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Tendinitis – elbow Essay

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What is Tendinitis Elbow?

In general, Tendinitis refers to the inflammation and irritation of the tendons.  Although Tendinitis may occur in the different parts of the body, the condition usually affects the tendon tissues around the elbow (Premkumar, p318). Basically, people call the condition “Tennis elbow” if the pain or the injury affects the outer elbow tendon. On the other hand, if the injury is in the inner tendon, then it is called “Golfer’s elbow.

Despite the names however, it should be noted that the different kinds of Tendinitis do not only come from playing tennis or golf. Rather, a variety of industrial activities, daily living tasks, and other types of sports and games can also cause this condition. Apart from sports enthusiasts, the list of high risk individuals for Tendinitis-elbow also includes painters, sculptors, writers, typists, musicians, gardeners, dentists, and carpenters.

Technically, almost all “activities which involve repetitive wrist turning or hand gripping, such as tool use, hand shaking, or twisting movement”(NIH Publication: Questions and Answers) and all tasks which require the extensive and heavy use of the wrist and forearm muscles can lead to Tendinitis-elbow. In formal medical terms, tennis elbow is referred to as the “lateral epicondylitis” while the golfer’s elbow is known as “medial epicondylitis”. (NIH Publication: Questions and Answers)

What causes Tendinitis Elbow?

(From www.itendonitis.com)

a.                 Studies show that the most common cause of Tendinitis-elbow is the repetitive strain on the tendon. That is why factory workers who engage in repetitive chores and sports professionals who perform repetitive game movements are at high risk of developing Tendinitis.

b.                 As a person grows older, he becomes more susceptible to Tendinitis. This is because the tendons become harder and they lose their elasticity as people age. When this happens, the joints also become less flexible and mobility becomes more difficult for the individual.

c.                 Tendinitis elbow also occurs when the tendons are exposed to excessive pressure and strain. This is why strength athletes, weight lifters, and body builders usually develop the condition. They become more prone to Tendinitis elbow if they engage in activities with too much tendon strain without first engaging in warm up exercises or when they do not use proper training techniques.

d.                The condition can also be prompted by an injury on another tendon or on the joints. In such cases, the secondary Tendinitis develops because the first injury has not been healed completely.

e.                 In some cases, Tendinitis elbow can have an underlying health condition. Although such case is quite rare, rheumatoid arthritis or diabetes can cause Tendinitis.

f.                  Tendinitis-elbow can also occur as a result of thermal injury to the tendon. This is common to mountain climbers, hikers, and rock climbers. Thermal injury can also affect wrists and ankles.

g.                 Some people develop Tendinitis due to their abnormal tendon or muscle composition or structure – particularly, rough or twisted muscles or bones. In such cases, surgery is usually recommended.

What are the Signs and Symptoms of Tendinitis Elbow?

People who develop Tendinitis elbow usually experience four early warning signs (from itendonitis.com). First, the affected area will be painful and stiff. In some cases, it can also swell. As the condition gets worse, the patient would gradually tolerate the pain to the point that he may no longer feel it. However, there is a noticeable restriction with regards to movement. Soon after, the patient will notice that the pain returns on a periodical basis, that is – the affected area may be painful in the morning or at night. Then, the patient will also feel pain during and after movements. (iTendonitis.com)

People with Tendinitis-elbow can also experience excessive pain whenever he affected area is touched. Sometimes, the patient will also report a “burning” sensation after every exercise. When the condition becomes very serious, the tendon may accumulate fluid and become inflamed and swollen. As such, the affected area will become lumpy and warm.

Diagnosing Tendinitis Elbow

To diagnose the condition, the physician will have to examine the patient’s elbow and check his medical history. In most cases, the doctor will ask the patient to move the affected area – wrists, fingers, and elbow – in different ways. He may also apply pressure in order to determine the severity of the condition. In order to rule out arthritis, fractures and other possible causes of pain and swelling, the patient may need to have an X-ray, ultrasound or MRI scans. (MayoClinic.com)

Treating the Condition

There are a variety of ways to treat Tendinitis elbow. However, most people who develop the condition would just wait for the Tendinitis to just go away. After you’re the patient’s elbow usually gets better within a period of six months to two years.

For people who can’t tolerate the elbow pain, they can result to home remedies which MayoClinic.com dubs as the P.R.I.C.E. or Protection, Rest, Ice, Compression, and Elevation. Following this remedy process, the patient must prevent the condition from worsening by protecting his elbow. He should stop any activity that increases the pain. Furthermore, the patient should give his elbow a good rest, but not of all activities. Light activities are alright for as long as the tendon is not strained.

To limit the swelling, the patient must use a cold pack. Physicians recommend the application of a cold pack or ice immediately after the injury. Compression through bandage or an elastic wrap can also alleviate the pain and promote healing. Last but not the least, the patient must ensure that his elbow is elevated above the heart level so as to limit swelling.

