Tendon irritation can occur in many parts of the body, especially in your joints that are used often for day to day activities. In particular, the tendons in the elbow are often aggravated as they are used in the majority of everyday activities. The symptoms, also known as tennis elbow or golfers' elbow, usually go away with early treatment in milder cases. However, if the tendon strain/damage remains undetected - and above all if it is left untreated - there is an increased risk of long-term damage.
How does an elbow tendon irritation occur?
The elbow is surrounded by muscles that originate in the upper arm and stretch over the elbow joint and down to the wrist. They can be divided into flexor and extensor muscles, with the flexors on the inside and the extensors on the outside of the elbow. There they are connected with strong bony protrusions, the epicondyles, which are located on the elbow-side end of the upper arm. When the muscles are tensed, a tension pressure is created where the muscles attach to the bone. At first this is not a problem. However, if uniform movements are repeated over long periods of time - for example working with a mouse or keyboard all day - this can lead to issues in the joint. Lifting heavy loads, using large heavy tools as well as repetitive actions in work like cleaning and sports are among the more common causes of elbow irritation. This results in very mild injuries to the muscle attachments on the elbow, known as microtraumas. These mostly go unnoticedd, as pain only occurs when inflammation develops over time. The issues are usually localised and reversible if treated early.
However, if the initial causes are not stopped and no treatment takes place, the condition will progress, advancing to full blown golfer’s and/or tennis elbow. As a result, the pain occurs more frequently even without aggravation. The inflammation causes connective tissue scars and calcium deposits to form at the muscle attachment. These are no longer recoverable, and in the late stages, the irritated tendon becomes much more prone to rupture.
How is tendon attachment irritation noticeable?
The localised pain that occurs when bending ( golfer's elbow ) or stretching ( tennis elbow ) the wrist against resistance is typical of tendon insertion irritation. Tense muscles or swellings can often be felt at the tendon attachments, and the inflammation can also lead to overheating and reddening of the skin in the affected area. The muscle attachments on the inner or outer elbow are also tender when pressed. As the condition progresses, normal use of the arm becomes virtually impossible without resulting pain and potential damage.
Therapy of tendon irritation - protection and inflammation control
The basic treatment principles are the same for both golfer’s and tennis elbow: Focusing on relieving tension in the tendons and minimising inflammation. There’s a range of treatment options available, but the first step must be to avoid any of the activities that flare up the condition. Full immobilisation of the arm is usually unnecessary, instead compressive sleeves or bandages with massage pads work to address the pain. Anti-inflammatory and pain-relieving ointments or tablets can also help reduce pain and swelling. Physiothepary treatment can help a lot, especially when practising stretches and exercises at home. Some particular actions to help include :
- Exercises and stretches to reduce muscle tension
- If necessary, posture correction and movement training with a physio
- Manual treatment of the tendon attachments
- Electrotherapy (pain relieving TENS currents, iontophoresis)
- Ultrasound treatment
- Cold therapy (short-term ice treatment)
A direct injection of cortisone to combat inflammation is only used in exceptional cases, however, as the active ingredient can further damage the tendon and should only be done under clear recommendation of a clinician. Instead, injection of botulinum toxin (botox) into the affected muscles has recently been shown to be effective. This causes a temporary paralysis of the treated muscles, which effectively relieves the tendon attachments, which in turn leads to a rapid improvement in the symptoms. However, it should be noted that Botox is a neurotoxin despite everything and should therefore not be used too often, and only under the clear direction of a physician.
An operation should only be considered in the following instances
- the symptoms have become chronic
- calcifications or tendon ruptures occur
- conservative therapy does not work
- there are frequent recurrences of the same issue
The most common surgical procedures are:
- Tendotomy (transverse or longitudinal partial transection of the tendon)
- Denervation (sclerotherapy of the nerves in the affected area).
Both of these methods can also be combined.
Relief through supports and bracing orthotics in the event of irritation of the tendons on the elbow
Quality supports such as the EpiTrain were developed to support the treatment of tendon irritation as effectively as possible. The EpiTrain active support does not restrict freedom of movement and still offers comfortable compression of the affected muscle attachments. The compression promotes the relaxation of the muscles, reduces the muscle pull on the irritated area and the associated pain.
Concurrently, it helps reduce inflammation-related swelling of the soft tissue (oedema) and thereby relieves the nerves and blood vessels. The specially designed flat knit compression of the EpiTrain also guarantees a perfect fit and a high level of comfort. It is particularly skin-friendly, breathable with optimal ventilation to prevent overheating in the painful area. The EpiTrain active support, together with the other treatment measures effectively promotes the healing process.