Tendonitis of the elbow joint - causes, symptoms, treatment methods

Epicondylitis is an inflammation of the tendons of the forearm at their attachment point in the elbow joint. The disease is more typical for athletes, but workers in blue-collar jobs, office workers and housewives often suffer from it. Intrusive and prolonged pain in the elbow can deprive you of your usual activities for a long time, and the treatment methods offered by some surgeons are often ineffective and even dangerous. Modern orthoses and physical exercises can help faster than an injection, pill or cut; they are safer and more natural.

Causes of elbow tendinitis

Tendons attach muscle to bone and transmit muscle contractions to the bone lever, providing biomechanics for the musculoskeletal system. They consist of compact parallel bundles of collagen fibers. Collagen bundles are quite strong, but not elastic enough, so microdamages often occur that do not have clinical manifestations.

Microtraumas trigger an inflammatory process that culminates in fatty degeneration and calcification (deposition of calcium salts in tissues). A degenerated tendon is less strong and vulnerable, which leads to repeated injuries and inflammation.

Reference!
Long-term, low-grade inflammation causes degeneration and thinning of connective tissue structures. More often, inflammatory processes occur in the tendons and ligaments of the knee, shoulder and hip joints.

The occurrence of tendon pathology

The main cause of tendonitis is intense stress on the musculo-ligamentous system, leading to microtrauma. Tendons are damaged by frequent monotonous movements. At risk are athletes (tennis players, volleyball players, basketball players) and people who have to perform numerous monotonous movements due to their professional activities (painters, bricklayers, hairdressers).

Secondary tendinitis occurs against the background of rheumatic, endocrine, and infectious diseases.

Inflammation of the tendons is possible due to long-term use of medications.

In autoimmune pathologies, the patient’s immune system synthesizes antibodies that destroy fibroblasts and fibrocytes of collagen fibers, which leads to chronic inflammation, degeneration of ligaments and tendons.

Clinical picture

At the initial stage, symptoms of elbow tendonitis are mild or absent altogether. A person feels slight discomfort in his hand, which he attributes to fatigue or overload. As the inflammatory process intensifies, the intensity of clinical manifestations also increases:

pain. Usually it is clearly localized and does not radiate to the forearm or wrist. Painful sensations first occur during movement - flexion, extension of the joint, turning the hand inward or outward. Their intensity increases with strong tension in the skeletal muscles, the contraction of which leads to tension in the tendon. In the absence of medical intervention, the pain is felt at rest, it becomes constant, aching, and interferes with restful sleep and daily work;
restriction of movements. The inflammatory process is accompanied by swelling of nearby tissues. Pathological exudate interferes with the smooth sliding of the tendon. In addition to physiological disorders of the joint, neurological ones also occur. A person deliberately does not use his arm, since turning, bending, and extending causes him severe pain;

Pain and limited movement in the elbow are signs of tendonitis.

formation of seals. Sometimes, when palpating the inflamed tendon, the doctor detects characteristic nodules. Their formation usually indicates a traumatic origin of tendonitis. Fibrous tissues grow, become denser, and their dimensions can exceed several millimeters. When pressing on the nodular formations, they move slightly due to the tension of the muscle fibers. The seals are elastic, elastic, but can harden during the crystallization of calcium salts. Fibrous nodes sometimes resolve, but only if there are no calcifications in them;
ascultative noises. Auscultation is a method of clinical examination of a patient, which consists of listening to sound phenomena occurring in the body. A swollen, inflamed tendon makes specific sounds during movement. They are almost indistinguishable at the initial stage of tendonitis. The noise is more accentuated during the formation of fibrous nodes, especially if they contain calcifications;
redness of the skin. The inflammatory process quickly spreads, affecting the subcutaneous tissue and epidermal layers. Due to the rush of blood to the surface of the skin, it appears slightly red. This is clearly visible when comparing healthy and diseased elbow joints.

