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One of the most common problems seen by rheumatologists is elbow tendonitis.
This problem starts with the forearm muscles. The forearm muscles that are involved in gripping, squeezing, and lifting are attached both to the wrist and to the elbow. If those muscles are overloaded, or overstressed, they can partially tear at either end. This is what causes the most common of elbow tendonitis symptoms- pain!
Frequently the muscle attachment (tendon) becomes injured at its insertion on either the inside or outside of the elbow (epicondylitis). When tendonitis occurs on the ouside of the elbow, it is called lateral epicondylitis. When tendonitis occurs on the inside of the elbow, it is called medial epicondylitis.
Common causes of elbow tendonitis include excessive gripping or squeezing. Examples include too much tennis, golf, weightlifting, gardening, hammering, etc. Other situations that can bring this on are chronic overuse of the wrist extensor muscles such as excessive keyboarding. Symptoms occur with pain on the outside (lateral) or inside (medial) aspect of the elbow and are exacerbated with gripping or squeezing. Usually the patient is free of pain at rest. However, as time goes on, pain may be present even at rest.There are two major types of tendonitis in the elbow:
• Tennis elbow- lateral epicondylitis. Symptoms include swelling and pain around the outer edge of the elbow as well as tenderness around the elbow and pain during movement of the elbow. Tennis elbow is due to repetitive movement of the muscles in the lower arm and can be treated anti-inflammatory drugs, an elbow splint to support the arm or a cortisone injection.
• Golfer’s elbow- medial epicondylitis. This condition has similar symptoms to tennis elbow, with the difference that the swelling and pain affects the inside of the elbow.
The diagnosis is almost entirely made by history and physical examination. X-rays are not usually helpful. Diagnostic ultrasound and magnetic resonance imaging are useful.
Rest and anti-inflammatory medicines are usually the first line of therapy.
The use of forearm bands and wrist splints allows the injured tendon to rest.
Corticosteroid injections are often very helpful in speeding recovery. Physical therapy too early can actually aggravate symptoms. Gentle strengthening and stretching is helpful once the pain has resolved.
Surgical treatment- fasciotomy- or the release/removal of injured tissue is rarely required.
A new treatment, called percutaneous needle tenotomy uses a small needle with ultrasound guidance to "tease" the tendon. Following the teasing, injection of platelet rich plasma obtained from the patient's blood is injected into the area where the tendon has been "irritated." Platelets are blood cells that contain many growth factors that help stimulate the growth of collagen, a major constituent of tendon tissue. This procedure is particularly effective for patients with chronic tendonitis.