Bursitis and tendinopathies ("tennis player" and "golfer" elbows)

What are they?

The tendons are sturdy bands that connect the muscles to the bone. Tendonopathies are tendon problems that can result from repetitive activities or sudden trauma that cause inflammation (tendinitis) or age-related degenerative and aging changes (tendinosis); can sometimes be associated with other conditions, including rheumatic diseases.

These types of conditions are the most frequent affecting the elbow. The tennis elbow or lateral epicondylitis affects the outer face of the elbow; the golfer's elbow or medial epicondylitis occurs when the medial aspect of the elbow is involved. Despite the concepts, elbow tendinopathies do not only result from sportsmanship, but also from work activities that involve repetitive and forced use of the wrist and forearm muscles.


What are the symptoms?

Tendinopathies usually affect the elbow of the dominant limb (eg, right arm in a right handed person). Symptoms include: pain in the elbow that extends to the arm or along the forearm, weakness of the forearm, sudden or progressive onset of pain with aggravation with efforts and mobilities.


How is the diagnosis made?

The diagnosis is usually clinical, based on the description of the symptoms by the patient, on the observation and objective examination performed by the physician, and as a rule, complementary diagnostic tests are not necessary.


What are the therapeutic options?

Treatment should initially be conservative, based on the reduction of activities that promote the worsening of the pathology and analgesic or anti-inflammatory medication. Orthotics and directed physiotherapy may be used. Patients generally respond well to this approach, which can take 6 to 12 months to resolve.

If pain persists, local corticosteroid infiltration may be required and compounds derived from the patient's own blood, such platelet-rich plasma, are also currently being used.

Surgery is not usually necessary and is only indicated in resistant cases after 6 or more months of treatment.