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Elbow tendonitis, commonly known as either tennis elbow or golfer’s elbow, causes the tendons of the lower arm to swell and cause pain through the arm due to inflammation. Tendonitis is caused by either overuse or overload, and in most cases of elbow tendonitis, derives from microscopic tears in the muscle tissue.
Both tennis elbow and golfer’s elbow are types of elbow tendonitis but differ in the regions they affect or emanate from. Tennis elbow, or lateral epicondylitis, affects the tendons on the outer side, whereas medial epicondylitis causes pain on the inside of the elbow. In both cases, there is tenderness and pain in the arm that affects the wrists and hand movement. This means that the pain flares up during – or makes it impossible to perform – simple everyday tasks such as lifting or gripping objects, opening doors or shaking hands. In other words, movement in the fingers causes pain and makes it harder to perform these tasks.
While the names are associated with specific sports, elbow tendonitis arises as a result of the repetitive gripping motion of the first two fingers and thumb that occurs in activities and professions such as plumbing, painting, woodworking, knitting, and most forms of manual labor involving grip strength – or even desk and tech jobs with too much keyboard usage.
Owing to the tug-and-pull exerted on the muscles, elbow tendonitis tends to manifest over time. It is the most oft-reported elbow problem, and most common in people between the ages of 30 and 50, perhaps owing to the strain accumulated over the years. However, tennis elbow has also been known to be insidious, meaning it can occur without any apparent cause.
Apart from age and occupation, it is essentially the activities performed by the patient that puts one in the path of elbow tendonitis more than any other factors, meaning that it can be avoided and prevented in some cases. For example, problematic movements are central to this issue in sports players, such as the backhand stroke in tennis (particularly repeatedly using poor form) or a low elbow technique during a javelin throw.
While 10% to 50% of tennis players experience some form of epicondylitis in their careers, it is seen that a total of 1-3% of the general public also suffers from tennis elbow, with the number decreasing by a ratio of 1 to 5 for golfer’s elbow. However, despite the most diagnoses being made around the age of 50, these cases are spread equally across genders and symptoms can arise in anyone at any age.
No notable injury needs to be observed at the onset of elbow tendonitis. The first noticeable symptom will be a burning sensation traceable to the elbow joint where the muscles have experienced tearing. From there, the pain grows outside the elbow and towards the forearm and wrist, primarily due to the way the arm and handles muscles are connected. In some rare cases, the pain may develop suddenly instead of gradually, though usually, tennis elbow is a gradual onset.
If the pain worsens during activities involving a steady grip or load on the muscles, such as lifting objects, this is also understood as a symptom of elbow tendonitis. The arm muscles feel weak and painful, making it hard to hold drinks, shake hands, and open doors. Both arms can be affected, indicating bilateral symptoms, but it is the dominant arm that is affected in 75% of people.
These symptoms can get worse with activities that utilize the extensor muscles in the forearms. In such cases, pain is felt even while extending the middle finger, usually in cases of tennis elbow.
Hence, the symptoms of pain and a burning inflammatory sensation are felt in the outer side of the elbow in case of tennis elbow (possibly running down to the forearm and wrists) and felt on the inner side of the elbow when the diagnosis is golfer’s elbow.
However, in all forms of elbow tendonitis, the elbow itself should be able to move freely as it did before. In case the movement of the elbow is limited, alternate diagnoses would be considered.
Diagnosis for epicondylitis cannot be made through blood tests or lab tests such as X-rays. However, these may be used to rule out other diagnoses, such as an MRI scan for a potential neck problem, X-rays for arthritis, and an EMG (electromyography) for nerve compression, which presents with symptoms very similar to tennis elbow.
Thus, it is important to describe the pain and symptoms as accurately to your primary healthcare physician as the diagnosis hinges on the clinical and medical history provided by the patient during a physical exam. This can include describing when and how the pain was first felt, any occupational hazards, and the extent of your recreational activities.
The physical exam might consist of applying pressure to the affected areas to gauge the level and threshold of pain, or of activities such as being asked to move, rotate, or flex your arm in certain ways and in a specific pattern. Doctors are trained professionals who can use this data to assess and analyze information to accurately pinpoint the nature of the damage, if any, and what course of action should be followed for treatment. An example of such a test designed to give your physician insight into what has been affected is being asked to straighten the arm and, against resistance, try and straighten the fingers and wrists.
In more than 80% of cases and up to 95% of patients, epicondylitis is treated non-surgically. There are physiotherapy options, as well as lifestyle precautions and home remedies. The latter includes over-the-counter pain medication and NSAIDs to counter the pain, swelling, and inflammation, such as aspirin and ibuprofen.
A traditionally employed and medically sanctioned self-care treatment for elbow tendonitis is the application of an ice pack to the affected area, recommended by doctors and experts to be done around four times in a day after every four hours for 15 to 30 minutes. Wrist stretching exercises are also recommended, though only on the guidance and recommendation or under the supervision of your doctor. A brace or elbow strap may also be used to prevent the tendons from any further stress and damage.
However, surgery may be recommended as a final resort, particularly if symptoms have continued or gotten worse even after six to twelve months. Open or arthroscopic surgery is usually the first option looked at by most doctors. This involves operating on the elbow via either a large incision or several small incisions and allows the patient to return home the same day and focus on post-op care. The rehabilitation period might last as long as a week and involve a splint being placed in the arm, followed by its removal and physical therapy and exercises to get the strength and flexibility of the arm and elbow back in place.