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Strengthening exercises stimulate growth of new connective tissue in elbow tendons.
Overuse of tendons that move the fingers, wrist and elbow can lead to painful conditions caused by inflammation and subsequent breakdown of connective tissue. The terms tendinitis and tendinosis describe these types of tendon injuries. Although the symptoms frequently overlap, these are distinct conditions that require different treatment approaches.
Several tendons in the elbow can develop tendinitis or tendinosis. Muscles that straighten the fingers and bend the wrist backward attach via a common tendon to the bony prominence on the outer elbow. The tendon attached to the bony point on the inner elbow is the joining point of muscles that bend the fingers and wrist forward. Tendinosis or tendinitis can also affect the biceps tendon in the front of the elbow crease.
Elbow tendinitis is caused by inflammation of a tendon that attaches one or more muscles to an elbow bone. Elbow tendinitis is characterized by pain, swelling, redness and sometimes warmth over the elbow. Symptoms start soon after an aggravating activity, often repetitive wrist and elbow movements with gripping. Pain is typically located where the tendon attaches to the bone.
Tendinitis typically resolves within a few days to 2 weeks with early treatment. Later diagnosis may require up to 6 weeks for recovery. Treatment aims to decrease inflammation in the tendon. Antiinflammatory medications, such as diclofenac (Voltaren) and naproxen (Aleve, Naprosyn), are often prescribed to treat this condition. Cortisone is sometimes injected directly into the tendon to decrease inflammation and swelling.
Rest is recommended to allow the tendon to heal. Frequent or repetitive use of the muscles that move the fingers, wrist and elbow can provoke tendinitis. Deep friction massage is used to decrease tightness in the elbow tendons and promote healthy scar tissue formation after the inflammation has subsided.
Elbow tendinosis involves degeneration of a tendon caused by microtrauma. Tiny tears develop in the tendon with overuse of the muscles attaching to the elbow, aging or decreased blood flow. This condition develops over a longer period of time than tendinitis. By the time pain and weakness are evident, this condition has already been established in the affected tendon. In addition to a physical examination, doctors often use ultrasound and magnetic resonance imaging to diagnose tendinosis. These imaging tests show loss of collagen, which is the connective tissue that makes up a tendon. Reduced collagen makes the tendon unstable, leading to tiny tears.
Recovery from tendinosis typically takes 6 weeks to 6 months, depending on how long it has been present. Treatment of tendinosis aims to maintain joint mobility and flexibility, decrease pain and improve strength. Cortisone injections are sometimes given for short-term pain relief with this condition. However, these injections may cause further degeneration of the tendon, which increases the risk for recurrent tendinosis in the future.
Deep friction massage is performed to stimulate growth of new connective tissue. Relative rest is key to recovery from tendinosis. Use of the muscles in the wrist or elbow is limited as much as possible to reduce stress on the healing tendon. A counterforce strap wrapped around the forearm can reduce tension on the tendon with movement. Ice is applied to the affected area for 15 to 20 minutes several times each day to decrease pain, particularly after activities that use the injured tendons.
Exercises are often prescribed to treat elbow tendinosis. Eccentric strengthening -- resistance applied to the muscles during the "lowering" phase of a movement -- has been shown to be effective. For example, to strengthen the tendon on the outside of the elbow, a dumbbell is held with the hand in a palm-down position, forearm resting on the thigh. The opposite hand lifts the hand with the weight and bends the wrist backward. From this position, the injured hand slowly lowers the weight down until the wrist is fully bent. This is typically repeated 10 times, once daily.