The clinical picture can vary significantly depending on the origin of the tendinitis. For example, if the pathology is caused by arthritis or osteoarthritis, then the patient experiences morning swelling of the joint and stiffness of movement, which disappears during the day. If the cause of tendinitis is the penetration of pathogenic microorganisms into the joint cavity, then symptoms of general intoxication occur. A person’s temperature rises, headaches, dizziness occur, and digestion is upset.

Symptoms of Elbow Tendinitis

In the initial stages of the disease, the clinic is erased or absent. Minor discomfort in the elbow area is usually ignored. Gradually, clinical symptoms increase:

Local pain initially occurs during flexion, extension, and rotational movements. As the load increases, the intensity increases. Further, the elbow hurts at rest, at night, simple movements are difficult.
Inflammation leads to swelling of nearby tissues. The exudate prevents the tendons from slipping and puts pressure on the nerve fibers. As a result, movements are limited and neurological symptoms appear.
When palpating the tendons, the doctor identifies characteristic mobile nodules several millimeters in size. Elastic, elastic in the initial stages, later they acquire a stone density.
When the inflamed tendon moves, it produces specific sounds that are inaudible in the initial stages. When fibrous nodules and calcifications form, the noise is more accentuated.
With intense inflammation, the skin over the affected joint is hyperemic; upon examination, it is convenient to compare it with a healthy joint.

The clinical picture is variable and depends on the cause of the disease. With secondary tendonitis against the background of arthritis and arthrosis, patients note morning swelling of the joints and stiffness of movement. Symptoms disappear within a day. Tendinitis against the background of infectious diseases occurs with intoxication syndrome (increased body temperature, weakness, headaches, gastrointestinal disorders, etc.).

Lateral epicondylitis (tendinitis)

With lateral epicondylitis (tennis elbow), the pathological process affects the extensor tendons. This is the most common disease of the elbow joint; it occurs in tennis players (among them 45% of professionals, 20% of amateurs). Patients complain of pain in the outer surface of the elbow, radiating to the forearm or shoulder, gradually increasing weakness of the hand up to difficulty shaking hands and lifting a cup.

Medial epicondylitis

Medial epicondylitis (golfer's elbow) is an inflammation of the wrist flexors and pronator teres, and is 7-10 times less common than lateral epicondylitis. Occurs when performing repetitive rotational movements with the hand, golfers, baseball players, gymnasts, assembly workers, and seamstresses suffer. The painful area is localized on the inside of the elbow joint.

Causes of epicondylitis

At the bottom of the humerus there are two large protrusions - the epicondyles. They serve as attachment points for the tendons responsible for the movement of the hand. In this case, the tendons of the wrist extensor muscles are attached to the external epicondyle, and the wrist flexor muscles are attached to the internal epicondyle. Decreased elasticity or strength of the forearm muscles, repetitive unnatural movements, and direct trauma damage the tendons and periosteum of the epicondyles. Epicondylitis, or inflammation of the epicondyle, occurs as an acute condition but in many cases becomes a chronic problem.

Overload of the hand extensors leads to lateral, or external epicondylitis. This form of pathology is called “tennis elbow”, as it is often found among tennis fans. Golfer's elbow, or medial epicondylitis, affects office workers when using an uncomfortable keyboard or mouse. In this case, the flexors of the hand and fingers, attached to the internal epicondyle, are most affected.

Diagnostics

The doctor makes a diagnosis of tendonitis of the elbow joint based on examination and medical history (trauma, sports, predisposing professional activity). To confirm the diagnosis and assess the severity of changes in the tendon, additional studies are indicated.

Ultrasound is informative in case of injuries; it reveals ruptures of collagen fibers, bursitis, and synovitis.

X-rays provide information about the condition of bones and cartilage. Deformation of the joint structures indicates tendonitis against the background of arthritis and arthrosis.

CT and MRI are the most informative; they allow one to assess the degree of tendon damage and identify islands of fatty degeneration, calcifications, and fibrous nodules.

