Elbow tendonitis (or tendinitis) is one of the more common non traumatic injuries that we experience in everyday life. Victims will experience pain in the elbow joint and stiffness of the joint. In some cases, they will also experience gripping weakness. Elbow tendonitis is, in almost all cases, treatable at home using the traditional R.I.C.E. (Rest, Icing, Compression and Elevation) strategy. Only in the most severe and persistent cases are doctors likely to consider surgical treatment.
Elbow tendonitist is a result of irritation and inflammation of the tendons that connect forearm muscles to bones of the elbow.The term is actually an umbrella expression that spans two names that represent the main types of this injury – tennis elbow and golfers elbow.
To understand the causes of this injury, it is first necessary to understand a little about the anatomy of the elbow and forearm.
The forearm has two primary muscle groups known as the flexor and extensor muscles. The flexor muscles run along the inside of the forearm. They attach to the elbow by means of tendons that connect to the bony prominence on the inside of the elbow. The flexor muscles are responsible for wrist flexion (i.e. bending of the wrist).
The extensor muscles run along the outer forearm. They attach to the elbow by way of tendons that connect to the bony bump at the outside of the elbow. These muscles are responsible for wrist extension (i.e. straightening of the wrist joint).
The forearm muscles are also responsible for gripping forces applied by the hand.
Causes Of Elbow Tendonitis
Broadly speaking, elbow tendonitis is the result of any activity that requires extensive and precise wrist movements and/or extensive use of gripping forces. These activities make demands of the forearm muscles which, in turn, places stress on the tendons that connect these muscles to the elbow. The result is irritation of those tendons and, in many cases, inflammation around them. In the most serious cases, the flexor and extensor tendons may actually have tiny tears in them, further contributing to the inflammation that is present.
Irritation of the (lateral) tendons at the outside of the elbow leads to lateral epicondylitis (tennis elbow). On the other hand, irritation of the tendons of the inner elbow leads to golfers elbow (medial epicondylitis).
Which Activities Cause Elbow Tendonitis?
Many cases of elbow tendonitis are caused by excessive playing of tennis and golf. However, these sports are by no means the only activities that can cause the condition. Many other racquet sports require the use of gripping forces and can therefore cause this type of tendonitis. Even sports like baseball or cricket can give rise to elbow tendonitis if the grip of the bat is too small and requires excessive use of gripping forces.
Non sporting activities like gardening, painting or even writing can give rise to this condition. They all require extensive use of the wrist to perform finely controlled movements as well as the application of a firm grip.
As we mentioned at the beginning, elbow tendonitis can cause severe pain and tenderness at or near the elbow joint. It can also result in:
significant difficulty in bending the elbow and therefore cause a reduction in the range of motion;
Pain radiating along the forearm from your elbow to your hands;
Gripping weakness due to the injured state of your flexor tendons.
Treatment Of Elbow Tendonitis
In the vast majority of cases, elbow tendinitis is treatable at home without the need for surgery. Despite this, if you suspect that you have a case of this condition, you should first consult with a doctor for medical advice. Your doctor will be able to confirm (or otherwise) that you have elbow tendonitis and to make a decision on the most appropriate treatment options..
If your doctor confirms that you have elbow tendonitis and opts for a home based conservative treatment, this will involve:
Rest – i.e. try to avoid activities that may stress your forearm muscles. These would involve activities such as those we have mentioned above e.g. tennis, golf, painting, etc.
However, rest would also in general require avoidance of any activities that would involve extensive wrist movement or the application of high gripping forces. Allowing the forearm muscles (and their corresponding tendons) to rest will help to promote their recovery.
To further allow the tendons to rest, consider wearing an elbow strap. It will reduce the vibrations travelling up along the forearm and affecting the elbow tendons. For example, the impact of hitting the ball in tennis or golf produces these vibrations and further stresses the elbow tendons;
Apply ice or a cold compress to the elbow (or the region just below it, where the elbow tendons are) to reduce pain and inflammation. For best results, do this for periods of 20-30 minutes at a time and no less than 6-7 times a day.;
Apply compression to the elbow joint. It will help to increase blood circulation through the elbow regions and that will in turn accelerate the healing process. You can apply compression by wearing an elbow sleeve or a tensor bandage;
Try to keep your elbow elevated above heart level as much as possible, as that too will aid blood circulation.
In addition to the use of ice or a cold compress, your doctor may be willing to prescribe an anti Inflammatory medication such as ibuprofen. You should consider this option, however, only if your pain and inflammation are unusually severe.
Other Conservative Treatments
Other elements of a home based treatment program may include:
Gently flexing and extending the wrist several times a day. These stretching exercises will help to stimulate the inflamed tendons. You should hold each stretch for around 30 seconds and then repeat 3 times.
Rub the injured tendons (just below the elbow) 3 to 4 times daily in order to break down any scar tissue that may have accumulated.
What To Do If Your Symptoms Do Not Improve
If your tendonitis symptoms do not improve after 2 weeks of conservative treatment, you should seek another appointment with your doctor for an updated medical opinion. This will give your doctor an opportunity to consider whether surgery may be an appropraite option to treat your injury.
If your elbow tendonitis does not respond to conservative treatment, your doctor may suggest surgery as an option. The surgeon will try to remove the injured portion of the tendon and then reattach the remaining healthy portion to the adjacent bone.
An essential part of the healing process will be referral to a physical therapist (ideally one with a sports medicine background). He or she can devise an exercise program to stretch and strengthen the forearm muscles and tendons.
The purpose of this physical therapy will be to better prepare the forearm muscles for your regular program of activities. This will allow you to continue with those activities with less risk of recurrence of elbow tendonitis.
If your elbow tendonitis is associated with a sports activity, you should consider working with a coach. He or she can check whether there is any aspect of your technique or equipment that may be improved.
For example, tennis players may find that changing their racquet grip size may reduce the pressure on forearm flexor and extensor muscles by requiring less gripping force.
As another sports related example, you may be encouraged to use a less stiff racquet frame. Such a frame will absorb more of the impact of striking the ball. As a result, there will be fewer vibrations traveling along the forearm muscles and irritating the elbow tendons.
Even if your elbow tendonitis has a non sports related cause, an occupational may be able to recommend changes to your equipment. The purpose of these changes will be to help reduce the risk of return of this painful condition.