Elbow Tendon Pain

Kara Giannone

March 24, 2022

What?

When you think of elbow tendon pain, the phrases “Golfer’s Elbow” and “Tennis Elbow” probably come to mind.

Like many common musculoskeletal conditions, history often bestows a name that could be a little misleading.  Elbow tendon pain doesn’t just happen to those that play golf or tennis – in the same way that “Student’s elbow” doesn’t just happen to students and “Housemaid’s knee” doesn’t just happen to housemaids!

You may also hear them incorrectly referred to as lateral or medial epicondylitis or tendonitis in which the “itis” suffix refers to inflammation. However, we now know that in fact very little inflammation is present. 

Instead, at the heart of this condition is a disarray of collagen within the tendon structure. Therefore, the more accurate terminology is common flexor origin tendinopathy (Golfer’s elbow) and common extensor origin tendinopathy (Tennis elbow).

Whilst Golfer’s and Tennis elbow may be the most common sources of tendon pain at the elbow, biceps and triceps tendinopathies can also occur. This newsletter will investigate the assessment and management of elbow tendon pain and other potential differential diagnoses. 

How?

As with almost every musculoskeletal injury, tendinopathies are considered an overload injury, whereby an increase in tasks loading the tendon results in trauma to the collagen of the tendon. Continued repetition of the activity (for which the tendon was unprepared) results in a situation in which the rate of breaking down of the collagen structure exceeds the rate of your body’s ability to repair it.  For example, you may have changed your exercise or work routine or started a new hobby such as gardening or painting in the last 3-6months. 

Examination:

Your physiotherapist will perform a comprehensive subjective and objective assessment in order to diagnose your elbow tendon pain.

Subjective Findings

Objective Findings

  • The tendon will be tender to palpate
  • Increased tightness in the muscles of your arm 
  • Weakness of wrist, elbow and often, shoulder muscles 
  • Reduction in grip strength 

Treatment:

Load management

As tendinopathies are considered an overload injury, “relative rest” is required. Tendons do not respond well to complete rest as by doing so you actually reduce the capacity of the tendon making it much harder to return to the activities you love. Your physiotherapist will be able to give you advice regarding factors that may be contributing to your pain such as modifying your work set up, exercise technique or exercise load. Important roles of the physiotherapist are:

1. Establish the best methods to reduce and manage your pain: This may include techniques such as soft tissue release, dry needling, bracing or cryotherapy. 

2. Provide exercise for rehabilitation:  Establish the best course of action required to rebuild the weakened tendon and the individual person.

There is no one size fits all approach! 

In some cases, we need assistance to help compliment the treatment and this may come by way of medical interventions. 

Medical Interventions 

In cases where elbow tendon pain is difficult to settle, anti-inflammatory medication or cortisone injection may be required. However, it is worth noting that research suggests only short-term relief (on average 6 weeks) from cortisone injection for irritable tendons, however poorer outcomes in the long term. This is likely because the individual may have failed to properly rehabilitate the tendon. Therefore, cortisone injections should only ever be used to settle an irritable tendon in order to give the patient the means to engage in the rehabilitation exercises needed to provide longer lasting relief. Shockwave therapy is another modality that can be delivered in conjunction with an individualised exercise program. Shockwave therapy is a non-invasive intervention whereby shockwaves are passed through the skin to the tendon to block nerves that transmit pain. Your physiotherapist will be able to discuss these options with you if necessary.

About the Author

Kara Giannone is a Physiotherapist at Grand Slam Physiotherapy Geelong. Kara has completed her Masters’ Degree in Sports Physiotherapy and has a special interest in managing tendinopathies.

References

Girgis, B., Duarte, J.A. (2020). Efficacy of physical therapy interventions for chronic lateral elbow tendinopathy: a systematic review. Physical Therapy Reviews, 25(1), 42-59

Kane, S., Lynch, J., & Taylor, J. (2014). Evaluation of Elbow Pain in Adults. American Family Physician, 89(8), 649-657