Tendons are tough tissue bands that connect muscles and bones. There are several types of tendon problems (called tendinopathy):
Repetitive activities and sudden trauma can damage tendons and cause inflammation, pain, and difficulty using the joint. This is called tendinitis.
More commonly, tendons break down (degenerate) or even tear as you age; this is called tendinosis. Symptoms of tendinopathy usually last more than a few weeks.
Less commonly, tendon problems may be caused by other diseases, including rheumatic diseases.
Tendinopathy (abnormal tendons) is a common problem. The risk of tendinopathy increases with age and is greater in people who regularly perform activities that require repetitive motion, which increases stress on susceptible tendons.
Treatment for tendinopathy focuses on resting and protecting the injured tendon so it can heal and improve muscle strength. In most people, tendinopathy improves with simple treatment unless there is underlying tendinopathy (tendon degeneration).
Tendinopathy affects many different tendons in the body. Other types of tendon problems are discussed in separate articles (see "Patient education: Biceps tendinitis or tendinopathy (The Basics)" and "Patient education: Rotator cuff tendinitis and tears (The Basics)"). More detailed information on elbow tendonitis is available by subscription. (See "Elbow tendinopathy (tennis elbow and golfer's elbow)" )
What is elbow tendinopathy?
Tendinopathy (tendinitis or tendinopathy) is the most common condition affecting the elbow, and probably the most accurate term.
When the tendon of the lateral elbow is injured, it is called "tennis elbow" (or formerly known as lateral epicondylitis)
When the medial elbow tendon is injured, it is called "golfer's elbow" (or medial epicondylitis formerly)
However, elbow tendinopathy can be caused by sports other than golf and tennis and work-related activities that involve heavy use of the wrist and forearm muscles.
Elbow tendinopathy symptoms
Elbow tendinopathy most commonly affects the dominant arm (ie, the right arm of right-handers, etc.). Symptoms include:
Elbow pain that spreads to the upper or forearm
Pain can start suddenly or develop gradually over time
You may have difficulty with activities that require arm strength, including sports that require you to backhand or throw a ball
Elbow tendinopathy diagnosis
Elbow tendinopathy is usually diagnosed based on an exam and your description of the pain.
Elbow tendinopathy treatment
The treatments described can be divided into those that provide short-term pain relief (eg, pain relievers, forearm braces, topical injections) and those that improve the long-term health of the tendon (eg, eccentric strength exercises). The best long-term improvements occur with long-term health treatment regimens, especially in more abnormal and degenerated tendons.
Short-term pain control options — These treatments may offer some short-term benefits, but have not been shown to provide long-term relief or improvement in tendon health.
Pain relief — If short-term pain control is needed, you can take pain relievers such as acetaminophen (sold as Tylenol and other brands), ibuprofen (sold as Advil, Motrin), or naproxen (sold as Aleve) (see "Patient education: Nonsteroidal anti-inflammatory drugs (NSAIDs) (The Basics)"). You should not take more than 3000 mg of acetaminophen per day. If you have liver disease or drink alcohol regularly, you should talk to your doctor or nurse before taking acetaminophen.
Arm braces — Tennis elbow braces or straps put pressure on the muscles of the forearm and reduce the pressure on the injured tendon in the elbow. You can use a suspender or harness while working or exercising. Using the brace, place the pad against the forearm muscles, about 3 to 4 inches (10 cm) from the tip of the elbow bone. You may need to wear the brace for up to six weeks. Avoid wrist splints (to prevent movement of the forearm).
Flexibility exercises — Flexibility exercises improve elbow and wrist mobility and may help relieve symptoms in the short term.
Tennis Elbow - While standing or sitting upright, place the injured arm straight in front of you with your fingers pointing down towards the ground. With the hand of the uninjured arm, grasp the hand of the injured arm, with the thumb pressed against the palm, and try to flex the wrist further (picture 1). Hold for 30 seconds; repeat three times. Do this stretch every day.
Golfer's Elbow — Keep an arm's length from the wall, with the affected arm closest to the wall. Rest your palms against the wall with your fingers facing down (picture 2). Press lightly on the hand. Hold for 30 seconds; repeat three times. Do this stretch every day.
Injections — If your pain persists, injections into the painful tendon may help relieve pain in the short term. Injecting cortisone (a steroid) into an unhealthy tendon is generally discouraged, but for those rare cases where the pain is severe and short-term pain relief is needed, a single injection may be considered.
