Elbow Tendonitis, as the term implies, is an inflammation of tendon tissue. It can involve several tendons throughout the body. When it occurs around the elbow it is often called “tennis elbow” (the outer side of the elbow) or “golfer’s elbow” (the side of the elbow closer to your body). It can happen to anyone, even those who don’t play either of these sports. Most often there is no obvious cause. It just develops slowly overtime. Before you know it, a few months have passed by before you seek attention. Occasionally, the problem develops after an injury. The intensity of the pain can vary from mild symptoms after use to severe constant pain that affects your ability to write, work, grip objects, perform power activities and even shake hands.
The diagnosis is usually straightforward. The clinical examination and history is all that is needed to make this diagnosis. X-rays are usually taken at least once but are commonly normal. Special studies such as MRI scans are usually unnecessary. Once the diagnosis is made, the treatment depends on the severity of the symptoms.
Treatment involves the following program:
- Friction massage
- Stretching
- Strengthening
- Ice massage
- Bracing
- Anti-inflammatory medication and/or injection of cortisone
- Activity modification
- PRP Injection
- Surgery
Tendons that are inflamed can shorten and become fibrotic (develop scar tissue) and that can lead to loss of elbow motion. That is why we stretch the elbow. Muscles and tendons that are inflamed also will become weak. Instead of using weights to “work out”, we use low weight and high repetition rehabilitative exercises for those muscles. Most of the time patients can do their therapy at home after being shown the proper way to massage, stretch and strengthen. If the problem is more longstanding and there is elbow stiffness, then supervised therapy may be more productive.
A “tennis elbow” strap can be very helpful at reducing the stress on the inflamed tendon during activities that might provoke symptoms such as sports, yard work or even repetitive work like keyboarding. This is not an elastic sleeve; it is applied around the forearm just below the bend of the elbow. Activity modification is very important. This means that “if it hurts don’t do it.” By continuing painful activities you keep the area inflamed. It’s like blowing on a coal that keeps the fire going.
Cortisone shots can help to make the discomfort more tolerable. However, they don’t necessarily cure the problem. It may recur after an injection. An injection of Platelet Rich Plasma (PRP) may help with a more severe problem or a chronic occurrence of tendonitis. PRP injections are proven to be a longer lasting treatment. The best way to reduce the possibility of recurrence is to follow the whole program. For the very rare case that is resistant to all non-surgical treatment, surgery can be done. It is a simple procedure that can be done under a local anesthetic as an outpatient. There is no need for a cast. Recovery should take about 6 weeks.
