Tendonitis elbow, is a condition in which the tendons, supporting the elbow joint get inflamed. This is an inflammatory condition, which causes swelling, pain in the area around the elbow joint and makes it difficult to move the elbow or lift weights in the hands.
Tendons are flexible, tough bands made up of fibrous tissue that help in supporting and movement of the muscles of the elbow. When tendons of the elbow joint get irritated, inflamed, they result in micro tears, which may be difficult to heal and results in tendonitis elbow.
Understanding the structure of the elbow joint can help in getting a picture of the location of tendons of the elbow and about tendonitis elbow.
Structure of the Elbow Joint
Elbow joint is where the bones of the arm and the forearm meet, to form a hinge joint that gives free movement of the hand and the elbow. The elbow is supported by many muscles, and ligaments around it. There are soft tissue structures called tendons, which connect the muscles to the bones of the elbow joint. Muscles of the elbow help in making movement of the hands, wrists and fingers.
The main muscles of the elbow are the triceps, at the back of the arm and the biceps, in the front of the arm, which help to bend and straighten the elbow joint. The muscles of the elbow that help in movement of forearm, wrist and fingers include:
Extensors – These are attached to the outer side of the elbow or the lateral side. The extensor muscles enable straightening or extending of the wrists and fingers of the hand.
Flexors – These are attached to the inner side of the elbow or the medial side. The flexor muscles enable bending of the wrists and fingers of the hands.
While there are many tendons around the elbow joint, the important ones include those connected the main muscles. These are:
Extensor tendons – These attach to the extensor muscles of the forearm o the outer or lateral side of the elbow joint. The bony prominence on the outer side of the elbow is called the lateral epicondyle. The extensor tendons help to straighten the elbow.
Flexor tendons – These attach to the flexor muscles of the forearm on the inner or medial side of the elbow joint. The bony prominence on the inner side of the elbow is called the medical epicondyle. The flexor tendons help to bend the elbow.
What is Tendonitis Elbow?
Inflammation of any of the tendons supporting the muscles of the elbow can result in tendonitis elbow and affects the movements of the elbow joint. The term tendonitis means inflammation of a tendon and is commonly used in case of an acute injury to the tendons of elbow causing swelling or sometimes may also be a result of repeated injuries.
What are the Causes of Tendonitis Elbow?
Tendonitis elbow are a result of injuries commonly noticed in sportspersons, using racquets, bats, etc. or those involved in adventure sports, to make forceful movements of the hands, which exerts great pressure over the elbow joint. These are also commonly seen in people who use their hands for repeated activities at work or for recreation.
Common causes of tendonitis elbow include:
- Overuse – Repeated use of the elbow tendons resulting in small injuries and inflammation of the tendons; it can strain the soft tissues around the elbow joint resulting in tendonitis elbow.
- Overload – Lifting of weights in the hands or sudden increase in the activity levels using elbow joint, intense involvement in sports, etc. can increase the workload on the elbow joint, increasing the risk of tendonitis elbow.
- Infection – Sometimes inflammation of the tendons or tendonitis elbow can be result of certain infections like gonorrhea or some viral infections.
- Certain medical conditions like diabetes, arthritis, rheumatoid arthritis, some autoimmune or connective tissue disorders etc. may increase the risk of tendonitis elbow in some people. Some researchers are considering the involvement of certain medications in causing inflammation of tendons in tendonitis elbow.
The common conditions noted in tendonitis elbow include:
- Tennis Elbow – This is a condition of tendonitis elbow, in which the extensor tendon on the outer side of the elbow is inflamed, causing pain and stiffness on the outer side of the elbow and forearm.
- Golfer's Elbow – This is a condition of tendonitis elbow, in which the flexor tendon on the inner side of the elbow is inflamed, causing pain and stiffness on the inner side of the elbow and forearm.
Tendonitis Elbow in Tennis Elbow
Tennis elbow is a common term given to the inflammation of the tendon attached to the elbow joint on the lateral or the outer side, causing tendonitis elbow. Tennis elbow is medically termed as lateral epicondylitis, which is a painful condition and a type of tendonitis elbow. In this type of tendonitis elbow, the muscles of the forearm and the tendons on the outer side get damaged and inflamed, which leads to pain, swelling and tenderness around the outer side of elbow.
