Lesson

Tendinopathy

Common extensor origin tendinopathy (‘tennis elbow’) and common flexor origin tendinopathy (‘golfer’s elbow’) are considered to be overuse issues that are not common in football players. These conditions are more likely to be associated with injuries that can occur off the football field (e.g. related to supplemental resistance training) or in those working with football players. The condition is related to overload or tendinosis. The peak incidence is between the ages of 35 and 55 years. Tendinopathy of the common flexor tendon origin is seven to 20 times less common than the common extensor origin.5

 

History

The patient will complain of activity-related lateral (common extensor) or medial (common flexor) elbow pain. This is generally worse with dextrous tasks. It is generally related to continued or repetitive wrist movements and usually develops insidiously. In rare cases, there may be a sudden acute onset with a partial tear. Once established, there can be pain in bed or at rest.

 

Examination

The patient will have localised tenderness at either the lateral or medial epicondyle. Generally, there is pain with resisted wrist and middle finger extension and reduced grip strength in common extensor origin tendinopathy. Resisted wrist flexion provokes pain when the common flexor origin is involved.

 

Investigations

While this is typically a clinical diagnosis, changes consistent with tendinopathy can generally be seen on ultrasound or MRI. X-rays are generally normal, but can help rule out other causes of pain.

Click on the following images to view examples of tendinopathy at the elbow.

  • Normal common extensor origin

    Observe the uniform thickness and tight packed fibrillar pattern.

  • CEO tendinopathy

    This USS show images shows a large hypoechoic area within the CEO.

  • CFO tendinopathy Doppler

    This Doppler image shows modest neovascularity related to the CFO.

  • Old ossicle triceps insertion

    An old well corticated ossicle is related to the distal triceps tendon.

Treatment

As with all causes of tendinopathy, education, load reduction, and a strengthening programme are important. Topical NSAIDs have been shown to be better than placebo for short-term pain relief and patient satisfaction.6 A counterforce brace can be used. While corticosteroid injections have been widely used, they may not be effective in the longer term. They provide proven pain relief in the short term, but have a worse longer-term outcome in comparison to reassurance or physiotherapy.7,8 Surgery may be considered in more refractory cases.

 

Other tendinopathies

 

Triceps tendon

This condition causes chronic posterior elbow pain with extension. It is most commonly seen in men in their fourth decade and is often associated with traction spurring of the olecranon, which can be seen on x-rays.

 

Distal biceps tendon

Distal biceps tendinopathy is uncommon, but can occur after repeated hyper-extension or during pronation and supination activities.

Learn more about tendinopathy and tendon disorders in the ‘tendon’ module. This was developed by clinicians at FC Barcelona.

André Pedrinelli

Orthopaedic – Prosthetics / Sports Medicine