Experience with ruptured elbow tendon surgery?

MP community -

I had severe bilateral, medial and lateral epicondylitis and was just notified (MRI's) that I have a few tears on my medial and lateral tendons on both elbows, including my left wrist cartilage.

In June, I had the FAST Technique procedure ( tenexhealth.com) done on both sides/both elbows and 3 weeks ago had Platelet Rich Plasma shots on both sides/both elbows + the wrist. I've done PT 3-5 times a week since early July.

I'm 10x's better than prior to all of that but I'm still nowhere near being stable/pain-free. If I don't see greater improvement over the next month, I'm going to have to look at surgery. Anyone had experience with the surgery to repair elbow tendon tears? Any insight/advice appreciated. Thanks!

• Also, I looked into the Regenexx clinic in Boulder/Denver but insurance won't cover it and I'd be looking at $4-8K. Anyone have experience with them?

Hi Cotton,

In the mid-1990s I took a leader fall in Yosemite that resulted in a partial tear--medial side--to my right elbow. Surgery was recommended, but I chose conservative--rest, PT, stretching and strengthening. Frankly I do not know if I made the right call. But very, very gradually over time it did heal. Now, over 15 years later I sometimes get pain in the site and when I do I back off. My recovery was not in weeks or months. It took several years before it seemed comparable to the left side. During that time there were ups and downs. Face climbing was more painful than crack or ice climbing--the latter tend to put the elbow into a neutral "thumbs up" orientation and is therefore less stressful. To summarize my situation suggests that possibly if one is patient and faithful to doing everything right, that over a period of years one can heal--perhaps not 100% but into the high 90% recovery. Hope that helps.
Cheers,

Bob Loomis, Spokane, WA.

Cotton, based on my clinical experience surgery isn't a great option for tendonopathy. I'm the founder of the clinic you referenced. In our experience, when patients aren't recovering with PRP it's either because of a subtle neck issue that also needs to be treated or the tissue needs stronger therapies like stem cells. Happy to answer any questions you may have, my e-mail is centenooffice@centenoschultz.com.

SpokaneBob -
Thanks for your reply. I've been dealing with this issue for 2 years and have tried everything with the exception of surgery (or Regenexx). I don't really want to approach this conservatively for another 10 years before I feel good again. I'm young and otherwise healthy and want to take advantage of that. I'd rather have surgery, rehab for 6-12 months and then get back at it.

Chris -
Thanks for your reply.
Regenexx has me intrigued, but I can't afford an uninsured $8,000 procedure on the notion that it may work. I emailed you privately and look forward to your response.

If anyone else has actually had the epicondylectomy procedure I'd appreciate hearing from you. Thanks!

Cotton, surgery isn't a sure thing as there is no good medical evidence to show that it's all that effective. Our current process is in the 4K range, but I understand if that's too much. In the meantime, if PRP didn't work, I can't emphasize enough that it's likely a shoulder or neck issue rather than an elbow issue. this is explained further in this book: regenexx.com/wp-content/upl… .

Thank you for the information, Chris. I'll look into it and will follow up with questions when I get through the 100+ pages. Are your citations hyperlinked? I didn't notice any citations within the e-book.

I did email you with specific questions as you suggested and I am looking forward to a more specific, private reply. Cheers.

Yes, the whole book is extensively hyperlinked.

Hey Cotton,

Did you ever end up getting the surgery? How did it go for you?

I too have medial and lateral epicondylitis in both arms. 5 weeks ago, I had Tenex done on my left arm and am not feeling much better so I am holding off on the right for now

I will probably do PRP but I've been suffering with this for 6 years now and I'm getting older and need more aggressive measures now.

From what I've read on the forum, its sound like surgery is really the only way to go since they really get in there and can target and excise the damaged tissue.

Would love to hear where you're at now.

Somehow I missed this thread back in 2013, but here's my experience. Suffered a significant partial tendon tear to left medial epicondyle in 2010 while cleaning an aid line (I know, sounds weird but got in a very awkward position and it tore). Did the PT thing for a number of months, then got MRI which was described by doc as the torn portion "retracted and coiled up like a spring" so unlikely to heal. Opted for surgery at age 54. Had a sports med surgeon who specialised in shoulders and elbows. He sliced the tendon, cleaned up the damage, installed a bone anchor and reattached the tendon. Recovery was much more difficult than I expected, probably compounded by age and the fact I'm not particularly patient. While the left arm was immobilised and recovering, I developed a terrible case of lateral epicondilytis in the right arm from overuse. The low point was when I found myself in the drugstore buying the smallest bottles of mouthwash I could find because it was too painful to lift a regular size bottle. But 6 mos later I was back on really easy trad. 5 years later neither arm is 100%, and will get painful if I overdo things either climbing or working around the house. Normal everyday activities = no pain. The arm that was surgically repaired is more durable than the other one. But I can climb again at similar levels to prior to the surgery - just gotta be careful not to overdo it and I use the tension bands on the arms when climbing. Would I do it over again? Yes and no......yes, the surgery worked on left arm. But the whole process resulted in chronic lateral epicondilytis on the right arm that still gives me problems. My fault, not the surgeon's but be very careful of that effect if you do the surgery. And be very patient on the recovery - tendons take a very, very long time to heal.

Palazzo (and any others with similar situations),

To answer your question first off - no I did not have surgery and am happy that I did not. If you're curious about where I'm at now and what it took to get here, I'll outline that below.

I finally eased back into climbing again in November 2014. I was traveling for work most of this spring. My work is pretty intense - I work as a contract mechanic so I'll work 72hrs/week for 4-6 weeks at a time in the spring and fall doing lots of wrenching and lifting parts. With all of the wrenching, I have had some pain though it's a tiny fraction of what it was at its worst in 2012/2013.

