Expert: Dr. J. Shawn Leatherman - 7/14/2006

Question
I have developed tendonitis in my right elbow over the last few weeks. At times it is not too bad, and at other times it can be quite painful.
The location of the tenderness is - if I were to put my arm straight out, with the back of my hand facing up(hurts when I do this, by the way), it is the first "bump" as I feel down from the top of my arm, at the elbow location . Hope that makes sense.
I am a golfer, but I have been playing for 25 years with no problems whatsoever up until now. Could I have just injured it somehow? What can I do to rehabilitate it? Should I use ice or heat on it?
The funny thing is - it doesn't really hurt when I swing a golf club.
Any recommendations, etc. will be greatly appreciated.
Thanks,
Dave


Answer
Dear Dave,

Tendinitis at the elbow is always the result of an overuse injury.  When you use the elbow joint repetitively, there are microtears that occur at the junction of the muscle and the bone, which is the tendon, and inflammation and pain is the result. The tendon attaches to the covering of the bone which is called the periosteum, and this structure is loaded with pain sensitive receptors that communicate with the brain.

From what you have described, it sounds like you have what is called lateral epicondylitis, a.k.a. Tennis elbow.  This is due to extension of the elbow, and wrist extension with a motion called supination (rolling the palm outward from the body).  Interestingly enough, if the pain was on the other side of the elbow, that is medial epicondylitis, a.k.a. golfer's elbow!  This is caused from hammering, using screwdrivers, or swinging your arm across the body and pronation of the arm (rolling the palm toward the body).

The bottom line is what ever your problem is, the treatment is the same for both problems.  First thing to do is ICE and REST the area.  Remember this is an overuse problem.  An ice pack over the area of pain for about 20 minutes 3 to 4 times a day will help reduce the inflammation.  In addition when your pain starts to be reduced, manual therapy of the involved muscular attachment is effective.  Cross friction massage, and  manual mobilization of the muscular structures alleviates the buildup of abnormal scar tissue as the area heals, and breaks up any adhesions that may have formed.  You may also choose to have the joint evaluated for any fixations, and if present, adjusted for proper mobilty by a chiropractic physician.

Lastly there is an inexpensive brace you can buy to help reduce the tension placed on the musculo-tendinous structure while you recover, and while you use the arm.  You should be able to find the brace at any sporting goods store, or local pharmacy that has supports.  It works by applying tension below the insertion point of the tendon into the bone, therfore creating a new stress point more towards the belly of the muscle, which reduces the stress on the tendon (this point is about 1 inch below the elbow) These braces look like a small cuff with either an elastic cosure or velcro closure and con be adjusted to apply pressure.  The good ones have a foam pad for equal distribution and comfort.  They run about $10.00 to $22.00 depending on the quality, but any of thenm will help.

Okay Dave, that's it.  This is a relative easy injury to recover from and you should notice improvement within the first week.  If the pain continues or gets worse, you should have a more indepth analysis of the joint in case there is any internal derangement or biomechanical dysfunction that I am not able to ascertain.  Obviously a physical exam of the area will yield more information about the condition.  Good Luck.

Respectfully,
Dr. J. Shawn Leatherman