Elbow Tendinitis

ΠΕΡΙΕΧΟΜΕΝΑ

Elbow tendinitis (otherwise known as epicondylitis) constitutes one of the most frequent, persistent, and often debilitating conditions of the musculoskeletal system. The elbow joint is a pivotal point for the movement of the entire upper limb, as through it forces are transferred from the shoulder toward the palm and fingers. Consequently, when the tendons supporting this region become inflamed or undergo degeneration, the patient’s daily life is dramatically affected.

This condition makes its appearance primarily in adult individuals, and more specifically in those belonging to the productive age group from 30 years up to 70 years old. In the majority of cases, it appears in individuals with intense sports activity (racket athletes, weightlifters) or even in individuals whose occupation presupposes manual labor on a daily basis (such as plumbers, painters, carpenters). However, it is extremely possible to present also in individuals who are not athletes or whose work does not presuppose heavy manual labor. In the modern digital era, a huge percentage of patients with elbow tendinitis are office workers, who spend countless hours in front of a computer, using the keyboard and mouse with poor ergonomics.

What is Elbow Tendinitis and how is it created?

To understand the condition, we must look at how tendons function. Tendons are strong, fibrous bands of connective tissue that join muscles to bones. In the elbow, the tendons of the forearm muscles attach (end) at two characteristic bony prominences at the lower part of the humeral bone, which are called epicondyles (lateral and medial epicondyle).

Tendinitis is created by overuse. The continuous, repetitive contraction movements of the forearm muscles exert huge mechanical tension at the point where the tendon joins the bone. When this tension exceeds the tolerance limits of the tissue, microscopic tears (micro-injuries) are created in the collagen fibers. If the body does not manage to heal these micro-tears due to continued strain, a process of inflammation begins.

In advanced stages, the condition ceases to be a simple inflammation (“-itis”) and turns into tendinopathy, meaning a permanent degeneration and structural alteration of the tendon’s quality, a fact explaining why the condition can become exceptionally persistent.

Ο μόνος Ορθοπαιδικός στην Ελλάδα στην χειρουργική ώμου και άνω άκρου με προϋπηρεσία μόνιμης διευθυντικής θέσης (substantive Consultant ) για 10 συναπτά έτη στην Μεγάλη Βρετανία

Into which categories is elbow tendinitis distinguished?

Tendinitis (or epicondylitis) is medically distinguished into two basic types, depending on the exact anatomical spot at which the lesion is located and the specific tendon that has been affected. More specifically there is:

Lateral elbow tendinitis (Tennis Elbow)

It constitutes by far the most frequent type of epicondylitis. It is medically called lateral epicondylitis and refers to the inflammation of the common tendon of the extensor muscles. These muscles are responsible for the extension (lifting upward) of the wrist and fingers.

The pain is located on the external, lateral side of the elbow. Despite its name (Tennis Elbow), less than 5% of patients suffering from it play tennis. It appears frequently in people who make repetitive movements with their wrist (such as screwing, squeezing tools, computer mouse use, haircutting, or intense cleaning).

Medial elbow tendinitis (Golfer’s Elbow)

This condition is less frequent than lateral epicondylitis and is medically called medial epicondylitis. It concerns the inflammation of the common tendon of the flexor muscles, meaning the muscles we use to bend the wrist inward and close the fingers creating a tight fist.

The pain in this case is located on the inner side of the elbow (toward the side that touches our ribs). It is usually caused by activities requiring a powerful grip, throws, or bending of the wrist under resistance (such as the serve in tennis, golf, weightlifting and bodybuilding, or tasks with heavy tools).

Other Forms of Tendinitis in the Elbow

Apart from epicondylitis, less frequently observed are:

Biceps Tendinitis: Pain in the front (anterior) part of the elbow, usually from lifting heavy weights with a bent arm.
Triceps Tendinitis: Pain at the back of the elbow, due to violent extension of the arm.

Symptoms of elbow tendinitis

Epicondylitis, unfortunately, is one of the conditions characterized by intense, debilitating, and deep pain, sometimes on the inner and sometimes on the outer side of the elbow, which can worsen with the passage of time. There are cases where the pain is so sharp that it can radiate (travel) along the forearm down to the wrist or hand.

The most common symptoms include:

Localized Pain: Pain centered on the bone of the elbow, which increases dramatically when you palpate or press the area.
Sensation of weakness in the wrist and reduced grip: The patient discovers that they no longer have the strength to hold objects. Even holding a coffee mug, a pen, or a pot can become impossible.
Painful handshake: The simple movement of squeezing someone’s hand or turning a doorknob causes pain that resembles a “sting”.
Morning Stiffness: A sensation of “catching” and tightness in the elbow in the morning as soon as you wake up, which improves slightly as the joint “warms up”.
Sensation of numbness in the fingers of the hands: Particularly in medial epicondylitis, due to the proximity of the area to the ulnar nerve, the edema can cause mild pressure translated into numbness.
Night Pain: In acute phases, the pain can appear even in a state of rest, disrupting sleep.

