Elbow tendonitis
Due to the number of recent injuries in football in the first half of the season, we are back discussing another football related injury. Recently, Brett Favre of the Minnesota Vikings has reportedly been suffering from elbow tendonitis. The 20 year veteran has had his fair share of injuries in his storied carrier, some serious some minor. Although elbow tendonitis is a nagging and painful injury, it is not something that may put his consecutive games started record, which reached 291 with Sunday’s game against Green Bay, in jeopardy.

 
Definition and Symptoms of Tendonitis of the elbow
Tendonitis is the inflammation of tendon. The tendon is a connective tissue that connects the muscle to the bone. Tendonitis is usually related to an acute strain, and if not properly cared for, can become a chronic issue. Symptoms of tendonitis are pain and tenderness over the tendon and it's insertion into the bone, as well as pain upon movement of the muscle or joint where the tendon has a direct biomechanical relation. In this article we will discuss tendonitis of the elbow.
 
The two types of tendonitis that affect the elbow are tennis elbow (lateral epicondylitis) and golfers elbow (medial epicondylitis). If you wrap your hand around your elbow and you will feel two bumps, one on the inside, and one on the outside. These are your condyles. This is where the muscle attaches and inflammation of one of these areas is either medial or lateral epicondylitis.
 
 


Lateral Epicondylitis
Lateral epicondylitis is the more common of the two. Tennis elbow, also sometimes referred to as archer’s elbow or shooter’s elbow, causes pain on the outside of the elbow where the extensor muscles of the forearm attach. The extensors muscles of the forearm have two main functions: extension of the hand (or to bend your wrist back), and external rotation of the arm below the elbow (turning your thumbs out is an example of external rotation). The main muscle usually involved in this type of injury is the Extensor carpi radlias brevis (ECRB). This muscle’s main function is extension and abduction, which means the wrist extends back and moves the thumb to the outside. Although named Tennis elbow, tennis players are not the only ones to suffer from this injury. Others who suffer from this are baseball, football, and hockey players as well as gardeners, assembly line workers and house cleaners.
 
Anything that causes a repetitive extension of the wrist can cause tennis elbow. This constant stress is what causes damage to the area over time; very rarely will we see a case of lateral epicondylitis that happened all of a sudden or from one specific event. Although, this area can have acute flare ups and must be treated as an acute injury, not as chronic. We call this an acute exacerbation of a chronic condition. From the repetitive strain to the area, a weakness will develop in the extensor musculature (usually in the ECRB). Most of the movements in our daily lives involve what is called flexor dominance; this means we use our flexors more through the day than the extensor group. For example, using a computer all day predominantly requires the use of   flexor muscles. As the flexors become stronger, they will begin to shorten, which will cause a stretching of the extensor muscle group, including extensor tendons and insertions. In the case of tennis elbow, extensors connect the lateral epicondyle. These tendons begin to stretch near and at the insertion point, and will develop micro tears. These micro tears cause pain, irritation, tenderness, and inflammation of the area, which  lead to lateral epicondylitis pain. Some of the symptoms of lateral epicondylitis are pain or burning on the outside of the elbow, tenderness over the lateral epicondyle, weakness of grip strength, and pain in the elbow upon extension of the wrist.

 
Medial epicondyltis is an injury very similar to tennis elbow. However, the pain is on the inside of the elbow and affects the flexor muscle group rather than the extensors. Medial epicondylitis, most commonly known as golfer’s elbow, is the most common injury to the medial portion of the elbow, but is about 5-10 times less common than lateral epicondylitis. The injuries

are very similar in the fact that they are both caused by overuse or muscular imbalance. The flexor muscle group of the forearm has two main actions: flexion of the wrist and fingers, and pronation (turning the palm down) of the wrist. Medial Epicondylitis can occur from the repetitive stress of work, sports, or from an acute injury. Athletes most commonly affected by this condition are golfers, pitchers, bowlers, and weightlifters. The people in the work force most commonly affected have a frequent turning of the wrist motion on the job such as construction workers using a hammer or screw driver. This injury can also come from a specific trauma such as hitting a divot with a golf club or a hard pitch thrown improperly. The muscles most commonly involved are the pronator teres and flexor carpi radialis. These muscles make up the flexor compartment of the forearm; their main functions are to adduct the wrist (bend towards pinky) and flexion of the wrist and hand.

The symptoms are also similar to lateral epicondylitis, but with this injury, the pain and tenderness is felt on the inside of the elbow. Other actions that can cause pain are pushing open a door, opening a jar, or anything that requires flexing the wrist against resistance. In some cases one may experience pain radiating down the inside of the elbow and forearm. This is due to irritation of the ulnar nerve caused by inflammation of the medial epicondyle and attaching tendons. Patients who suffer from this may also notice a weakness in grip strength.
 
Examination and diagnosis
The diagnosis of elbow tendonitis is a fairly straight forward process that can almost always be diagnosed with a simple history of the problem. There are several different types of ailments that can affect the elbow, so your doctor may run a few orthopedic tests to pinpoint the problem. In some severe cases with an increased amount of inflammation, the entire elbow may be sore. This could call for imaging of the elbow with either an x-ray or MRI. An x-ray is not needed to diagnose a tendonitis issue, but your doctor may use it to rule out other causes of pain. The reason x-rays are not commonly used to diagnose a tendonitis is because soft tissue such as muscle and tendons rarely show up on x-ray. If the case is severe an MRI may be ordered, but this is an uncommon step unless your doctor wants to rule out a complete tear or further underlying issues.
Once the tendonitis has been pinpointed to either the medial or lateral location, your doctor will run you through basic range of motion tests to see which areas are limited. This will help your doctor design a more appropriate rehab program.
 
This article contains the opinions and examples of treatment plans for injuries from Mountain View Pain Center in Centennial, CO, and is not intended as a substitute for specific medical advice from your doctor regarding your specific injury or condition. If you have any further questions or concerns feel free to contact our office or leave a comment below.

 Look For Part 2 next week on ChiroEco.com.

Author Bios

Ihsan Erhuy, DC and Niall McNally, DC of Mountain View Pain Center

We are both graduates of Parker College of Chiropractic and because of our love for sports we have decided to specialize in sports medicine and open a practice in Centennial, CO. We are the official sports medicine doctors for the Susan G Koman Breast Cancer 3-day of Denver, CO. We are involved in the community as the team doctors for a pair of semi pro football teams in the Colorado Football Conference, the Mile High Grizzlies, and the Denver Titans. We are also the athletic doctors for several local high schools located in Littleton, CO and Highlands Ranch, CO. We volunteer for events such as American Cancer Society's Relay for Life, Walk to Empower as well as many other volunteer events.

 In addition to our practice, we are active writers for Midwest Sports Fans and Advance Healing magazine. Our practice Mountain View Pain Center is located in Centennial, CO which is a suburb of Denver,CO and we specialize in Chiropractic care and Physical Therapy. If you want more information about us please feel free to visit our website at www.mountainviewpaincenter.com.