Laboratory studies of synovial fluid and blood help to establish the root cause of secondary tendinitis (gout, rheumatism, tuberculosis, etc.). The level of leukocytes, uric acid, C-reactive protein, rheumatoid factor, etc. is informative.

Treatment

To treat elbow tendonitis, it is important to identify the cause of the pathology. Treatment of a disease that is complicated by tendinitis is often indicated. After injuries, joint fixation is indicated. For the purpose of immobilization, a plaster splint is applied for 2-3 weeks or the joint is fixed using rigid, semi-rigid orthoses.

Next, the rigid fixation is replaced with elastic supports and bandages with silicone inserts. Immobilization prevents further trauma and promotes healing.

Medications

For acute pain and severe swelling of the joint, glucocorticoids (Triamcinolone, Kenalog, Diprospan, Hydrocortisone or Dexamethasone) are prescribed. Hormones are used in short courses due to significant systemic side effects, including progression of tendon degeneration.

If the disease is infectious, the doctor prescribes antibacterial drugs.

Nonsteroidal anti-inflammatory drugs relieve inflammation, eliminate swelling and pain. Apply topically in the form of ointments (Nurofen, Finalgon, Ortofen, Indomethacin, etc.), applied 3 times a day, rubbed into the skin. Systemic NSAIDs are indicated for severe inflammation and persistent acute pain (Diclofenate, Nimesulide, Ketorolac, Ibuprofen, Meloxicam).

NSAIDs have side effects: they can cause drowsiness, dizziness, nausea, vomiting, diarrhea, skin rashes, and swelling. Possible blood changes: anemia, leukopenia, thrombocytopenia. They cannot be used for gastric and duodenal ulcers, liver, kidney and heart failure, pregnancy and lactation, and children under 12 years of age.

“HYAL-IN” and “HYAL-IN PROLONG” are biological products based on hyaluronic acid, which is part of connective tissue. Penetrating into the intercellular spaces, the drug stimulates metabolism, accelerates the regeneration of ligaments, cartilage, joint capsules, and synovial membranes of muscles.

Reference! Biological products “HIAL-IN” and “HIAL-IN PROLONG” have no side effects and no restrictions on the duration of use. Indicated for tendonitis of any etiology, degenerative-dystrophic changes in tendon-ligament structures and soft tissues.

Physiotherapeutic procedures

In subacute tendonitis, hormones and NSAIDs are preferred to 5-7 physiotherapy procedures, which accelerate tendon regeneration and have no side effects.

Laser therapy stimulates metabolic processes in cells, potentiates the healing of collagen fibers, and activates the local immune response.

Magnetotherapy. The electromagnetic field improves blood supply to the tendon, thereby increasing the flow of nutrients and bioactive substances into the cell.

UHF therapy helps resolve swelling, eliminates pain, and increases range of motion.

Electrophoresis is the effect of weak electric current discharges on the affected joint. A metal plate is placed on top of the napkin soaked in the preparation. When current passes, drug molecules penetrate directly into the area of inflammation, which is effective and safe.

After the elimination of acute phenomena, physical therapy (stretching exercises) is prescribed.

Reference! If conservative therapy is ineffective, surgical treatment is indicated - excision of the inflamed tendon.

Symptoms of epicondylitis

The main and often only symptom of epicondylitis is pain. Usually it is aching or pulling, and occurs or intensifies after movements with the hand. Located in the area of the elbow joint, such pain often “radiates” to the forearm or hand. With external epicondylitis (“tennis elbow”), the external epicondyle hurts. The pain spreads to the back of the forearm and intensifies when the hand is extended. A sharp increase in typical pain is observed when trying to straighten the hand against the resistance created by the other hand. Pain from medial epicondylitis occurs in the inner part of the elbow. They can be felt along the lower part of the forearm and become worse when the wrist is flexed. During an exacerbation, the area of the epicondyle may swell moderately and become especially sensitive to touch.