I've been climbing regularly (3x/week) for the past 6 weeks and haven't had any troubles. I'm a former college football fullback so I am a bigger climber (5'11", 220) which doesn't benefit me in any way climbing or with elbow pain. Recently, I've been climbing some short, mid 5.10's again without any pain. That's good progress for me, given the weight I'm pulling.

I'll be doing a 5 day trip to Colorado to sport climb in July and then a week in the Cascades in August followed by a week in the Wind Rivers - both of these trips will be long, moderate (<5.9), alpine stuff so shouldn't be too hard on the elbows.

Here was the treatment timeline I had.

June/July 2013:
Tenex on medial/lateral epicondyles of both right and left elbows.
Tenex also done on left Triangular fibrocartilage complex (TFCC) tear.
Performed by Dr. Steven Stahle at the US Center for Sports Medicine in St. Louis.
They were great to work with and I would work with them again.

September 2013
Platelet plasma injections on medial/lateral epicondyle + left TFCC tear.
Performed by Dr. Steven Stahle at US Center for Sports Medicine in St. Louis.
Again, great people.

June 2014
Adipose and bone marrow stem cell treatment on medial lateral epicondyle + left TFCC tear.
Hard to say if this actually helped because of all the other stuff I was doing but I think it probably did benefit me to some degree. I didn't have a good experience with the doctor at this place - he ripped a nerve in one of my elbows so I had the funny bone sensation for months afterwards whenever I bent my elbow. When I called him to ask about it, his response was "Bummer dude, I zinged ya! That shit'll feel weird for awhile but you'll be fine." He was right, but that's more of a response I'd expect from the bro's than the doc if you feel me.

A couple of things I did (and still do though not as frequently) on my own.
Eccentric loading exercises. There are a ton of resources out there on this but Dr. J has written extensively for Rock and Ice geared towards climbers ( drjuliansaunders.com/resour…) Because I had bilateral medial/lateral pain, I had to do every angle 3 times a week which was time consuming. I'd usually just throw in a documentary a few nights a week and go through these exercises.

Stretching. Again, Dr. J has a good recommendation on what kinds of stretches + frequency/duration.

I bought this contraption called an Arm-Aid. It's over-priced in terms of materials (you could probably 3D print one and buy a few parts at a hardware store if you have the time and inclination to tinker) but it definitely helps blood flow and breaking up scar tissue.

That's generally been my road up to this point. I'm built like a powerlifter/linebacker so I'll never be a high-grade climber but the joy I get from being in the hills and testing myself physically and mentally is unparalleled to anything I've ever done so I can say without a doubt that this road up to now has been worth it. Feel free to write if you have any more questions. I know it's a frustrating process when the condition progresses beyond just inflammation and this is something I definitely feel like I can offer first-hand experience on.

Be easy

Hey guys,

Thanks for the response and the updates.

Cotton - It sounds like PRP is what really helped your condition. How long did it take to start feeling a difference after the injection?

Thanks also for mentioning the Arm-Aid device. I recently bought one and it definitely provides relief and helps loosen up the tightness.

I am about 8 weeks out now from having the Tenex procedure done on my left elbow for medial epicondylitis.

I feel that I've gotten my ROM back but as far as feeling better, I can't say that I'm at all any better. I feel that I've simply recovered from the procedure but not the injury. I'm still in a lot of pain and can not lift or apply any pressure with my left elbow.

Tuesday I am schedule for a PRP injection so I'll keep you guys posted on how this progresses. My doctor says he has about a 90% success rate with PRP.

I really hope this helps because I am now getting close to the end of my options. After this, I have the stem cell option and then the final frontier is surgery.

Anyone currently dealing with medial epicondylitis should check out this info: Healing Medial Epicondylitis. Very helpful reference and great method for getting rid of the pain and healing the elbow. My climbing buddy and I both had elbow issues and couldn't find any relief until 2 months ago when we tried these products. I will continue to use them throughout the climbing season in the hopes that my issues don't return.

Palazzo,

I'd say after about 3 months I started to feel better and about 6-8 months before I was really feeling solid about things again. There are a lot of variables and other nuances that could impact that too.

Ludgate,
I tried one of those and sent it back. They're a waste of a lot of money in my opinion and experience.

Chris, so is Regenexx stem cell injection(s) and if so how does it differ from AmnioFix or is it merely another form of PRP?

Sorry for the tardy reply. AmnioFix is a non-cellular amniotic tissue with no stem cells. It's basically a growth factor cocktail and more similar to PRP. Regenexx-Sd is a bone marrow stem cell procedure. think of growth factors as espresso shots for the local construction worker cells that are supposed to repair injury. Stem cells are like a general contractor who can hire subs and at the end of the day differentiate into the type of cells needed (bricks and mortar).

So, is there any peer reviewed evidence or long term study that clearly shows these stem cells can rebuild/repair long term chronic tendonopathy such as medial epicondylosis?

We don't use many stem cells for this purpose, but use PRP. I was answering a question about the differences. Here's what's out there:

PRP-Yes- ncbi.nlm.nih.gov/pubmed/238…, ncbi.nlm.nih.gov/pubmed/262…
Amniotic Membrane-(i.e. AmnioFix, but there are many brands)-No
Steroids-Yes-Makes pain better in short-term, worse in long run- medpagetoday.com/Orthopedic…
Tendon surgery-No
Shockwave Therapy-Probably/conflicting- ncbi.nlm.nih.gov/pubmed/262…

As for stem cells, we rarely use these for garden variety tendinopathy as it's usually overkill. In our clinical experience, in the rare instance that patients fail PRP, they will usually respond to a stem cell injection, but it's too early for RCTs on stem cells for this indication-however that's coming.