Is Elbow Tendonitis Causing
Your Elbow Pain?

Elbow Tendonitis is the most common source of elbow pain. Pain around the elbow can make every day activity such as writing, gripping, and even opening a door difficult. It can also keep you from enjoy recreational and athletic activities. What causes this common injury and what can you do to reduce your elbow pain?




What is Elbow Tendonitis?

Tendons are the soft tissue link between muscle and bone. In the elbow, a group of tendons are located on both the medial and lateral aspect of the elbow. The tendons on the medial or inside of the elbow work to flex the fingers and wrist as well as rotate the forearm. On the outside or lateral aspect of the elbow are the tendons that assist in extending the wrist and fingers.

The definition of tendonitis is simply an inflammation of a tendon. Although tendonitis implies inflammation, there is a growing body of evidence that the tendons themselves may not actually be inflamed. Therefore, tendon related pain may be described as tendinopathy.

What causes Tendonitis?

The most common cause of tendonitis is overuse. This overuse can be from excessive gripping of a golf club or tennis racquet or spending too much time at the computer. These activities can cause the tendons to work harder than they are accustomed to, resulting in localized inflammation or breakdown of the tissues. A less frequent cause of injury to these tendons is trauma to the area such as getting hit by a baseball. This type of injury is generally classified as acute tendonitis.


Types of Tendonitis

Elbow tendonitis can occur in the group of tendons on the medial or inner portion of the elbow or the lateral or outside aspect of the elbow.

The group of tendons located on the medial side of the elbow helps to flex the wrist and fingers and rotate the forearm from palm up to palm down. Tendonitis of this group of tendons is often referred to as golfer’s elbow. Pain generally occurs with activities involving gripping.

The lateral or outer group of tendons can also become inflamed. These tendons help to extend the wrist and fingers and rotate the forearm from palm down to palm up. Tendonitis of these lateral elbow tendons is also called tennis elbow.

In the lateral aspect of the elbow, it is common for the area in which the tendons attach to become inflamed more so then the tendons themselves. This bony attachment point is called the epicondyle of the elbow, thus the condition is referred to as lateral epicondylitis.


Typical Elbow Treatment

As with all joint related issues, treatment goals include first reducing inflammation, second restoring flexibility, and third restoring strength.

Since many elbow issues are related to overuse of the muscles/tendons, restricting painful activity is a key to elbow tendonitis treatment. If a specific sport or activity aggravates the pain, rest from that activity is a must. Another means of helping to rest the painful area is by using an elbow brace, specifically with lateral epicondylitis/tennis elbow. These braces function by minimizing pressure on the muscles of the forearm by taking strain off the epicondyle where the muscles attach.


Elbow Tendonitis Brace


If use of the computer is a common activity, pain in the lateral elbow can be directly related to wrist position at the computer. As the extensors of the wrist and fingers attach to the lateral aspect of the elbow, repetitive activity of these muscles with typing can perpetuate symptoms. Utilizing a wrist support for the keyboard minimizes the position of wrist extension, reducing the stress on the lateral elbow.


Ergonomic Keyboard


For golfers or tennis players, addressing equipment may be necessary. Often times changing the grip position and specifically in tennis adjusting the size of the grip on the racquet (generally a larger grip is better) can help reduce pain with gripping.

Because of the superficial nature of many of the structures surrounding the elbow, ice massage works well as a means of reducing inflammation and/or pain. Ice massage is performed by filling a Styrofoam cup with water and freezing it. Then, peel off the rim off the top of the cup, exposing the ice, and leaving the bottom for you to hold. Massage the ice directly over the painful area of the elbow for 5 minutes.


Elbow Ice Massage


If inflammation is a component to your tendon pain, oral or topical anti-inflammatory medications may be recommended (consult your doctor regarding medications). There are medicated anti-inflammatory creams such as Voltaren that are quite effective in treating these superficial tendon issues. Generally cortisone injections are not recommended into the tendon itself as these medications can weaken the tendon. Sometimes an injection into the local area, such as the epicondyle, instead of the tendon itself can be helpful if chronic inflammation is suspected.


Physical Therapy

Physical therapy can be an effective means of restoring elbow flexibility and strength. Modalities such as ultrasound, iontophoresis, shock wave therapy, and electric stimulation may all be helpful in reducing pain and inflammation. Manual soft tissue massage, specifically cross friction massage, can help to reduce the thickness that accumulates around inflamed tendons.

Elbow tendonitis can result in limited soft tissue flexibility. Stretching exercises for the elbow include both wrist flexion and extension stretches. While keeping the elbow straight, hold each stretch for 20 seconds and repeat a few times each.


Elbow Extensor Stretch

Elbow Flexor Stretch

As pain is reduced and muscle flexibility is improved, strengthening exercises can be initiated. Research suggests that doing high repetitions of eccentric exercises are generally the best form of strengthening for overcoming tendonitis. Thus a program of performing sets of 15 repetitions with an emphasis on lowering the weight slowly should be incorporated as part of the rehabilitation process.

For medial elbow tendonitis, wrist flexion strengthening and gripping activities using putty can be helpful for medial tendonitis. For lateral tendonitis, wrist extension and finger extension exercises can help regain lateral elbow strength.


Wrist Strengthening


Elbow tendonitis can be an annoying injury that can impact function for months. Follow these treatment recommendations and you’ll be on the road to reducing your elbow pain in no time.



References

J Orthop Surg Res. 2012 Mar 20;7:11. Extracorporeal shockwave therapy in musculoskeletal disorders. Wang CJ.

Zhongguo Gu Shang. 2011 Nov;24(11):969-72. Research advancement of the tennis elbow. Li ZY, Zhang L.

BMJ. 2011 May 10;342:d2687. doi: 10.1136/bmj.d2687. The management of tennis elbow. Orchard J, Kountouris A.

J Hand Surg Am. 2009 Mar;34(3):566-76. Elbow tendinopathy and tendon ruptures: epicondylitis, biceps and triceps ruptures. Rineer CA, Ruch DS.


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