Tennis and Golfer's elbow

Tennis Elbow(lateral epicondylitis)Outside of Elbow
Cause & Symptoms
The onset of pain, on the outside (lateral) of the elbow, is usually gradual with tenderness felt on or below the joint's bony prominence. Movements such as gripping, lifting and carrying tend to be troublesome.

Golfer’s Elbow(medial epicondylitis)Inside of Elbow
Cause & Symptoms
The causes of golfer's elbow are similar to tennis elbow but pain and tenderness are felt on the inside (medial) of the elbow, on or around the joint's bony prominence.

Tendons?

Tendons themselves are cords of tough, fibrous connective tissue that attach muscles to bones. Tendonitis is an inflammation of the tendon. The condition may also involve the tendon sheath usually occurring close to where the tendon goes into the muscle.
Tendons are generally healthy structures that appear glistening white to the naked eye. If you've ever carved a turkey, the tendons are the tough bands you cut through to get the drumsticks apart.

Prognosis, Recurrence and Prevention of tendonitis

Expectations (prognosis)
Symptoms improve with treatment and rest. If the injury is caused by overuse, a change in work habits may be indicated to prevent recurrence of the problem.
Complications

Recurrence of tendonitis
Chronic inflammation of the tendon predisposes it to further injury, such as rupture.
Calling your health care provider
Call for an appointment with your health care provider if symptoms of tendinitis occur.

Prevention
Avoid repetitive motion and overuse of an extremity
Warm up by exercising at a relaxed pace before engaging in vigorous activity
Keep all your muscles strong and flexible

The facts on tendonitis treatment

The goal of treatment is to relieve pain and reduce inflammation.
Rest or immobilization of the affected tendons is helpful for recovery. This may be achieved using a splint or a removable brace. The application of heat or cold to the affected area can help.
Non-steroidal anti-inflammatory medications (NSAIDs), such as aspirin or ibuprofen, can also reduce both pain and inflammation. Steroid injections into the tendon sheath can also be very useful in controlling pain and allowing physical therapy to start.
Physical therapy that stretches and strengthens the muscle and tendon is essential. This can restore the tendon's ability to function properly, improve healing, and prevent future injury.
Rarely, surgery is needed to physically remove the inflammatory tissue from around the tendon.

Tendinitis overview

Definition
Tendinitis is inflammation, irritation, and swelling of a tendon, which is the fibrous structure that joins muscle to bone. In many cases, tendinosis (tendon degeneration) is also present.

Causes, incidence, and risk factors
Tendinitis can occur as a result of injury, overuse, or with aging as the tendon loses elasticity. It can also be seen in systemic diseases such as rheumatoid arthritis or diabetes. Tendinitis can occur in any tendon, but some commonly affected sites are the shoulder, the wrist, the heel (Achilles tendonitis), and the elbow.

Symptoms
Pain and tenderness along a tendon, usually in proximity to a joint (hip pain, knee pain, shoulder pain, elbow pain, wrist pain, or pain in other joints)
Pain is worse with movement or activity
Pain at night

Signs and tests
On physical exam, a doctor will look for tenderness along the affected tendon and pain when the muscle to which the tendon is attached is used against resistance. There are specific tests for specific tendons. The tendon can be inflamed and the overlying skin may be warm and red.

Medical research on tendonitis

Vitamin E may speed up the regeneration of tendons through action on fibroblasts. Research also suggests that nitric oxide plays an important role in tendon healing and inhibition of NO synthesis impairs tendon healing. A potential implication is the supplementing with arginine, the amino acid that the body uses to form NO. Other preliminary research suggests that the injection of stem cells might promote tendon-injury healing. Completely ruptured tendons may be sutured together with or without grafted material.

More remedies

Walk bowlegged. Okay, maybe you don't have to go that far. But for Achilles tendinitis, wearing cowboy boots or high heels some of the time is a fine idea, according to Dr. Percy. "It lifts the heel off the ground," he says, "and the muscles and tendons don't have to work as hard."

Go over-the-counter. Aspirin and other nonprescription, nonsteroidal, anti-inflammatory drugs are effective temporary pain relievers for tendinitis, Dr. Percy says. They also reduce inflammation and swelling.

Strengthen. "When we say strengthen, we're not asking people to be an Arnold Schwarzenegger," Mangine says, "just to get better defined muscles by working out at home with light weights. You can even use pennies in a sock to work arm muscles." And that's a lot cheaper than a set of weights.

