. That can be successful, but it can also cause more harm than good. This is really a logical way to improve that approach." Sullivan was not involved in Nazarian's study.

Asked if the ultrasound-guided approach would be used to treat professional athletes, Nazarian says "we were at spring training with the Phillies last year and I can tell you that this was very effective for a minor league pitcher. You know if you operate on an athlete that often means missing all or most of a season. Using this approach he was back in the lineup in a short time. I don't know if he will ever make the major leagues, but I think this procedure helped him have a better chance."

Nazarian says that he also used the ultrasound-guided technique to treat an English soccer player who was frequently benched by injuries but after treatment the man went on "to be named an alternate to the Britain's World Cup Team."

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SOURCES: 88th Scientific Assembly and Annual Meeting of the Radiological Society of North America, Chicago, Dec. 1-6, 2002. -->
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