Diagnosis of elbow tendinitis

Valid diagnosis is the first and most critical step for correct treatment. The diagnosis of elbow tendinitis is made primarily through a thorough clinical examination by the specialized orthopedic doctor.

As in every medical examination, so in this specific one, the patient’s medical history constitutes the “A and Z”. The doctor will ask about your occupation, your sports habits, when the pain started, and which specific movements exacerbate it, in order to recommend the most appropriate treatment method for you.

Clinical Examination

In more detail, the doctor subjects the patient to a local tenderness test, carefully palpating both the inner and outer side of the elbow region.

In combination with the local tenderness test, the doctor will perform a specific diagnostic test on the patient. For example:

Cozen’s Test (for lateral epicondylitis): The patient makes a fist, turns the wrist upward (extension), and the doctor exerts resistance against them. If this causes sharp pain in the elbow, the test is positive.
Medial Epicondylitis Test: The patient bends their wrist inward under the doctor’s resistance.

Imaging Examinations

In most cases, the clinical examination suffices. However, in cases where the condition does not respond to treatment or the doctor requires a further picture, it is possible to ask the patient to perform additional examinations in order to exclude the possibility that symptoms originate from some other condition (e.g., arthritis, cervical radiculopathy, nerve entrapment syndrome):

Plain X-ray (X-ray): It helps to rule out osteoarthritis, any old fractures, or the presence of calcifications (calcium deposits) inside the tendon.
Ultrasound: An excellent and fast examination showing the thickness of the tendon, the presence of inflammation (hyperemia), and any small tears.
Magnetic Resonance Imaging (MRI): It is the most detailed method. It is used in persistent, chronic conditions to evaluate with absolute accuracy the degree of tendon degeneration (tendinopathy) or the existence of a larger tear that might need surgical management.

Treatment of elbow tendinitis

Following a thorough examination by the doctor, the patient receives the appropriate personalized treatment in order to stop the progression of the lesion and not suffer henceforth from epicondylitis.

Conservative Management (First Line)

Rest and Modification: The first step and the most important is for the patient to abstain immediately from the activity that caused the epicondylitis. It does not necessarily mean complete immobility, but avoidance of movements triggering the pain.
Medication: When the pain is unbearable or quite intense, then the appropriate medication is administered which includes taking simple analgesics and Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), either in the form of pills or in the form of topical gel.
Ice Therapy: In combination with the medication, ice can be applied (always wrapped in a towel) 3-4 times a day for about 15 minutes each time, especially after activity, to reduce edema.
Splint – Elbow Strap (Bracing): In cases where avoiding the activity that caused the epicondylitis is deemed impossible (e.g., due to work), the patient can use a specific compression splint for epicondylitis (the elbow strap). This is tied slightly below the elbow, absorbs vibrations, and changes the pull point of the muscles, so that when the patient makes the movement, the inflamed tendon remains protected.

Physiotherapy and Special Exercises

Targeted physiotherapeutic interventions have proven very effective.

Stretching and Strengthening: Mild stretches (stretching), which are followed by certain eccentric strengthening exercises (where the muscle produces work while lengthening), are the gold standard for the rehabilitation of tendons.
In order for the implementation of the exercises to be done in the correct way, it is important that they are initially done in the presence of a specialized physiotherapist, so that there are no further injuries to the area.
Shockwave Therapy: The physiotherapist, apart from monitoring and demonstrating the exercises, can soothe the pain with various modern means, such as for example extracorporeal shockwave therapy. The acoustic waves stimulate blood circulation and activate the natural healing process of the tendons, “breaking” the chronic scar tissue.

Biological Treatments (PRP Injections)

When classic conservative treatment does not yield after a few months, modern orthopedics turns to Regenerative Medicine. PRP (Platelet-Rich Plasma) injections constitute an exceptionally successful solution. A small amount of blood is taken from the patient, centrifuged to isolate the growth factors, and subsequently injected exactly at the spot of the damaged tendon, promoting its rapid biological regeneration without the side effects of traditional cortisone.

Surgical Management

In a small percentage of patients (approximately 5-10%), where pain persists for more than 6 to 12 months and dramatically affects the quality of life despite treatments, surgery is indicated. Modern techniques (such as minimally invasive surgery – MIS or arthroscopy) allow the surgeon to clean the damaged, necrotic tissue of the tendon and improve the blood supply of the area, securing a definitive solution to the problem. The operation is fast (usually Day Clinic) and recovery is rapid.