Causes of Tendonitis Elbow in Tennis Elbow
Tennis elbow, being a form of tendonitis elbow, occurs due to similar causes in addition to certain specific conditions causing damage to the extensor tendon. Some causes include:
- Overuse injury – The muscle of the forearm, extensor carpi radialis brevis (ECRB) is involved in straightening the elbow and stabilizing the wrist. Sports like tennis and other games or work related activities that involve forceful movements of the hands or repeated bending and straightening of the elbow, can cause injury to the extensor tendon. Injuries in tendonitis elbow can be of acute type or may be due to overuse and repeated strain on the already injured tendon. Acute injury to the tendon and repeated wear and tear can cause inflammation of the extensor tendon, resulting in pain and swelling on the outer side of the elbow joint. Tendonitis elbow can be a result of acute trauma to the tendons or gradual repeated overuse injury.
- Occupations – Certain activities are known to increase the risk of tendonitis elbow, due to the nature of work, which involves using the tendons of the elbow joint. People involved in hand related activities or recreational activities that require regular twisting, repetitive and forceful movements of the forearm muscles can be at risk of tennis elbow type of tendonitis elbow. Occupations like cooking, painting, plumbing, machine workers or work involving typing can increase the risk of injury to the lateral tendons.
- Others – While tennis elbow and tendonitis elbow can affect at any age, people in their middle ages between 30 to 50 years may be more commonly affected.
Certain factors can increase the risk of injury to the lateral tendon causing tendonitis elbow include:
- Presence of previous injury to the elbow joint, ligaments, tendons or other soft tissues.
- Weak shoulder or wrist muscles and other joint conditions
- Awkward positions of the hands or improper techniques of using the hand in sports or work related activities.
- Repeated activities with forceful exertion, overhead reaching, excess bending and straightening of the elbow joint and activities involved with overhead reaching.
Sometimes, inflammation of the tendons in tendonitis elbow can occur without any specific cause.
Symptoms of Tendonitis Elbow in Tennis Elbow
Symptoms of tendonitis elbow in tennis elbow may develop gradually; symptoms may be mild in the beginning and continue to worsen over a period of time. The main symptom of tendonitis elbow when the lateral tendon is damaged includes pain in the outer side of the elbow and forearm. There may be repeated pain in the elbow extending to the forearm on the outer border of the hand in tendonitis elbow.
Pain may be worse on straightening or extending the forearm, grasping objects or lifting heavy objects. Sharp pain on the outer side of elbow may be felt while performing the activities or after doing it. Using the wrists and twisting activities may be painful. Rest may help relieve pain or sometimes dull pain may be present even at rest. Tendonitis elbow is in general a painful condition with inflammation and palpable swelling at the outer end of the elbow.
Sometimes, numbness and tingling may be felt in the hands or fingers, if a nerve passing through the elbow joint, is compressed. Burning pain on the outer part of the elbow and forearm can be felt. The grip and strength may worsen, making it difficult to hold objects and use the elbow joint effectively.
While tendonitis elbow can occur in either or both the elbows, mostly the dominant hand may be more commonly affected.
Tendonitis Elbow in Golfer's Elbow
Golfer's elbow is a common term given to the inflammation of the tendons attached to the elbow joint on the medial or the inner side, causing tendonitis elbow. Golfer's elbow is medically termed as medial epicondylitis, which is a painful condition and a type of tendonitis elbow. In this type of tendonitis elbow, the muscles of the forearm and the tendons on the inner side get damaged and inflamed, which leads to pain, swelling and tenderness around the inner side of elbow.
Causes of Tendonitis Elbow in Golfer's Elbow
Golfer's elbow, being a type of tendonitis elbow, occurs due to similar causes in addition to certain specific conditions causing damage to the flexor tendon. The condition commonly results from repeated strain or excess force due to movements of wrists and fingers. Some causes include:
Injury – Injury to the muscles and tendons of the forearm, during sports that involve forceful movements of the hands like in golf, racquet sports or games involving forceful throwing of objects like in baseball, archery or javelin throwing.
