Elbow Tendinitis Assessment and Treatment
Clinical Assessment
- The American Academy of Family Physicians recommends looking for insidious onset of load-related localized pain coinciding with increased activity in patients with elbow tendinitis 1
- Most patients with elbow tendinitis report engaging in a new activity or increasing intensity of current activity before symptom onset 1
- In early stages of elbow tendinitis, pain is present during activity but may subside after warm-up; later stages show increased pain intensity and duration, possibly present at rest 1
- Patients with elbow tendinitis typically describe pain as "sharp" or "stabbing" 1
- The American Academy of Family Physicians suggests inspecting for muscle atrophy, asymmetry, swelling, erythema, and joint effusions in patients with elbow tendinitis 1
- Note that atrophy suggests chronicity, while joint effusions are uncommon with tendinopathy and suggest intra-articular pathology in patients with elbow tendinitis 1
- The American Academy of Family Physicians recommends assessing range of motion, which is often limited on the symptomatic side in patients with elbow tendinitis 1
- Palpate for well-localized tenderness that reproduces the patient's activity-related pain in patients with elbow tendinitis 1
- Perform physical maneuvers that simulate tendon loading to reproduce pain in patients with elbow tendinitis 1
- Multiple symptomatic tendons should prompt evaluation for rheumatic disease in patients with elbow tendinitis 1
Imaging
- Plain radiography is the initial choice for acute injuries and may show osteophyte formation at epicondyles, degenerative joint disease, loose bodies, or fractures in patients with elbow tendinitis 1
- Plain radiography has limited ability to demonstrate soft-tissue changes of tendinopathy in patients with elbow tendinitis 1
- Reserve further imaging for unclear diagnoses, recalcitrant pain despite adequate conservative management, or preoperative evaluation in patients with elbow tendinitis 1
- Ultrasonography can show thickening and heterogeneous echogenicity in elbow tendinopathy 1
- MRI can show degenerative thickening of tendons, fibrovascular proliferation, and mucoid degeneration in patients with elbow tendinitis 1
Treatment Approach
- The American Academy of Family Physicians recommends relative rest to decrease repetitive loading of the damaged tendon in patients with elbow tendinitis 1, 2
- Avoid complete immobilization to prevent muscular atrophy and deconditioning in patients with elbow tendinitis 3
- Allow patients to continue activities that don't worsen pain in patients with elbow tendinitis 4
- Cryotherapy is recommended for short-term pain relief in patients with elbow tendinitis 2, 4
- Apply melting ice water through a wet towel for 10-minute periods for cryotherapy in patients with elbow tendinitis 2
- Eccentric strengthening exercises are proven beneficial in tendinosis and may reverse degenerative changes in patients with elbow tendinitis 2, 3
- Tensile loading stimulates collagen production and guides normal alignment of newly formed collagen fibers in patients with elbow tendinitis 4
- NSAIDs are recommended for short-term pain relief (no effect on long-term outcomes) in patients with elbow tendinitis 2, 3
- Topical NSAIDs may provide similar pain relief with fewer systemic side effects in patients with elbow tendinitis 2, 3
- Corticosteroid injections are more effective than NSAIDs for acute pain relief in patients with elbow tendinitis 2, 5
- Corticosteroid injections do not alter long-term outcomes in patients with elbow tendinitis 2, 3
- Deep transverse friction massage is recommended to reduce pain in patients with elbow tendinitis 3, 5
- Extracorporeal shock wave therapy (ESWT) is a safe, noninvasive option for chronic tendinopathies, though expensive in patients with elbow tendinitis 2, 3
- Surgical intervention is recommended if conservative treatment fails after 3-6 months in patients with elbow tendinitis 2
Special Considerations for Elbow Tendinopathy Types
- Lateral epicondylitis (tennis elbow) is seven to ten times more common than medial epicondylitis 5
- Lateral epicondylitis involves the dominant arm 75% of the time 5
- Lateral epicondylitis affects men and women equally, most common after age 40 5
- Lateral epicondylitis is common in racquet sports players and occupations requiring repetitive wrist flexion/extension 5
- Medial epicondylitis is less common than lateral epicondylitis 5