Tendinopathy is a common term used to describe conditions affecting tendons and causing pain, swelling and weakness / impaired function. Tennis elbow, golfers elbow and DeQuervain's tenosynovitis are the 3 most common tendinopathies we see in our clinic. These conditions are typically, but not always, caused by overuse and fall under the category repetitive strain injuries.
Tennis elbow / lateral epicondylitis
Tennis elbow, also known as lateral epicondylitis, is a type of tendinopathy affecting outside of the elbow. The group of muscles that move the wrist and fingers up (wrist and fingers extensors) starts just above the elbow with a tendon. Overloading the extensors muscles and tendons by repetitive movements can lead to micro-trauma inside the tendons and muscles and inflammation causing pain and weakness in the elbow and forearm.
Despite the name it is not just tennis players who suffer tennis elbow; people who perform lots of repetitive loading movements like plumbers, carpenters, mechanics, painters, butchers, housekeepers, kitchen porters, valeting specialists or tree surgeons often suffer from tennis elbow.
The symptoms of tennis elbow include:
- pain on the outside of the elbow can radiate to the upper arm and wrist
- weakness especially on lifting, gripping and twisting (e.g. opening a jar, lifting kettle, shaking hands)
The tennis elbow usually responds to conservative treatment (meaning treatment without surgery) - rest, medication, tennis elbow brace, sometimes steroid injections, physiotherapy and neuromuscular therapy are all used to successfully treat the tennis elbow. If the conditions is not responding to the conservative treatment surgery might be necessary to fix the problem.
In the Perfect therapy clinic we see many clients with tennis elbow both for conservative treatment and after surgery. After assessment we make a treatment plan that would usually involve:
- myofascial and soft tissue work
- tailored exercise program
- ultrasound or electrotherapy
- dry needling
- scar therapy if you had a surgery
- advise on work modification, sporting technique improvement and suitable bracing
golfers elbow / medial epicondylitis
Golfers elbow or medial epicondylitis is similar to tennis elbow but it affects the inside of the elbow. The group of muscles that move the wrist and fingers down and turn the palm down (wrist and fingers flexors and pronator) starts with a tendon on the inside of the elbow . Overworking these muscles and tendons by repetitive loading can lead to micro-trauma inside the tendons and muscles and inflammation. This can manifest as pain and weakness on the inside of the elbow and the pan can radiate to wrist. Certain sports can lead to golfers elbow, like racket sports or throwing sports. Occupations that may lead to golfer elbow are similar to the tennis elbow - heavy manual repetitive work like plumbing, carpentry, housekeeping and cleaning, long distance driving etc.
The symptoms of golfers elbow include:
- pain on the inside of the elbow, and possibly radiating to wrist, especially on gripping, lifting and twisting
- weakness when griping
- tingling on the inner part of forearm and in the small and ring finger
- stiffness in the elbow
Treatment for the golfers elbow is much the same as treatment for the tennis elbow.
de quervain's tenosynovitis
De Quervain tenosynovitis is condition affecting the wrist on the thumb side. It's cause is inflammation of tendons of muscles that move the thumb out away from index finger and up towards the ceiling if the hand lies flat on the table. These 2 tendons, Abductor pollicis longus (APL) and Extensor pollicis brevis (EPB), run in a tunnel like structure called tendon sheath. Sometimes the tendons or the sheath get swollen or thickened and this causes friction resulting in inflammation, pain and weakness at certain movements. The exact cause is not always clear but it is believed that hormonal changes and repetitive strain can contribute to developing De Quervain's disease. It is more common in women, it often affects new mothers (hormonal changes and lifting the child) but also people who repeatedly overwork the thumb and the wrist.
The symptoms of De Quervain's synovitis are:
- pain on the thumb side of the wrist aggravated by lifting something with thumb pointing up (e.g. lifting a child), forceful gripping or twisting, making a fist
- swelling and redness at the thumb side of the wrist
- difficulty moving the thumb due to pain
The treatment for the De Quervain's disease is aimed to reduce the inflammation in the area. Conservative treatment consists of resting the thumb in a splint for 4-6 weeks with gentle regular exercises only as instructed by your physiotherapist, taking anti-inflammatory medication and if indicated steroid injection. If the conservative treatment doesn't work surgery might be the only solution - it is very important to get physiotherapy and scar therapy after the surgery to gradually build up strength and movement, prevent scar adhesions and safely return to vocational or sporting activities.
In our clinic we see clients with De Quervain's tenosynovitis for both conservative treatment and after surgery. After assessment we make a treatment plan that would usually include: