Chronic shoulder and elbow pain can be difficult to treat because of the nature of the underlying cause. Most commonly, this is caused by a type of tendonosis. Tendonosis is different than tendonitis, which refers to tendon inflammation. When the tendon pain is chronic the inflammation has come and gone and left behind a tendon with areas of degeneration. This does not mean that the tendon is almost falling apart, but that some parts of the tendon have lost their normal collagen architecture and have filled in with areas of abnormal tissue that is similar to scar tissue. These areas are painful and do not respond well to anti-inflammatory medications. Many other treatments are helpful, but there is not one that is always successful. Relative rest is a good place to restart. Physical therapy is often helpful. Stretching, range of motion, and eccentric strengthening are mainstays. Another type of treatment that is helpful goes under trade names like Graston or ASTYM. These are types of deep massage using metal or plastic tools to break up scar tissue and incite inflammation. The theory is that this inflammation may start the body’s own repair process so that the degenerative tendon can be repaired. Some providers use slightly different techniques like ART.
Injections are sometimes used to either increase inflammation or add growth factors to injured tendon. Platelet Rich Plasma (PRP) is one of these techniques. In PRP blood is drawn from the patient and then the platelets and growth factors are removed and concentrated for injection into the injured tendon. A few providers are even harvesting a person’s own stem cells from their bone marrow and injecting them. Many patients have good results, but large, quality studies are lacking.