What is Elbow Tendinopathy?
Inflammation is not the most common cause of tendon pain. Rather, many small (micro) tears in the connective tissue around the tendon is the more common cause of tendon pain; this condition is sometimes termed as tendinosis. Note that we are not including tendon tears or ruptures - they are another matter altogether! Tendinopathy (and also peratenonitis) is becoming the term more commonly used by experts to describe tendonitis (inflammation) and tendinosis (small tears in surrounding tissue) together, as it is common for both conditions to occur collectively. Elbow Tendinopathy specifically relates to tendinopathy pertaining to tendons located within the area of the elbow joint.
Causes and Treatment for Tendinopathy
Overuse and repeated movements (RSI), sudden injuries, slow degeneration or just aging can all cause tendinopathy. Remember that healing is slow, and proper recovery is important to get your tendon back to proper health and avoid re-injury. BFST® treatment is quickly becoming very popular for treating this problem, as results have been very positive as long as the patient (1) keeps the area inactive throughout the healing process and (2) sticks to the treatment properly until healing has completed.
Patients with chronic tendonitis (long term tendinitis that won't go away) are instructed to avoid activities that aggravate the condition, as the tendon will not heal properly if it is constantly stressed through overuse. Occasionally, patients suffering from chronic tendonitis may have surgery on or injections of corticosteroids, but this is invasive and is a method of last resort after the physician has tried a conservative treatment regimen for the patient.
The four tendons that make up the elbow; the bicep tendon, the tricep tendon, the lateral epicondyle, and medial epicondyle tendon, are responsible for all major motions of the elbow joint, allowing it the range of motion that is expected. All of these tendons refer to either the name of the muscle or the muscle group that they are attached to.
Any injury to the tendons in your elbow joint can be referred to as elbow tendinopathy. The suffix "pathy" means suffering or disease, therefore tendinopathy is a general term that is used to describe any condition of a tendon.
To describe the exact injury of a tendon, the terms tendinitis (also spelled tendonitis), tendinosis, and tenosynovitis are used.
Tendinopathy is commonly used by health care professionals to refer to the combination of tendonitis and tendinosis in the same tendon. It is common for both to occur at the same time in a tendon.
Elbow tendons are fairly susceptible to injury, given the tremendous loads taken on by the elbow joint and the fact that we use elbow joint for so many things, it is almost always in motion unless we are resting. As you may or may not know, all tendons receive very little blood flow which is can prevent certain areas of the tendons from getting adequate blood supply in order to repair and maintain themselves. If the tendon can not repair itself as damage occurs, tendonitis and other tendon injuries begin to occur. In cases of chronic tendonitis, this is often the case - the tendons just cannot get the blood flow they need to repair properly; as this happens over time, the tendon just continues to slowly degrade over time.
The suffix "itis" means something is inflamed; therefore, the term elbow tendonitis is used when a tendon in the elbow joint is inflamed. Inflammation in an elbow tendon is often due to irritation and/or micro-tearing of the collagen fibers. When the fibers tear, they become weaker, inflamed and swollen causing pain and tenderness in the area.
There are 2 types of elbow tendonitis; acute and chronic. Acute tendonitis refers to inflammation that comes on suddenly, usually from an elbow injury such as a dislocation (not common) or overloading it during exercise. Chronic tendonitis occurs over time and generally results from long term repetitive use of one or more of the elbow tendons.
With both types of tendinitis, scar tissue develops on the tendon(s) as the tears try to heal. This scar tissue mends the tears in an abnormal way leaving the collagen fibers connected, but weaker and more prone to further injury. In the case of chronic tendinitis elbow tendon(s) may actually become thicker and less flexible with a build up of scar tissue over a long period of time, making it more prone to impingement in the subacromial space. Keep in mind that scar tissue is not flexible, so a buildup of scar tissue will most certainly create decreased flexibility.
The term tendinosis refers to the non-inflammatory, degeneration, and weakening of the collagen fibers in a tendon. This tissue break down is often caused by repetitive stress on the fibers of the elbow tendons and failure of the fibers to heal. When the rate of tissue damage exceeds the rate of healing, damage will continue to accumulate on the elbow tendon. Collagen fibers of the tendon deteriorate to a point where the once straight, strong, flexible bundle is weakened by abnormally formed fibers that look more like a mess of strands.
You may not feel any pain with tendinosis, which can lead to more damage as you continue to use the tendon. Since there is no inflammation either, you will not experience swelling, heat or redness.
Tenosynovitis, also called paratendonitis or peritendinitis, is a term used to describe inflammation and degeneration of the tendon's outer layer or sheath. Depending on the tendon, the sheath is also called the synovium or paratenon. Typically, the sheath is damaged when the tendon (contained by the sheath) swells and starts to cause micro splits in the sheath. This often leads to leakage of synovial fluid as well as scar tissue formation attaching the sheath to the tendon. This can cause a lot of pain:
- the lack of proper lubrication between the sheath and the tendon creates more friction and pain when this tendon moves
- there is often a bond created between the sheath and the tendon through growth of scar tissue (naturally created by the body when a sheath or tendon is damaged). Once this bond is there, any tendon movement will "pull" on the sheath and can be a major source of pain and frustration.
It is possible to suffer from tenosynovitis alone or in conjunction with the degeneration of the tendon(s), called tendinosis. In either case, as your body tries to heal, scar tissue forms inside the sheath attaching the inner tissues of the tendon(s) to its outer covering, the paratenon. This scar tissue limits the gliding movement of the tendon in the paratenon reducing the range of motion and causing pain, tenderness, redness and swelling.
Tenosynovitis is not uncommon in the elbow tendons, often showing up in cases of chronic tennis elbow and golfers elbow. Tenosynovitis of the long bicipital tendon (one of the two biceps tendons attaching the biceps to the humeral head at the shoulder) is fairly common as well. In the case of biceps tenosynovitis, a patient will feel pain in the rotator cuff and upper arm area; in some cases this pain may continue down to the elbow joint.
Tests for Elbow Tendon Injuries
Your doctor may take an x-ray to look for fractures, loss of joint space in the elbow, bone spurs or calcification in the corresponding tendons. An MRI may also be ordered to look at the soft tissue in the elbow joint. This will give your doctor a clear picture of the muscles, tendons and ligaments in the elbow, and will allow him or her to assess any damage.
These assessments, along with some range of motion tests performed by your doctor, will determine the treatment options available to you. Treatment options will likely include physical therapy, supervised stretching, targeted exercises, and conservative treatments such as Cold Compression Therapy and Blood Flow Stimulation Therapy™.