Patient Information Resources

Alpine Physical Therapy
Three Locations
In North, South, and Downtown Missoula
Missoula, MT 59804
Ph: 406-251-2323
Fax: 406-251-2999

Child Orthopedics
Pain Management
Spine - Cervical
Spine - General
Spine - Lumbar
Spine - Thoracic

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With limited health insurance, I'm trying to pick and choose carefully what tests and treatments I have for my elbow pain. We are trying to sort out what's causing the pain: neck or elbow? Tests done in the doctor's office haven't been able to answer the question. And I don't want surgery if I don't need it. What do you recommend?

Without knowing where the pain is located and what tests have been tried, this is a little difficult to answer. There are specific tests for suspected tennis or golfer's elbow. Tennis elbow typically presents with pain along the outside of the elbow. Golfer's elbow (also known as pitcher's elbow) tends to show up as pain along the inside of the elbow. Your history, along with a postural assessment, palpation, muscle testing, and motion testing (joint and nerve mobility) direct further testing if needed. Sometimes there is enough information gained from these tools to direct the initial treatment. A hand therapist is often involved at this point, providing rehab to resolve the symptoms and restore full pain free function. The therapist's treatment is somewhat diagnostic. If there is no improvement with conservative care, then it may be necessary to conduct additional tests. Electrodiagnostic testing including nerve conduction velocity (NCV) or electromyography (EMG) are used to see what's going on with the nerves causing the painful symptoms. These tests also help pinpoint the location of the problem. Imaging studies can also be helpful. Plain X-rays help show if there are any structural reasons for the symptoms such as tumors, bone spurs, or even disc protrusion in the neck pressing on the nerves. Cervical spine degeneration with or without disc involvement can produce painful elbow problems whenever the spinal nerve roots are pinched or impinged. MRIs are also diagnostic. The images can confirm (or rule out) cervical radiculopathy (the medical term for pinched nerve in the neck). Most surgeons take a step-by-step approach in ordering tests. Everyone is interested in reducing health care costs. By letting your physician know of your situation, the most conservative, yet appropriate tests can be ordered as needed.


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