Long-term healthy options — These treatments may provide longer-lasting benefits and have been shown to provide long-term relief or improvement in tendon health.
Strengthening exercises — A special type of strengthening exercise called "eccentric strengthening" is the most effective treatment for elbow tendinopathy. Once the patient's flexibility has improved and there is little or no pain while performing the strengthening exercises, the patient can begin these exercises. Eccentric strengthening involves exercising the affected wrist extensor tendons and muscles while stretching. Patients can perform these exercises using weights, elastic bands, or specially designed rubber bands, and these exercises can be performed under supervision or independently. Eccentric training outperforms other types of reinforcement . This type of strengthening is important for improving the long-term health of the tendon.
Tennis Elbow — People with tennis elbow should perform eccentric stretches (Figure 3). You should expect some slight discomfort with these exercises. If the pain becomes severe or more than moderate, stop exercising and rest for two to three days. Start over with fewer repetitions.
Sit with arm support (on a table) at shoulder height. The backs of your hands should be facing the ceiling and your hands should be hanging over the table. Start with the elbow bent, which reduces the pain, and continue to keep the elbow straight. Hold a 1-pound weight in your hand. Using your unaffected hand, lift the weight toward your body and bend your wrist (keeping your arm flat on the table).
Remove the unaffected hand and slowly lower the affected hand (with the weight). Repeat 15 times, then rest for a minute. Repeat two more times. Do it five times a week.
After a week, try lifting your hand with a heavy weight without help. Gain 1 to 2 pounds per week. Don't add weight unless you can do 15 reps.
Golfer's Elbow — The golfer's elbow is treated with eccentric flexion exercises. You should expect some slight discomfort with these exercises. If the pain becomes severe or more than moderate, stop exercising and rest for two to three days. Start over with a lighter weight or fewer repetitions. These exercises are the opposite of the stretches above: start with the back of the hand facing the floor, using the wrist flexors, not the wrist extensors. Otherwise, the performance is the same.
Kinetic Chains — If you are doing a sport that requires arm strength (like tennis or golf), hold a 1 to 2 pound weight in your hands and reproduce the wrist and elbow motions in your movement. At the same time, support your lower body and core (back and abdominal) muscles.
Then, replace the weight with a golf club or tennis racket and practice your swing (without the ball). If you do the wrong exercises, you may experience more pain. If you experience pain during strengthening exercises, consider seeing a rehabilitation specialist, such as a physical therapist or exercise coach, to help supervise your recovery.
When will I feel better? — Most people respond well to treatment. You may experience some pain during up to 6 to 12 weeks of work or exercise. Some people require formal rehabilitation with a physical therapist.
In addition, many new treatments are being developed to promote tendon healing, such as the use of needles to promote tendon healing, injection of blood products, acupuncture, and nitroglycerin patches. Further research is needed to determine the effectiveness of many of these therapies. Surgery is usually not necessary unless symptoms do not improve after six months or more of treatment. (See "Elbow tendinopathy (tennis elbow and golfer's elbow)" )
Elbow tendinopathy prevention
A healthy elbow requires healthy shoulder and wrist joints as well as strong muscles around the shoulder blade (scapula) and arm to reduce the load on the smaller forearm muscles.
To prevent elbow and forearm overuse and strain:
Take frequent breaks from activities that require a lot of hand/wrist movement.
Reduce or avoid lifting objects with arms extended.
Reduce repetitive grasping and grasping of hands and wrists. Reduce the overall tension of the grip.
Avoid extreme flexion and full extension.
Elbows are in a partially bent position for work or weight training. Use a wrist rest when training with weights.
When using tools, increase the grip area by wearing gloves or adding padding. Use a hammer with extra filler to reduce tension and impact. Hold heavy tools with both hands.
Use a two-handed backhand in tennis. When hitting tennis, use your entire lower body, hips, pelvis, and back, and reduce the use of your elbows. Using proper technique in tennis can help reduce symptoms. Re-evaluating grip size, cord tension, cord type, new shots, and new grips for new shots can all cause problems.
Some suggest lowering the string tension, finding the heaviest racket that doesn't affect your swing speed, finding the largest grip you're comfortable with, and using softer strings.
Use grip tape or oversized grips on golf clubs.