Prevention of Elbow Tendinitis

Prevention is always better than treatment. To avoid the appearance of the condition, follow these rules:

Ergonomics at the office: Adjust the height of your chair and desk so that the elbows form a 90-degree angle and the wrists are straight when typing. Use an ergonomic mouse.
Correct Sports Equipment: If you play tennis or padel, ensure that the thickness of the racket’s grip is correct for your hand and the strings are not excessively tight.
Warm-up and Stretches: Never start manual work or sports without 5-10 minutes of warm-up and stretches of the forearm muscles.
Listen to your body: If you feel a “pull” or fatigue in the elbow, stop the activity. Pain is the body’s warning signal.

A Few Words About the Doctor (Dr. Polyzois)

Managing persistent elbow conditions, such as tendinitis, requires high specialization and experience. Ioannis Polyzois is an Orthopedic Surgeon with vast experience across the whole spectrum of Orthopedics and specifically in upper limb surgery.

He constitutes the only Orthopedic surgeon in Greece in shoulder and upper limb surgery with certified prior service in a permanent directorial position (substantive Consultant) for 10 consecutive years in Great Britain. His work experience is not limited only to the Greek space but also abroad, and more specifically in the ultra-modern environment of London (NHS) of Great Britain, where he successfully managed thousands of complex cases.

The doctor’s philosophy focuses on honest communication with the patient, offering modern, evidence-based treatments and implementing innovative biological (PRP) or minimally invasive techniques when required, always with respect to the anatomy and aiming for a rapid return to normal life. You can contact him for all your concerns.

Cost and Prices for the Treatment of Elbow Tendinitis

The treatment cost for elbow tendinitis varies, as it depends directly on the stage of the condition and the therapeutic plan that will be chosen after the diagnosis. In our clinic, priority is the provision of medical services of the highest level with an absolutely transparent and affordable cost.

For the initial stages, where management includes a clinical examination, instructions, and prescription (medications, physiotherapies, splints), the cost concerns exclusively the medical visit. If the implementation of biological treatments of regenerative medicine is deemed necessary (such as Platelet-Rich Plasma – PRP infusions), the cost is shaped based on the specialized consumables required for their safe preparation within the clinic.

In the rare case that conservative treatment fails and surgery is scheduled, the cost is determined by the clinic expenses (usually extremely reduced, as it concerns a hospitalization of a few hours – Day Clinic). Our clinic cooperates excellently with all private insurance companies, while the use of the public insurance body (EOPYY) is also supported to cover a significant part of the expenses (medical tests, hospitalization). Following your examination, you will receive a full, clear, and personalized brief for every potential cost, without absolutely any “hidden” charge.

Movement is life! Contact the doctor for specialized orthopedic care, tailored to your needs.

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Συχνές ερωτήσεις

Can elbow tendinitis become chronic?

Yes, it is absolutely possible and happens frequently if the condition is not treated timely. If you continue to burden the elbow despite the pain, the acute inflammation (tendinitis) transitions into “tendinopathy”. This means that the tendon tissue itself undergoes permanent structural degeneration, loses its elasticity, and fills with scars, rendering the pain chronic. At this phase, simple anti-inflammatory pills cease to be effective and more dynamic treatments are required, such as PRP injections or physiotherapy with shockwave.

Can elbow tendinitis affect grip strength?

Absolutely. The huge reduction in grip strength (Grip Strength) is one of the most characteristic clinical symptoms. Because the tendons attaching to the elbow are the same ones controlling the muscles of your fingers, when these become inflamed, the nervous system reacts: as soon as you try to squeeze something (e.g., to open a jar or hold a pot), the brain reflexively “cuts” the power to protect the tendon from further tear. The result is that you feel your hand “empties” and objects drop from you.

Can I continue to exercise if I have elbow tendinitis?

Exercise is not fully forbidden, but it requires strict modification. You must immediately stop exercises causing pain (e.g., exercises with a racket, pull-ups, biceps/triceps curls, lifting weights that press the wrists). You can, however, continue aerobic exercise (running, cycling) and strengthening the core and legs. The “key” is the active rest of the specific joint. Returning to upper limb exercises must be done gradually and always in consultation with your doctor or physiotherapist.

Are there daily movements that burden tendinitis?

Yes, and usually they are movements we make mechanically without realizing it. The continuous use of the computer mouse with an extended wrist, typing at the wrong height, squeezing the steering wheel while driving, screwing, holding heavy grocery bags from the supermarket, wringing clothes or a mop, even the prolonged holding of the mobile phone, can trigger the pain. The patient must be educated ergonomically, so that they change the way they use their hands in their daily routine.

Can tendinitis appear in both arms?

Yes, bilateral appearance (tendinitis in both elbows) is a real phenomenon, although rarer than unilateral (usually in the dominant hand). It appears mainly in office occupations (typists, programmers) where both hands make exactly the same, repetitive micro-movements for hours, or in individuals who systematically lift weights with wrong technique with both limbs (such as movers or bodybuilders). In these cases, changing the ergonomics of the entire workspace is absolutely imperative.

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