Tennis Elbow, or Lateral epicondylitis, is a painful condition involving the tendons that attach to the bone on the outside (lateral) part of the elbow. With lateral epicondylitis, there is degeneration of the tendon’s attachment, weakening the anchor site and placing greater stress on the area. Sports such as tennis can be associated with this, but the problem can occur with many different activities whether it be athletic, or otherwise. The most common group that this condition affects are people between the ages of 30 to 50 years old, but it may also occur in younger and older age groups as well. Tennis elbow affects both men and women.
Pain is the primary reason for patients to seek medical evaluation. The pain is located on the outside of the elbow, over the bone known as the lateral epicondyle. This area becomes tender and painful with activities which stress the tendon, such as gripping or lifting.
The pain usually begins at the elbow and may travel down the forearm.
Occasionally, any motion of the elbow can be painful.
Sometimes the tendon on the outside of the arm degenerates over time with no direct cause. In other cases, repetitive activities that place stress on the tendon attachments of the extensor muscle-tendon unit increase the strain on the tendon. These stresses can be from holding a racquet grip or from other “repetitive” gripping and grasping activities, such as plumbing, painting, lifting weights, etc.
Golfer’s elbow, or medial epicondylitis is a condition that causes pain where the tendons of your forearm muscles attach to the bony bump on the inside of your elbow (whereas Tennis Elbow pain occurs on the outside of the elbow). Other causes of medial elbow pain can be little league elbow (a stress injury to the growth plate in young pitchers), ulnar collateral ligament tears, and ulnar neuropathy.
The main symptoms are pain and tenderness on the bony bit on the inside of the elbow called the medial epicondyle, particularly when gripping hard with the hand. There will be general weakness in the wrist and pain will be reproduced by bending the wrist palm downwards against resistance and resisting pronation or rotating the wrist inwards. And, the pain might spread into your forearm and wrist.
Golfer’s elbow is not limited to golfers. Tennis players and others who repeatedly use their wrists or clench their fingers also can develop golfer’s elbow. It is typically caused by repeated wrist flexion or bending the wrist, particularly against resistance such as holding a golf club. It can also occur from throwing actions, as well as in occupations such as through manual jobs like carpentry or working at a computer work station. It tends to occur after a period of repeated overuse.
Olecranon bursitis is a painful swelling that develops at the back of the elbow due to inflammation of the bursa, the thin sac of fluid that lies between the bony tip of the
elbow (olecranon) and the skin. Normally, this sac only has a tiny bit of fluid inside of it to help the skin slide smoothly over the bone. However, the bursa can become irritated or inflamed and fill with extra fluid.
Gradual swelling at the back of the elbow might not be noticed at first. However, sometimes the swelling develops quickly and can enlarge to the size of a golf ball at the tip of the elbow. If the bursa remains uninfected, it may not cause pain. Once infected, you will experience tenderness, redness, or warmth in the area. In some instances, a fever may develop. Left untreated, an infected bursa can break open and drain pus.
In many cases, the cause of the olecranon bursitis is unknown. Trauma, such as hitting the elbow or falling on the back of the elbow, can sometimes lead to olecranon bursitis. People who lean their elbows against hard surfaces can develop this problem over time. Those with conditions such as gout, rheumatoid arthritis, or kidney failure needing dialysis can be more likely to get olecranon bursitis.
Distal Biceps Tears
The biceps muscle has two tendons that attach the muscle to the shoulder and one tendon that attaches at the elbow. The tendon at the elbow is called the distal biceps tendon. It attaches to a part of the radius bone called the radial tuberosity, a small bump on the bone near your elbow joint.
Tears of the biceps tendon at the elbow are uncommon. They are most often caused by a sudden injury and tend to result in greater arm weakness than injuries to the biceps tendon at the shoulder.
Once torn, the biceps tendon at the elbow will not grow back to the bone and heal. Other arm muscles make it possible to bend the elbow fairly well without the biceps tendon. However, they cannot fulfill all the functions of the elbow, especially the motion of rotating the forearm from palm down to palm up. This motion is called supination.
To return arm strength to near normal levels, surgery to repair the torn tendon is usually recommended. However, nonsurgical treatment is a reasonable option for patients who may not require full arm function.
Biceps tendon tears can be either partial or complete.
Partial tears. These tears damage the soft tissue but do not completely sever the tendon.
Complete tears. A complete tear will detach the tendon completely from its attachment point at the bone.
In most cases, tears of the distal biceps tendon are complete. This means that the entire muscle is detached from the bone and pulled toward the shoulder.
There is often a “pop” at the elbow when the tendon ruptures. Pain is severe at first, but may subside after a week or two. Other symptoms include:
- Swelling in the front of the elbow
- Visible bruising in the elbow and forearm
- Weakness in bending of the elbow
- Weakness in twisting the forearm (supination)
- A bulge in the upper part of the arm created by the recoiled, shortened biceps muscle
- A gap in the front of the elbow created by the absence of the tendon
The main cause of a distal biceps tendon tear is a sudden injury. These tears are rarely associated with other medical conditions.
Injuries to the biceps tendon at the elbow usually occur when the elbow is forced straight against resistance. It is less common to injure this tendon when the elbow is forcibly bent against a heavy load.
Lifting a heavy box is a good example. Perhaps you grab it without realizing how much it weighs. You strain your biceps muscles and tendons trying to keep your arms bent, but the weight is too much and forces your arms straight. As you struggle, the stress on your biceps increases and the tendon tears away from the bone.
Men, age 30 years or older, are most likely to tear the distal biceps tendon.
Additional risk factors for distal biceps tendon tear include:
Smoking. Nicotine use can affect tendon strength and quality.
Corticosteroid medications. Using corticosteroids has been linked to increased muscle and tendon weakness.
For many people, arthritis of the elbow can cause pain not only when they bend their elbow, but also when they straighten it, such as to carry a briefcase.
- Pain. In the early stages of rheumatoid arthritis, pain may be primarily on the outer side of the joint. Pain generally gets worse as you turn (rotate) your forearm. The pain of osteoarthritis may get worse as you extend your arm. Pain that continues during the night or when you are at rest indicates a more advanced stage of osteoarthritis.
- Swelling. This is more common with rheumatoid arthritis.
- Instability. The joint isn’t stable and gives way, making it difficult or impossible to do normal daily activities.
- Lack of full movement. You are not able to straighten (extend) or bend (flex) the elbow.
- Locking. Your elbow joint catches or locks. This can happen with osteoarthritis.
- Stiffness. This happens particularly with arthritis that develops after an injury.
- Pain in both elbows. Having pain in both elbows or pain at the wrists or shoulders (or both) as well as pain in the elbows is a sign of rheumatoid arthritis.
The most common cause of arthritis of the elbow is rheumatoid arthritis. Osteoarthritis and injuries can also cause arthritis in the elbow joint.
Rheumatoid arthritis is a disease of the joint linings, or synovia. As the joint lining swells, the joint space narrows. The disease gradually destroys the bones and soft tissues. Usually, RA affects both elbows, as well other joints such as the hand, wrist and shoulder.
Osteoarthritis affects the cushioning cartilage on the ends of the bones that enables them to move smoothly in the joint. As the cartilage is destroyed, the bones begin to rub against each other. Loose fragments within the joint may accelerate degeneration.
Trauma or injury to the elbow can also damage the cartilage of the joint. This can lead to the development of arthritis in the injured joint.