Treatment Options

You should consult your doctor with any questions regarding your health. Standard prescriptions for inflammation of the epicondyles include measures such as:

non-steroidal anti-inflammatory drugs,
physiotherapeutic procedures (magnets, ultrasound, electrophoresis),
therapeutic blockades with steroid hormones,
if therapy is ineffective - surgery.

All of the above methods only affect the symptom, but not the cause of epicondylitis. Anti-inflammatory pills harm the stomach, liver and kidneys, the results of physiotherapeutic treatment are not always noticeable, “heavy artillery” in the form of blockades can destroy healthy tissue and affect hormonal levels, and the effectiveness of operations is minimal compared to their risk. The greatest effect is achieved only by influencing the source and cause of pain - the muscles, tendons and nerve endings of the elbow joint. It is advisable to temporarily or completely eliminate the factor that caused the onset of the disease. To do this, it is worth bringing your workplace into compliance with orthopedic standards and convenience, choosing the optimal height of the table, chair, location of the keyboard, mouse or work tools. Special exercises and massage of the forearm, elbow and hand show good results.

Modern solutions for prevention and treatment

For most patients with acute or chronic epicondylitis, properly fitted orthoses provide excellent results. In the case of severe and persistent acute pain, it is rational to create complete rest for the hand and elbow. Oddly enough, fixing the hand helps more in such cases. It is the flexors and extensors of the hand that “pull” the epicondyles and cause typical pain. The best solution is a moderate to rigid wrist splint. After stabilization of hand movements and complex special therapy, it is possible to reduce the intensity of the pain syndrome and achieve tangible comfort. For maximum effect, it is also recommended to use a scarf bandage, which guarantees rest and support for the elbow and forearm.

Both during periods of exacerbation and chronic pain in the elbow, special elbow pads, called epicondylitis orthoses, help eliminate the problem. The most effective orthoses have the following characteristics:

availability of a certificate, instructions in Ukrainian;
a proven manufacturer operating in many countries;
anatomical shape and knitting;
warming or breathable hypoallergenic material;
moderate compression to reduce pain;
special silicone inserts for fixing the epicondyles and providing a massage effect;
correctly positioned straps for fixing and changing the tension of the forearm muscles;
maximum comfort during long-term wearing, etc.

Medtechnika Orthosalon presents only certified and most effective orthoses for the treatment of epicondylitis of the elbow joint. Their shape, material, placement of inserts, stripes and straps were designed specifically to solve the problem of tennis elbow and golfer's elbow. Comfortably fitting and gently pressing fabric of the retainer relieves pain and swelling, silicone inserts pleasantly massage and stabilize the epicondyles, durable straps correct the tension of the tendons, relieving the load on the bone tissue.

Considering that in most people, epicondylitis can reappear even after complete recovery, the use of an elbow pad will be useful not only during the illness, but also during periods of increased stress to prevent relapse. A large selection of high-quality orthoses, serious experience and responsibility of Medtechnika Orthosalon consultants guarantee the selection of the most suitable solution for any problem and budget.

Prevention

To prevent elbow tendinitis, do not overload the joints, avoid repeated monotonous movements, group correctly when lifting weights, do not make sudden movements, warm up your muscles before training.

To increase the strength and elasticity of tendons, include beef, beef liver, eggs, vegetable oils, dairy products, fish, bell peppers, and nuts in your diet.

Fatty foods, black tea, coffee, chocolate, sorrel, radish, as well as hormonal contraceptives block the absorption of calcium, which is necessary for the functioning of muscles, ligaments, and tendons.

Important! A drug based on long-acting hyaluronic acid “HYAL-IN PROLONG” stimulates the metabolism of connective tissue structures, accelerates regeneration in case of microtrauma, and prevents inflammation. Indicated for long-term preventive use by athletes during professional activities with a high risk of tendinitis.

Timely initiation of comprehensive treatment of tendinitis will avoid surgical intervention. Elbow pain indicates the need for medical examination and treatment. The earlier therapy is started, the more effective the treatment and the more favorable the prognosis.