Keep Your Elbow In The Game: A Case Of A Pickleball Player's Pain

HISTORY: A 58-year-old right-handed female pickleball player presented to our sports medicine clinic with recurrent right lateral elbow pain. A year ago, she developed sharp pain at the right elbow while playing pickleball and was diagnosed with lateral epicondylitis at a separate sports clinic. Pain resolved after a lateral epicondyle steroid injection six months ago. Pain slowly returned, so she presented to our clinic for re-evaluation. Pain was now achy and non-radiating. Worse with opening bottles, turning a steering wheel, and push-ups. Better with rest. Playing pickleball did not change symptom severity. Denied any trauma, bruising, swelling, numbness, tingling, or hand weakness. PHYSICAL EXAMINATION: Bilateral upper extremities had full strength, intact sensation to light touch and pinprick, 2+ reflexes. Negative Hoffman’s. Tenderness to palpation (TTP) over the right lateral epicondyle and in the region just inferior. No TTP over the radiocapitellar joint. Full elbow extension, supination, and pronation. Pain with overpressure on right elbow extension and flexion. No pain or laxity with varus or valgus stress. Pain with right elbow resisted wrist and finger extension, and passive wrist flexion. DIFFERENTIAL DIAGNOSIS: 1. Lateral epicondylitis 2. Forearm extensor tendon partial tear 3. Anconeus muscle tear TEST AND RESULTS: Right elbow anterior-posterior, lateral, and oblique x-rays: No acute bony abnormality, joint dislocation, or bone lesions. Right elbow bedside ultrasound: Chronic tendinopathic changes with calcification within the finger extensor tendons and triceps tendon. Right elbow MRI without contrast: Common extensor tendon origin high-grade undersurface tear. Full-thickness radial collateral ligament tear. FINAL WORKING DIAGNOSIS: Common extensor tendon tear, concomitant radial collateral ligament tear TREATMENT AND OUTCOMES: 1. Pain improved 50% after four weeks of eccentric and concentric strengthening. Continued home exercise program with stable symptoms. 2. Orthopedic surgery consultation for ligament reconstruction; patient opted for conservative management. 3. Remains limited with wrist twisting but utilizes adaptive equipment like a two-handed jar opener. 4. Continues baseline frequency of playing pickleball twice a week with a counterforce brace.