Lifting Heavy Weights - Lifting weights, particularly in awkward position or with improper techniques, holding heavy objects in an incorrect manner can cause damage to tendons on the inner side of the elbow resulting in tendonitis elbow.
Repetitive strain – Performing repetitive activities that need repeated flexing of the wrist, swinging, rotating or twisting the arm, can exert excess pressure on the tendon on the inner side, thus increasing the risk of tendonitis elbow. Recreational activities, painting, use of machines and tools too can be contributing factor to cause damage to the flexor tendon in tendonitis elbow.
Some studies also suggest that damage to the flexor tendon in tendonitis elbow can occur due to degenerative changes in the tissues around the medical epicondyle or the inner end of the elbow joint.
Symptoms of Tendonitis Elbow in Golfer's Elbow
Symptoms of tendonitis elbow in golfer's elbow may develop suddenly or gradually depending on the cause. Symptoms may be mild in the beginning and continue to worsen over a period of time. The main symptom of tendonitis elbow when the medial tendon is damaged includes pain on the inner side of the elbow, which can extend to the forearm. Pain and tenderness is present on the medial or inner side of the elbow.
Pain may worsen on bending and straightening the elbow. Stiffness is often felt in and around the elbow. Using the fingers, wrist and making a fist maybe painful. Pain may aggravate on grasping objects or lifting heavy objects. Sharp pain in the inner side of elbow may be felt while performing the activities involving the wrist and fingers. Using the wrists and twisting activities may be painful. Rest may help relieve pain or sometimes pain may be there at rest even. Tendonitis elbow can present with a palpable swelling at the inner end of the elbow.
Weakness may be felt in the hands and the wrists, making it difficult to perform routine activities. Activities that require squeezing, pinching, turning door knobs, using the wrist to swing a bat or flexing the wrist may be difficult and painful.
Sometimes, numbness and tingling may be felt in the hands or fingers, if a nerve passing through the elbow joint is compressed. Burning pain on the inner part of the elbow and forearm can be felt. Numbness and burning sensation can extend up to the fingers, particularly the ring finger and pinky, as the course runs on the inner side of the forearm.
How is Tendonitis Elbow Diagnosed?
Tendonitis elbow pain and swelling can resemble other conditions, hence a proper diagnosis is important to plan appropriate treatment. History and clinical examination can reveal a great deal of information, which can help in deciding the necessary investigations. Any history of injury, fall or accident, repeated use of hands, occupation of the person, recent infections, surgeries, other medical illnesses and history of medications is taken. Any history of rheumatoid arthritis, nerve disorder or previous ailments related to this is important.
Clinical examination in tendonitis elbow includes assessment of the elbow pain, degree of severity of elbow pain and range of motion of the elbow joint. Swelling and tenderness is noted around the elbow joint. Various clinical tests are used during clinical examination for tendonitis elbow. Tendonitis elbow can be suspected when a person has elbow pain on trying to make different movements of the hands, wrists and fingers against resistance as performed by an expert.
Some of the investigations done to diagnose tendonitis elbow include
Blood tests – These are done to rule out other forms of arthritis, inflammatory joint conditions and possibility of infections. Otherwise, there are no blood tests that can detect tendonitis elbow.
X-ray – X-rays give an idea of the bones of the elbow joint. They are used to rule out fractures in case of suspected injuries, degenerative changes and rule out other forms of arthritis.
MRI – MRI gives an idea of the soft tissues around the elbow joint. Depending on the clinical examination, MRI of a particular area may be ordered. If the physician suspects involvement of the neck or cervical spine, an MRI can help to detect the spinal vertebrae, arthritis, degenerative disorders of the cervical spine, intervertebral disc protrusion or herniation, injury and any damage to the nearby structures, nerves and soft tissues. As these problems too can cause elbow pain of referred type and nerve compression symptoms, it is important to rule them out.