If the home remedies are not enough, “the patient can take acetaminophen (Tylenol, others) or over-the-counter anti-inflammatory medications like ibuprofen (Advil, Motrin, others) or naproxen (Aleve, others)” (MayoClinic.com). It is always safer to check with the physician prior to taking any drugs or medication.

Some Things that the Physician may Suggest

Upon consulting the physician and having been diagnosed with Tendinitis elbow, the patient may be asked to (from MayoClinic.com):

a.                 Analyze the way he uses his arm and develop new ways upon which he can reduce the stress that is usually applied on the injured tissue.

b.                 Engage in exercises and other constructive activities. These exercises are primarily geared at stretching and strengthening the muscles – especially those in the forearm.

c.                 Wear straps, splints, or braces in order to prevent further damage to the injured tendon tissue and reduce stress and strain on the elbow.

d.                Use corticosteroids if the pains are becoming severe and quite persistent. These drugs can reduce pain and inflammation. However, injectable corticosteroids should not be used for a long term treatment plan as they may have dangerous side effects.

e.                 Undergo Surgery. Surgery is often recommended by physicians only after all the other treatment approaches have been totally exhausted. Patients who are often recommended for surgery are those who have tried all the other non-invasive options but still experience persistent elbow pain. The surgical procedure may involve the trimming the inflamed tendon.

Alternative Medications

There are two alternative methods that Tendinitis elbow patients can result to – acupuncture and massage therapy. Based on traditional Chinese healing methods, acupuncture can “release the natural pain-relieving opioids which send signals that calm the sympathetic nervous system” (altmedicine.about.com). The method can also trigger the release of neurotransmitters that can alleviate pain. Acupuncture is not for people who have a bleeding disorder.

As for the “Transverse Friction Massage”, it is a massage technique that is used to reduce pain and improve blood flow. In the process, the technique also reduces inflammation and scar formation. Basically, this type of massage is characterized by deep strokes which are directly applied to the affected area perpendicular to the injured tendon’s direction.

Although the massage therapy is generally safe when performed by a licensed therapist, patients with recent fractures, osteoporosis, rheumatoid arthritis, deep vein thrombosis, cancer, heart problems, open wounds, should first seek their doctor’s advice. Pregnant women should also try other treatment options (altmedicine.about.com).

Cautions and Recommendations to Therapists
(Derived from Premkumar, p319)

a.                 In lateral tennis elbow, the symptoms are prominent on the wrist flexion, ulnar deviation with the forearm pronated and flexed.

b.                 In the medial tennis elbow, the symptoms persist when the wrist and the fingers are extended and the forearm supinated.

c.                 If the condition is in its acute phase, begin with gentle effleurage and kneading strokes. The joints must be moved gently, whenever necessary.

d.                In chronic cases, strenuous and straining repetitive movement should not be allowed. Use the deep transverse friction massage over the tendon in order to promote proper fiber orientation without causing trauma to the injured tendon.

e.                 After the friction massage, an ice massage must follow. Stretches can also be added to the line of treatment.

f.                  Lastly, the therapist can add exercises which aim to strengthen the atrophied muscles.

g.                 The treatment phase will usually take four or more weeks. It can begin with half-an-hour daily sessions for the first week. As the pain gradually subsides, the treatment session can subside to twice a week for the second week and finally, once a week for the last two remaining weeks.

h.                 The patients must be advised not to engage in activities that can hamper complete healing or cause another Tendinitis in the next two to six weeks after the treatment phase.

References

Itendonitis.com. “Tendonitis: Causes”. Retrieved 25 Apr 2009 from

http://www.itendonitis.com/causes.html

Itendonitis.com. “Tendonitis: Symptoms”. Retrieved 25 Apr 2009 from

http://www.itendonitis.com/symptoms.html

MayoClinic.com. “Tendonitis: Lifestyle and Home Remedies”. Retrieved 25 Apr 2009 from

http://www.mayoclinic.com/health/tennis-elbow/DS00469/DSECTION=lifestyle%2Dand%2Dhome%2Dremedies

MayoClinic.com. “Tendonitis: Treatment and Drugs”. Retrieved 25 Apr 2009 from http://www.mayoclinic.com/health/tennis-elbow/DS00469/DSECTION=treatments%2Dand%2Ddrugs

Premkumar, Kalyani. “Pathology A to Z – A Handbook for Massage Therapists”. Retrieved 24 Apr 2009 from <http://books.google.com.ph/books?id=tWyEJbNfy3EC>

National Institute of Health. “Questions and Answers to Bursitis and Tendinitis”. NIH Publication No. 07–6240 April 2007. Retrieved 25 Apr 2009 from <http://www.niams.nih.gov/Health_Info/Bursitis/bursitis_tendinitis_ff.pdf>

Wong, Cathy. “Natural Remedies for Tendonitis”. About.com. 11 April 2007. Retrieved 25 Apr 2009 from <http://altmedicine.about.com/od/healthconditionsdisease/a/tendonitis.htm>

 

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