ORTHOPEDIC QUESTION, SERIOUS! Please help if you are experienced in this field. I have been suffering from?
tendonitis of both arms and tennis elbow of both arms for 3 years. I have been going to physical therapy on and off for 3 years. The first year it started out in my wrist, so I went for physical therapy and it went away. When it came back the next year it went up my forearms, so I went to physical therapy and it went away. The third year it went to my elbows and I have been out of work since April of 2006. I tried therapy for 6 months as to try and rule out surgery. It did not work this time so I had both arms operated on. I had the tennis elbow surgery done arthroscopically. I have been going to therapy twice a week since April of 2006. My right arm was operated on November 06 and my left arm March 07. I am still going to physical therapy. My right arm was doing well for a while and is acting up again, and my left arm, although has gotten somewhat better, refuses to heal. My doctor told me that he is sending me back to work without restrictions at my next appt. I know that I will further injure myself if I do.
This is a workers comp case from an injury at work and my lawyers can’t do anything against what my doctors say. So my question for you is, why am I not healing as fast as the doctors believe I should be? And is there something else that I could have where maybe I was misdiagnosed and that could possibly be the reason that I am not responding to the treatment that I am getting? The pain has moved to the inside of my elbow joints now and is traveling back down my forearms in the pain of tendoinitis again. I am very distraught about this. I feel I have done everthing I could possibly do to cure this problem. They have never given me and MRI even when I asked for one. I need to find a doctor that will listen to me and not worry about stepping on another doctors "toes" and really hear my concerns. I don’t want to end up totally disabled, I want to be healed. What should I do? I really don’t know what to do anymore. I just want my arms back so I can go back to my normal life.
My questions are these: Is there something I can have besides what they are saying? Is there any other treatment that can advance my healing? Will an MRI show things that might have been missed? How do I get a doctor to listen to me? Why am I not healing as fast as they "think I should?" I really need advice from a professional in this area. I am not messing around, I am not trying to stay out of work, I am being honest with my concerns and I feel like nobody cares. Please help!!!
In response to Mystify’s thorough and helpful answer, My pain started in my right arm and my left arm followed. It is a repetitive injury I incurred at work from typing all day which I believe to have been a poorly set up work station.
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First, let’s dicuss the issue of tendonitis. The term "tendonitis" is actually a misnomer because it infers inflammatory responses in the tendons. However, pathological studies show that there are vitually no inflammatory cells present in the tendons of said individuals with tendonitis. Rather, tendons are found to have celluar changes that include poor collagen formation and cross bridging. Therefore, it is not an "itis" (inflammation) issue, but a "pathy" (meaning a disorder or disease of) issue…thus, the new, more correct term is called tendonopathy. Previous therapies have been directed at reducing inflammation, rest, etc. These issues usually result in less pain because there is less mechanical force on the injured tissues. However, these therapies will not change the morphological structure of the tendon. Rather, "eccentric loading" exercises are now thought to break up the mal-formed cross bridges and reestablish healthy collagen fibers. These are usually exercises that involve a load that causes some degree of mild pain in a "lowering" type of motion…in the case of tennis elbow, it could mean focusing on the lowering of a weight from the extended wrist postion to the flexed position. Recent studies have shown that patients with achilles tendonopathy who engaged in eccentric loading therapies demonstrated positive tissue changes…however, at one year, about 1/3 of subjects that were no longer having pain after 1 year still demonstrated some degree of poor tissue quality. This implies that the time for this type of disorder to heal can be quite long…therefore, participants need to continue their program well beyond the length of time they spend in therapy. That being said, your repeated bouts of this problem may be simply due to:
1. Wrong treatment approach
2. Inadequate time for recovery
Yet, we do not know now is the nature of your work. Are you using your arms repeatedly throughout the day…and equally on both sides? Any time a disorder begins to occur bilaterally (on both sides of the body) and is also progressive despite medical treatment may be suspicious for underlying medical problems. This can be due either to disorders that affect the pain threshold response….such as smoking, depression, anxiety, fibromyalgia. Or this could be due to an entirely medical disorder of the tissue such as Ehrl-danlos syndrome.
So, you need to ask yourself…do I fit the characteristics of someone who has simply not had the right treatment or time for tissue recovery? Is the nature of my job consistent with my injury. If not, I would consider further medical work up…by a rheumatologist, psychologist, geneticst, etc…whatever that primary cause may be…it would require further discussion with your primary care physician.
Good luck
It is too long !!!!
First, let me say that I’m sorry to hear about how miserable you’ve been. It always takes a toll on you when you feel crummy and are limited by it.
I would strongly suggest you find another doctor. One you can really trust. If nothing else to get a second opinion. Because you can demand to have an MRI. It’s your health. And if it’ll make you feel better, the doctor should realize that and prescribe it for you. Tell him how crappy you still feel. Tell him you’re not ready to go back to work. And tell him you want to figure out what exactly is going on. If he’s still a dick about it, find someone else.
Ask around and get the name of another Orthpedic doctor, preferably one who specializes in your type of problem. Even if you have to go to the next town or city. Then go, take copies of your medical records and get a second opinion.
If you have told your doctors that you are still having problems and they won’t listen there’s no point in wasting your time with them. Doctors are just people and some people can be jerks.
I hope you get some help. Take care.