Take breaks. This is a simple way to at least temporarily relieve physical stress at work, says Scott Donkin, D.C., a chiropractor in Lincoln, Nebraska, and author of Sitting on the Job. "If you work in an awkward position," he says, "tendinitis can develop quite easily. Especially in the arms or wrists if you're working at a keyboard or typewriter all day.''

5 more soothing remedies for tendonitis

Warm with stretching. You should always stretch before exercising at full speed, says Terry Malone, Ed.D., executive director of sports medicine at Duke University. Stretching prevents the shortening of muscles and tendons that goes along with exercise.
In addition, says Mangine, some studies suggest that people who are less flexible are more prone to develop tendinitis. So stretching should be a regular part of your routine.
Brace yourself. Even a little extra support and warmth from a flexible brace or wrap can help during exercise and afterward, Mangine says. "There is no truth to the old wives' tale that wearing a brace will weaken the tendons and muscles, provided," he stresses, "you continue exercising."
Deep-freeze the pain. After exercising, ice is great for holding down both swelling and pain, Mangine says. However, people with heart disease, diabetes, or vascular problems should be careful about using ice because ice constricts blood vessels and could cause serious difficulties in people with such problems.
Wrap it up. Another alternative for reducing swelling is to wrap your pain in an Ace bandage, says Dr. Percy. Just be careful not to wrap the inflamed area too tightly or to leave the area wrapped for so long that it becomes uncomfortable or interferes with circulation.
Elevate. Raising the affected area is also good for controlling swelling.

Three soothing remedies for tendonitis

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Switch instead of fight. If your tendinitis is exercise induced, a new exercise may be just what your inflamed tendon needs. Runners with tendon problems in the lower legs, for example, can stay on the road if you're willing to hop on a bicycle, which will still give you a good upper-leg workout.
Give it a whirl. Taking a whirlpool bath or just soaking in warm bathwater is a good way to raise body temperature and increase blood flow. Warming the tendon before stressful activity decreases the soreness associated with tendinitis, says Mangine.
Use the ballerina treatment. The New York Jets football team finds using this method (inspired by a ballet dancer who had tendinitis) successful. With tendinitis of the knee, for example, treatment involves placing a warm, moist towel over the knee, then a plastic bag, then a heating pad, and last, a loose elastic wrap just to hold everything in place. Keep it on from 2 to 6 hours. To avoid burning yourself, keep the heating pad on low, advises Bob Reese, head trainer for the Jets and president of the Professional Football Athletic Trainers Society. For maximum success, your injured body part should be kept at a level higher than your heart.

Earning a living with tendonitis

Of course, resting is easier said than done if you make your living washing windows and have tendinitis of the shoulder from constantly raising your arms over your head. But if tendinitis is a side effect of your job, it might not be a bad idea to save a day or two of vacation for those times when tendinitis is painfully persistent.
But don't give it too long a rest. Muscles will start to atrophy. And for athletes, "we never recommend absolute rest," adds Ted Percy, M.D., an associate professor of orthopedic surgery and head of the Sports Medicine Section at the University of Arizona College of Medicine, Health Sciences Center.

Yes, there is hope

Like simple muscle soreness from overuse, tendinitis—inflammation in or around, a tendon—can be painful. But where simple muscle soreness is temporary, tendinitis is tenacious—it's soreness that doesn't quit.
In fact, if chronic tendinitis had a credo, it might go like this: "Here today, here tomorrow, here to stay."
But does it really have to be so bleak, or is there hope for what, after all, sounds like a rather minor problem?
Yes, there is hope, says Bob Mangine, chairman of the American Physical Therapy Association's Sports Physical Therapy Section. "But if you continue to use the tendon in the same repetitive motion that triggered the problem in the first place, it's going to be very difficult to get better." And that applies to everyone from world-class marathoners to window washers and typists.
Still, it's possible to lessen the effects of tendinitis and prevent intense flare-ups, says Mangine, who is also administrative director of rehabilitation at the Cincinnati Sports Medicine Clinic. The key, he says, is unlocking your mind and freeing yourself to change some of your old ways.

Everything has a price

The Price of Ignoring Your Body's Warnings
If you only feel the pain of tendinitis during or after exercise, and if it isn't too bad, you may be thinking that you could run a race or swim laps with that same amount of pain—if you had to. Or maybe you already have.
In either case, you would be wise to realign your thinking. "You shouldn't play through pain unless your physician or physical therapist tells you otherwise," says the American Physical Therapy Association's Bob Mangine.
If pain is severe and you continue to abuse the tendon, it may rupture, says athletics trainer Bob Reese. And that could mean a long layoff, surgery, or even permanent disability.In other words, exercising through tendon pain today could mean staying on the sidelines for the remainder of your tomorrows.