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Elbow Tendonitis

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Physiotherapist working with a female patient with an elbow injury.

Elbow tendonitis is a medical condition involving inflammation of the tendons of the elbow. Medical practitioners sometimes alternatively refer to it as elbow tendinitis. Typical symptoms are pain in the elbow as well as stiffness and difficulty using the elbow to perform everyday tasks. The standard treatment of elbow tendonitis is to allow the tendons to rest and recover naturally. Icing, compression and the use of a tennis or golfers’ elbow brace may also form part of the treatment of elbow tendonitis.

Elbow tendonitis is an umbrella term for 2 more specific types of tendonitis. When the affected tendons are those connecting to the bony points of the elbow (the epicondyles), this is a special case of elbow tendonitis known as epicondylitis. If the injured tendons are adjacent to the bony bump on the lateral (outer) elbow, the condition is commonly referred to as tennis elbow. When they are adjacent to the bony bump on the medial (inner) elbow, the resulting condition is commonly referred to as golfers’ elbow.

This painful condition is one of the most prevalent non traumatic elbow injuries across all walks of life. The overall prevalence is somewhere between 1% and 3%  but it most commonly attacks individuals between the ages of 30 and 50.

Causes

Elbow tendonitis is almost always a repetitive stress injury instead of a traumatic one such as an elbow strain. This means that it develops over time and its victims usually cannot trace it to a single discrete event. In general, tendons connect muscles to bones and the elbow tendons connect the forearm muscles to the bony bumps on the inner and outer elbow. Overstressing the forearm muscles leads to irritation of elbow tendons and thus to elbow tendonitis.

Contributory Factors

The factors that can increase the risk of developing elbow tendonitis include :

  • Weakness of forearm muscles – the ones that attach to the epicondyle (bony point) of the elbow via the elbow tendons;
  • Imbalances between the strength of the forearm flexor and extensor muscles can also be a factor;
  • Repetitively rotating the forearm and thus overloading the elbow joint and its tendons by excessive wrist flexion and extension;
  • If the elbow tendonitis comes from playing a sport, it could be related to the use of unsuitable  equipment. For example, the racquet grip size may be too small, thus causing too much use of the wrist gripping muscles and therefore overloading the elbow joint;
  • Poor sports technique such as excessive use of the wrist in tennis strokes or failing to make proper contact with the ball. If contact is made in a way that sends too much vibration through the forearm muscles and into the elbow tendons, the result can be irritation of those tendons, leading to elbow tendonitis.

Although athletes in racquet sports are especially at risk of developing elbow tendonitis, they are by no means the only individuals that can suffer from the condition. Instead, it can affect anyone who regularly undertakes activities that require extensive use of the forearm flexor and extensor muscles to control wrist movements. For example, painting and gardening are two other activities that can lead to tennis elbow. In general, any activity that requires repeated and precise wrist movements can result in the type of elbow tendonitis known as tennis elbow (due to the extensive use of forearm flexor and extensor muscles to control the wrist).

The same applies to the type of elbow tendonitis known as golfers elbow – although it affects avid golfers, people involved in other activities can also suffer from it.

Symptoms Of Elbow Tendonitis

In general, elbow tendonitis symptoms include the following:

  • Pain and tenderness around the bony bumps of the elbow, or just below those points;
  • Elbow stiffness;
  • Reduced range of motion of the elbow joint (due to the stiffness);
  • Gripping weakness.

Treatment Of Elbow Tendonitis

As with most soft tissue injuries, there are generally two treatment options  for elbow tendonitis – conservative and surgical. In the overwhelming majority of cases, conservative (home based) treatments will be enough to resolve the condition.

Conservative Treatments

These treatments can be summarized using the acronym P.R.I.C.E.:

  • Protecting the elbow tendons from further irritation by wearing an elbow strap that presses on the forearm muscles and reduces the vibration of elbow tendons due to forces traveling up the forearm;
  • Resting the elbow in order to allow the irritated tendons to recover naturally. In practice, this means that the patient should avoid any activity that makes extensive use of wrist gripping forces or that require precise wrist movements. These will merely result in additional work for the forearm muscles and further irritation of the elbow tendons that connect those muscles to the epicondyles of the elbow;
  • Applying Ice or, alternatively, a cold compress, to the elbow. This will help to ease elbow pain and reduce any inflammation that may have been caused by the irritation of the elbow tendons For best results, the patient should apply the ice or cold compress every 2-3 hours about 5 to 6 times a day;
  • Applying Compression to the elbow tendons by wearing an elbow sleeve. This compression will help to increase blood circulation through the elbow region. Alternatively, the patient can use a tensor bandage for the same purpose. An increased supply of fresh blood and its nutrients will help to heal the injured tendons more quickly than would otherwise be the case. An elbow sleeve with strap will both protect the elbow tendons and apply compression to them, thus “killing two birds with one stone”;
  • Whenever possible, keeping the elbow elevated above heart level. As with compression, this will help to improve blood flow through the elbow and will also help to reduce any swelling that may be present.

Additional Conservative Treatments

In addition to the use of ice or a cold compress as stated above, a doctor may suggest the use of anti inflammatory medications if the pain and inflammation are especially severe.

If these measures do not ease the elbow tendonitis after approximately 2 weeks, the patient should seek further medical advice. A doctor will be able to conduct an examination and suggest other treatment options including surgery.

Surgical Treatment

As we have mentioned above, if the home based conservative approach fails to ease the elbow tendonitis, surgery is another option.

The goal of surgical treatment will be to surgically release the elbow tendons from the epicondyle bone of the elbow. This will allow the removal of scar tissue and other by products of the injury to the tendons.

Rehabilitation

This is a critically important part of the healing process. The patient will need to work with a physical therapist (ideally one trained in sports medicine) to strengthen his or her elbow muscles and tendons. To do this, the physiotherapist can design an exercise program that includes stretching exercises for the elbow, fingers and wrist.

Successful completion of a physical therapy program will allow the patient to return to his or her previous activities with less risk of recurrence of elbow tendinitis.

Prevention Of Elbow Tendonitis

To help prevent a return of the condition, the patient can work with a sports coach or occupational therapist who can evaluate his or her technique in performing the actions that may have led to the tendonitis in the first place. The equipment (sporting or otherwise) used to perform the activity can also be evaluated.

The patient can then receive advice as to changes in his or her technique or equipment that, together with the other measures described above, can help to prevent a return of his or her elbow tendonitis.

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