Elbow Tendinitis

(e.g., TENNIS ELBOW & GOLFER'S ELBOW)

Elbow tendinitis is one of the most common types of tendinitis. This condition refers to the inflammation present in the tendons and connective tissue at the elbow. When the inflammation involves the bony attachment (epicondyle) of the elbow tendons, the condition is called epicondylitis. Elbow tendinitis and epicondylitis can occur in anyone who repetitively uses the elbow by consistently rotating the forearm muscle tendons. The tennis player risks tennis elbow, which is pain on the outside of the elbow. This pain is caused by inflammation of the forearm muscles, which extend (bend back or cock-up) the wrist and fingers. The golfer can develop golfer's elbow, which is pain on the inside of the elbow. This pain is caused by inflammation of the forearm muscles, which flex the wrist and fingers.

Contributing Factors

• Muscle weaknesses and/or imbalances
• Overuse and overload of the elbow joint by repetitive rotation of the forearm, which extends and flexes the wrist
• Improper equipment, such as too small or large grip size, too tight or loose string tension
• Incorrect technique and overtraining, such as excessive wrist action, uneven strokes, poor contact with the ball, and problems with balance and follow-through

Treatment

RICE

This stands for rest, ice, compression, and elevation.

REST. The degree of rest will depend on the severity of the inflammation. The athlete may have to temporarily stop playing tennis, golf, or other racquet sports to allow the injury to heal. Continuing the sport or activity often aggravates the injury, causing the athlete to experience pain, possibly more than initially. Once the pain begins to subside, elbow exercises can be started to improve flexibility and strength, allowing the athlete to resume his or her sport sometime in the future.

ICE. Ice can be applied to the elbow for 20 – 30 minutes, 3 – 4 times per day initially, and then 2 times per day. Ice massage is a very effective form of ice application. Apply ice for 15 minutes after any activity involving the elbow to minimize additional inflammation caused by the activity.

COMPRESSION. This can be achieved by using an ACE wrap or a neoprene elbow sleeve. An elbow brace may be recommended to help support elbow tendons, thereby reducing tension and pressure on these tendons and relieving the inflammation.

ELEVATION. Elevating the elbow is advised to help reduce swelling, which may be the result of the acute injury or the chronic inflammation.

Exercises. Stretching exercises of the elbow, wrist, and fingers are essential to help improve muscle tendon flexibility and strength. These exercises help reverse the muscle weakness, which results from the inflammation, and enable the tendons to resume the usual demands and workloads of the sport.

Physical Therapy. This may be necessary to help reduce the elbow inflammation. The physical therapist may use such modalities as ultrasound, phonophoresis, iontophoresis, friction massage, electrogalvanic stimulation, and soft tissue mobilization to treat scar tissue caused by the chronic inflammation.

Medication. An oral anti-inflammatory medication may be prescribed or recommended. An elbow injection of cortisone and a local anesthetic may be advised. The injection can help relieve the pain and tenderness and make physical therapy more effective. After an injection, the athlete should avoid return to sports for one to two weeks. A successful injection can often spare the need for surgery. Repeated injections should be avoided.

Braces. Although there is a variety of braces with different designs, the goal of reducing the pressure on and supporting the inflamed tendons is the same. As the elbow heals, the brace should be used less and less, and then just for support to protect the tendons from re-injury. See elbow brace below and other elbow devices in the Sports Med Store.

Surgery. If all other forms of treatment failed to provide relief, then surgery should be considered. This usually consists of surgical release of the origin of the common extensor tendons from the lateral epicondyle bone with removal of scar tissue in the area. This procedure can be performed as an out-patient surgery, and the results are usually excellent.

Returning to Sports

Warming Up. The athlete should move all major joints through their complete range of motion several times before starting play. Stretching and strengthening exercises help prevent injury.

The Equipment. Discussing equipment with a local pro or an informed sporting goods representative is highly recommended. A tennis expert might suggest a lighter weight, more oversized, or different composition racquet, a reduction of string tension, or a change in grip size. A golf expert might recommend lighter or a different composition club shafts or a change in grip or design of the irons and woods. Equipment changes such as these may prove to be helpful in preventing recurrence of elbow tendinitis.

Play the Game. When resuming the sport of choice, play at a lower intensity. In tennis, plan to rally for a short period of time and avoid difficult, problem shots. Play for less amount of time or play doubles. Resume competitive play once the elbow is healed. In golf, start with putting pitching strokes. At the driving range, progress from shorter- to longer-length clubs. On the course, gradually advance from a few holes, nine or less, to a complete game.

Exercises

Weak muscles are a major contributor to the problem of tennis and golfer's elbow. Exercises will strengthen the muscles associated with the injured tendons. Stretches and exercises should be avoided in the very painful stage. Do each prescribed exercise two times a day or more often if necessary.

Elbow Stretch. Hold your racquet arm at shoulder level in front of your body with the elbow straight. With your hand clenched, flex the wrist as far as possible. Return the wrist to neutral position, and alternately turn the arm inward with a flexed wrist, and then outward with an extended wrist. Repeat 15 times, 2 times/day.

Wrist Curls. Sit with your injured arm resting on a table and supported by your fist. Grasp a one-pound weight or unopened can of food and slowly raise your wrist as high as possible. Do the exercise first with palm up, then with palm down. As your strength improves, you can gradually increase the weight of the dumbbell. Repeat 10 – 15 times, 2 times/day.

Squeezing. Squeezing a rubber ball (racquetball size) will also strengthen the injured area. If that is too difficult, start by squeezing a sponge or washcloth in water. Repeat 15 times, 2 times/day.

Twisting. With your arms outstretched, practice wringing out a dry terry cloth towel with both hands. Repeat 15 times, 2 times/day.

I cannot give medical advice about how to treat a specific injury without evaluating the athlete first. While I may discuss general exercises to prevent and treat sports injuries, not all exercises are designed for all individuals or problems. A sports medicine physician should be consulted before starting any exercise program. If an athlete is experiencing any severe pain or discomfort, he should see such a physician and obtain a specific diagnosis and treatment plan. The exercises outlined here are general recommendations and are not intended as a substitute for professional medical advice.

Specialty Reference
Elbow Center