EMG – An electromyogram (EMG) is done to rule out nerve compression conditions as the symptoms of tendonitis elbow may be similar to nerve compression.
How is Tendonitis Elbow Treated?
Treatment of tendonitis elbow mainly includes conservative treatment, which also includes resting the elbow joint.
Pain Management in Tendonitis Elbow
In acute attacks of elbow pain due to tendonitis elbow, pain management aims at reducing the pain and swelling in the elbow joint.
- Rest - Rest is an important factor in the recovery process of tendonitis elbow. As repeated injuries, stress and strain on the inflamed tendons can cause more elbow pain and damage, resting the elbow joint is essential. Sportspersons, need to take a break from their sports and so should others involved in occupations that can hurt the elbow more in an already inflamed state.
- Braces - Sometimes, light compression of the elbow joint can help in reducing the swelling and also allows the joint to rest, but care should be taken and not kept for too long, not too tight or not while sleeping. Using a brace that supports the inflamed tendon can help in relieving symptoms of tendonitis elbow. The type of brace depends on the location and type of tendon inflammation, hence following medical advice is essential.
- Ice packs - Applying cold compresses, ice packs rolled in a cloth and gently rubbing over the inflamed area can help. Elevation of the joint and keeping the elbow joint raised above the heart level can help to reduce the swelling and pain in tendonitis elbow. Using ice packs for 10-15 mins can help reduce inflammation. Ice packs can also be used after exercising or after performing activities that cause elbow pain, once routine is resumed.
Medical Management in Tendonitis Elbow
Acute attacks of pain, swelling and inflammation of the elbow joint are treated with non-steroidal anti-inflammatory medicines (NSAIDs) that can provide relief in the joint symptoms. These medicines can cause irritation of the gastric mucosa and the one that suits an individual should be taken.
Steroids are another class of medicines that can help to fight inflammation and bring quick relief. There are oral and injectable steroids, which can also be taken directly into the inflamed elbow joint for immediate relief of symptoms. All medications and their side-effects should be discussed with the treating physician to plan the most effective and safe treatment plan.
Latest research involves studying the effects of a Platelet Rich Plasma (PRP) for its use in the tendonitis elbow and it is believed that PRP can help in healing process of tendonitis elbow. As proteins are important factors in the healing process, PRP, which is a preparation made from the patient's blood, may show some promising results. Hence, further research to study the efficacy of PRP injections in the treatment of tendonitis elbow is being conducted.
Rehabilitation for Tendonitis Elbow
For sportspersons and others who use tools for their work, need to get their equipment checked so as to use the best equipment and tools, if required modified ones to suit individual needs and help in minimizing the elbow pain when using. It is also important to learn the correct techniques of handling the equipment and tools and learn ways in which elbow pain can be minimized and further injuries can be prevented. Any modifications in seating arrangements, working tables, etc. should be considered as appropriate.
Physical therapy for tendonitis elbow is an important part of the recovery process of tendonitis elbow. It includes using therapeutic modalities like ultrasound, manual therapy, electrical stimulation and massage therapy to relieve pain and swelling in the elbow. Exercises are a crucial part of rehabilitation for tendonitis elbow. Physical therapy includes therapeutic exercises aimed at improving flexibility of the elbow joint, regaining elbow joint function, muscle strengthening and protecting it from further damage.
Exercises for Tendonitis Elbow
Tendonitis elbow, which is caused by inflammation of tendons of the elbow, can be protected and prevented from further damage with the help of exercises. Muscles strengthening exercises for tendonitis elbow are important during recovery period and also by sportspersons and those with an increased risk of tendonitis elbow to maintain the strength of the elbow tendons.
Some of the exercises for tendonitis elbow include
Flexibility and Range of Motion Exercises for Tendonitis Elbow
The following exercises help to improve the flexibility of the elbow joint, provide a gentle warm up and slowly improve range of motion.
- Gentle movements of the elbow joint, bend and straighten the elbow joint within its comfortable range of motion, while supporting the arm with the other hand.
- Gentle movements of the wrist joint, upwards, downwards and rotation of the wrists, while supporting the arm with the other hand.
