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My daughter has been dealing with an elbow pain on and off…

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My daughter has been...

My daughter has been dealing with an elbow pain on and off for 2 years. she is 14. @ 12 she was diagnosed with Plica and given a cortisone injection. Her pain dissipated. She went 1 year almost to the day essentially pain free. Her pain started again after almost 1 year to the day she was given another cortisone injection. Her pain started to decrease; however, it returned and worsened. She has been having pain in various rated levels since 09/16. We have had US, MRI's (x2), xrays, EMG's, acupuncture, PT, OT, ART, chiropractics, OTC rx; nothing has been revealed diagnostically to explain the pain. She has been seen by multiple doctors with a dx of lateral epicondylitis having been given but another doctor saying it isn't lateral epicondylitis. Overuse injury has been offered as a dx as well. Our daughter is a swimmer. We desire a confirmed dx, a resolve, a pain free daughter without having to quit what she loves. Can you assist?

Doctor's Assistant: What seems to make the symptoms worse or better? Have you noticed any swelling?

No swelling. Active Release Therapy. Ice. She did take 43 days off from swimming and any active 14 year old life activities. Although she had significantly decreased pain, the episodes of being pain free were intermittent.

Submitted: 10 months ago.Category: Neurology
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10/4/2017
Neurologist: drphophalia, Other replied 10 months ago
drphophalia
Category: Neurology
Satisfied Customers: 39,142
Experience: Regularly deal with musculoskeletal neurology, spinal issues, bowel and bladder dysfunctions etc.
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Welcome to Just Answer.
Answers here are for education and information.
I will respond shortly with an answer, or further information request.

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Neurologist: drphophalia, Other replied 10 months ago

Her recurrent and intermittent pain is suggestive of lateral epicondylitis. It is common in swimmer's. An MRI can miss the subtle changes of following;

1) tendons

2) bursa

3) Ligaments

4) muscles

5) joint inflammation

A combination of issues which are subtle and cannot be caught by the modern medical imaging happens many times. Diagnosis is a man made entity. Nature presents in combination of issues which may not be definable occasionally.

The treatment which can be helpful is a combination of;

1) Autologous platelet injection

2) Acupuncture

3) Physical therapy; initially stretching exercises only. Later against resistance exercises and exercises with weight should be added very slowly. A brace all the time for first three months would also be recommended.

4) Deep electrotherapy; iontophoresis / phonophoresis

5) Shock wave therapy.

Please feel free for your follow up questions.

I would be happy to assist you further, if you need any more information.

Thanks for using Just Answer.

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Neurologist: drphophalia, Other replied 10 months ago

Was this information helpful to you? I would be glad to answer any further questions.

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Neurologist: drphophalia, Other replied 10 months ago

Was this information helpful to you? I would be glad to answer any further questions.

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Customer reply replied 10 months ago
No. When I sent this question it was in hopes of soliciting a potentially different diagnosis/answer than we have received from EVERY physician we have visited.
Neurologist: Dr. David, Board Certified MD replied 10 months ago
Dr. David
Dr. David, Board Certified MD
Category: Neurology
Satisfied Customers: 50,194
Experience: Experienced physician in Neurology
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This is Dr. David

when your daughter takes a break from swimming, does her elbow pain get better?

what strokes does she swim? all of them? does any certain strokes worsen her elbow pain?

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Customer reply replied 10 months ago
Some relief, yes. She took a 43 day break this past summer & it did decrease the pain but did not completely erase it. Of note, her break was from everything; we limited her complete use of her right arm, which by the way is her don arm.
Breast stroke is her favorite stroke. She was going the direction of, and would like to resume, being an IMer. However, she is finding that the fly is a aggravating to her as well. Back & free don't bother it as much but she still says it hurts.
Neurologist: Dr. David, Board Certified MD replied 10 months ago

she has had 2 MRI scans?

did she have a 3 tesla closed high definition MRI scan.

most MRI scanners are are 1.5 telsa magnet strengthen and may not see a small hairline fracture or tendonitis inflammation of the tendons.

did the MRI scan see the plica?

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Customer reply replied 10 months ago
I don't know what type of MRI' were performed. Her 1/7/15 MRI revealed an anconeus epitrochlearis muscle, inconsistent medial subluxation of the ulnar nerve over the medial epicondyle with multiple trials of elbow flexion.
2/11/15 real time ultrasound of R ulnar nerve @ elbow performed to compare with 1/7/15 MRI. Findings: an anconeus epitrochlearis, which is an anatomical variant, superficial to the ulnar nerve within the cubital tunnel. The ulnar nerve was relatively uniform in size and shape both proximal to, within, and distal to the cubital tunnel.
6/17/15, dr visit dx'd with plica & being globally hypermobile
6/2/15 = XR Arthrogram R elbow (with MRI part 1of 2)
9/22/15 = X-RAY guided joint injection
Worked. Clicking gone, pain gone, approximately 8-10 months. Still swimming
9/26/16 = X-RAY guided joint injection
Started to work, then stopped.
Swimming changed to kicking, progressively decreasing yardage and competitions
11/18/16 = cortisone injection trial; no relief.
12/6/16 = 2nd MRI; findings: good capsular distinction with contrast. No evidence of any bone bruises or fractures. No osteochondral lesion. Common tendon insertion of the flexor and extensor muscles have a normal appearance with no evidence of any inflammation or tear. The biceps and brachioradialis tendons are intact. There is a normal appearance of the triceps tendon. The annular ligament is intact. There is no evidence of any intro articular loose body. There is no evidence of any musculotendinous junction tear
Dec 2016/Jan 2017 = EMG conducted; no erroneous findings
4/27/17 = consultation for prylotherapy; dr conducted US & said no lat epicondylitis. Not a candidate for prylotherapy
Neurologist: Dr. David, Board Certified MD replied 10 months ago

I see it sounds like that steroid injection decreased inflammation in the area and helped decrease pain for 1 year which means inflammation in the elbow joint is causing her pain

exercise and repeated muscle movements will increase inflammation there

ice and rest will decrease inflammation in the elbow.

has she tried a compression sleeve when she is out of the water to help protect the elbow and compress muscles and decrease swelling?

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