Tennis Elbow with Macy Stonner

Chuck and Chris are joined by podcast regular Macy Stonner to discuss tennis elbow. Macy shares therapy perspectives on 'LET'.  We also hear about about therapy for free functioning muscle transfers.

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Transcript

Podcast Plans: Rehab and Research

The group discussed upcoming podcast content focused on rehab protocols and approaches to lateral epicondylitis/tennis elbow, with Macy sharing her project on disseminating rehab protocols including free functioning muscle transfer. They reviewed a 5-star listener feedback from Erin Smith in Dallas requesting a show about tetraplegia, tendon transfers versus nerve transfers, which could feature Alan Peljovic as a guest. The discussion concluded with plans to have Dr. Lindley Wall on the podcast to discuss the upcoming ASH annual meeting in Vancouver, where Macy will be presenting as faculty.

Tennis Elbow Evaluation and Treatment

Charles and Macy discussed the evaluation and treatment of lateral epicondylitis, also known as tennis elbow. They outlined the importance of identifying the source of pain, conducting specific physical exams, and providing appropriate treatment options to patients. Macy emphasized focusing on exercises for the lateral side unless there are clear complaints of pain on both sides. The conversation also touched on the potential for patients to have related conditions like cubital tunnel syndrome or radial tunnel syndrome.

Lateral Epicondylitis Treatment Discussion

The discussion focused on the treatment and diagnosis of lateral epicondylitis, with Macy and Charles agreeing that physical therapy is the most effective approach. Macy explained that while there are limited exercises suitable for this condition, most patients require 3-4 visits for proper instruction and monitoring. Charles outlined the key diagnostic points, including lateral epicondyle tenderness, radial tunnel involvement, and intra-articular pain, while Christopher emphasized the importance of examining from distal to proximal to avoid causing pain that might distract from the exam.

Elbow Pain Treatment Options

Charles and Macy discussed treatment options for a patient with elbow pain. Macy recommended starting with a combination of therapy, an orthotic device, and anti-inflammatory medication. She explained that a wrist brace can be helpful for patients with resting pain, as it helps calm the brain and reduce repetitive motion. For more severe cases, Macy might consider a counterforce strap. The discussion also touched on the importance of educating patients about the connection between wrist motion and elbow pain.

Conservative Treatments for Epicondylitis

Macy discussed the use of counterforce braces for patients with epicondylitis, explaining how they can help cue patients not to engage certain muscles too strongly by providing resistance. She emphasized the importance of conservative strategies, including activity modification, proper lifting techniques, and ongoing exercise, even after corticosteroid injections or surgery, as recurrence is common. Charles and Christopher agreed that injections and surgery should be considered only when conservative treatments have failed, with the goal of facilitating better therapy and preventing recurrence.

Tennis Elbow Treatment Options Discussed

The group discussed PRP injections for tennis elbow, with Charles noting that while insurance rarely covers them, they can cost between $750 and $1,200 out-of-pocket. They explored surgical options, with Charles explaining his approach of debriding unhealthy ECRB fibers through an arthroscopic or open procedure, while Christopher shared that he only performs surgery when necessary and often includes radial tunnel treatment. Macy outlined her post-surgical rehabilitation protocol, emphasizing gentle active range of motion exercises and pain management, with a focus on avoiding excessive grip strengthening.

Muscle Transfer Rehabilitation Guidelines

Macy discussed her work on a case report about free functioning muscle transfer rehabilitation, which provides guidelines for managing patients post-surgery, including exercises, splinting, and precautions. She noted the lack of existing literature on rehabilitation for this procedure, highlighting a 2022 systematic review that found no rehabilitation information in the 39 articles published since 1981. Christopher and Charles expressed interest in the project, and Christopher mentioned their ongoing collaboration on a paper.

Nerve Transfer Surgery and Rehabilitation

Macy, Christopher, and Charles discussed nerve transfer surgeries and rehabilitation protocols. They addressed common questions from patients about stretching and splinting after surgery, emphasizing the importance of maintaining a specific range of motion to optimize muscle function. Macy and Christopher highlighted the benefits of using the spinal accessory nerve as a donor site over intercostals, citing better volitional control and more intuitive exercises. They also mentioned a new clinical manual on nerve transfers that Macy and her colleagues are developing to serve as a comprehensive resource for surgeons, surgical trainees, and therapists.

Nerve Transfer Rehabilitation Book Release

Macy, Charles, and Christopher discussed the upcoming release of a book on nerve transfer rehabilitation, which is already listed on Amazon with an October 17th release date. Christopher explained his role in securing a book deal with Springer for Lorna and Macy, highlighting the book's comprehensive content, including illustrations and exercises for therapists. Charles praised the work and predicted the book would be widely sought after, mentioning his own self-published therapy protocols. Macy clarified the book's title and encouraged listeners to pre-order it on Amazon.