- Raise one hand overhead and bend its elbow to reach the back. Gently push the elbow backwards with the other hand to feel the stretch.
- Hold a stress ball in the middle of the palm with all fingers covered over it and gently press the ball.
- Keep all fingers of the hand facing upwards and gently stretch the fingers to extend them, hold for few seconds and release.
Muscle Strengthening Exercises for Tendonitis Elbow
The following exercises are performed by keeping the hand stretched, elbows straight and palms facing down.
- Hold a light weight dumbbell in the hand. Turn the wrist downwards and raise it upwards.
- Hold the light weight dumbbell in the hand and twist the wrist to face the palm side upwards and rotate back to original position.
- Using the other hand, gently bend the wrist downwards, hold and gently push the fingers inwards with the other hand. Release and bring the wrist back to straightened position. Now bend the wrist backwards with fingers facing upwards and gently push the fingers with the other hand.
The following exercises are performed by bending the elbow at right angle.
- Hold a light weight dumbbell in the hand with palm side up. Rotate the wrist, to twist and slowly face the palm side down.
- Hold a light weight dumbbell with palm side up keeping wrist straight. Gently bend the wrist inwards, towards the body, hold for few seconds and release.
Surgery for Tendonitis Elbow
Some cases of tendonitis elbow, may fail to heal completely with conservative treatment, which has been followed for months or when elbow pain has not responded or temporarily responded to steroid injections. Surgery for tendonitis elbow may also be considered if elbow pain from tendonitis elbow is causing sufficient interference in daily activities, the elbow pain is considered unbearable or there are other associated conditions, which affect the healing process, like medical problems, smoking, etc.
Surgery is usually done using an arthroscope, in which a tiny camera is inserted with tube like instruments into the elbow joint, making small incisions around the elbow region.
Surgical treatment for tendonitis elbow includes:
- Releasing or cutting the inflamed tendon
- Removal of inflamed portion of the tendon
- Repairing of tendon tears
Surgical treatment has its own risks and the same should be discussed with the surgeon. Proper follow-up and rehabilitation program for tendonitis elbow is important to ensure optimal recovery. After surgery for tendonitis elbow, it may take around 3 to 6 months for complete recovery, depending on the severity of the condition and post-surgical rehabilitation.
What is the Recovery Period in Tendonitis Elbow?
Tendonitis elbow is usually a slow healing condition and the recovery period depends on the cause of the tendon inflammation, rest and rehabilitation that is done. Normally, an acute injury leading to tendonitis elbow may take around 3 weeks to recover. Chronic elbow pain condition of tendonitis elbow may take more than 3 weeks and may take few months to heal. Recovery of tendonitis elbow depends on the duration for which the symptoms have lasted and symptoms that have lasted longer may take more time to heal.
In some cases of tendonitis elbow, where there are additional injuries, associated joint problems or medical conditions like rheumatoid arthritis, the healing may be little slower or there are chances of repeated strain on the tendons.
Rehabilitation and physical therapy exercises with gradually increasing intensity may be required for few months to almost a year in some cases, to be able to regain the strength and resume normal activities involving the elbow joint or participate in sports without any discomfort.
What are the Complications of Tendonitis Elbow?
If tendonitis elbow is left untreated, it can result in long lasting elbow pain from tendonitis elbow, inability to function optimally with the elbow joint, difficulty in holding or gripping objects, limited range of movement of the elbow, nerve damage and sometimes permanent damage to the elbow joint. However, with timely diagnosis, treatment and rehabilitation, tendonitis elbow can be managed well and complications can be avoided.
How to Prevent Tendonitis Elbow?
Tendonitis elbow can be prevented by taking necessary precautions before involving in activities or sports that can cause damage to the tendons of the elbow.
- Sportspersons should perform proper warm up and stretching exercises before and after sports activities.
- Regular exercises and strengthening exercises of the elbow can help to protect the tendons from tendonitis elbow.
- Learning proper ways of using hands, lifting objects, using tools and typing can help to protect the elbow joint.
- Knowing when to take rest to avoid overuse injuries and damage to the elbow tendons is important.