Cellaxys

Flexor Tendonitis of the Elbow: Anatomy, Symptoms, Causes and Treatments

By November 18, 2019 No Comments

Flexor tendonitis of the elbow is a common issue which causes major dysfunction of the elbow and its surrounding tissues. Identifying the impacted tissues, root causes, and major symptoms can help patients understand what is going on and help them decide the best treatment option for their specific lifestyle. Read on to learn more about flexor tendonitis, what it is, how it’s caused, and potential treatment options.

Anatomy of Flexor Tendonitis of the Elbow
The elbow is a focal point for some of the most important soft tissues within the body. Groups of tendons, muscles, and cartilage converge here to create a versatile joint which can convert even the smallest amounts of tension into massive ballistic forces.

From swinging a tennis racket to hurling a baseball, the elbow’s only bounds are determined by the health of the soft tissues within it. While each group of these tissues serves a valuable purpose, the flexor group is perhaps the most vital to providing torque and movement to the elbow and forearm. These muscles include the:

  • Biceps Brachii – the most prominent of the flexor group of muscles, the biceps brachii sits atop the upper arm and connects to the bones on the outside of the shoulder and base of the forearm.
  • Brachialis – While the biceps brachii gathers the most attention and interest from athletes, the brachialis just beneath it is the primary driving force behind elbow movement, generating about 50% more power in terms of elbow flexion.
  • Brachioradialis – responsible for forearm flexion at the elbow, the brachioradialis allows the forearm to move 180 degrees, making the palms face upwards and downwards.

In a case of flexor tendonitis of the elbow, the tendons found at the end of these muscles become inflamed and degrade, causing a range of unwanted symptoms including pain, swelling, and reduced range of motion. Overtime, the health of the tendons degrades until even the slightest movements cause the symptoms to express themselves.

Signs and Symptoms of Flexor Tendonitis of the Elbow
Tendonitis begins as slight pain within the elbow and at the base of the underside of the forearm. This pain progresses slowly as the tendons degrade and may only appear after strenuous use of the elbow.

The pain may express itself as stiffness, throbbing, or mild discomfort as you begin activity, wane once the elbow is warmed up, and then return as activity is decreased. 

Other symptoms include:

  • Swelling
  • Reduced range of motion
  • Numbness in the elbow or forearm
  • Loose hand grip
  • Reduced fluidity in elbow movement
  • Chronic tension
  • Sensitivity to touch or colder temperatures

As the health of the tendons within and around the elbow worsens, the symptoms will become more overt and will express themselves with less and less activity. In some cases, a person may even lose the ability to move the elbow and forearm in certain ways depending on which tendons are impacted.

Causes of Flexor Tendonitis of the Elbow
Soft tissues are innately weak structures and anything that requires constant or repetitive strain on these structures can leave behind small amounts of damage. If left unchecked or if this damage isn’t allowed to heal properly, the impact to these structures amplifies and the health of the tendon’s wanes.

The most common cause of elbow tendonitis is repetitive, strenuous elbow motion. Flexor tendonitis is most often seen in tennis players, golfers, baseball pitchers, and blue-collar workers whose jobs require extended periods of elbow strain.

Other causes of flexor tendonitis include acute damage such as impact from a projectile or falling on the elbow. These types of injuries usually lead to a more rapid development of tendonitis as they not only impact the tendons, but the bones and other muscles they connect to as well. As the tie between bone and muscle breaks down, symptoms develop into chronic issues.

Diagnosing Flexor Tendonitis of the Elbow
Flexor tendonitis shares symptoms with several elbow issues, so diagnosis is best done through a consultation with a trained physiologist. These doctors will use the patient’s medical history and lifestyle to identify potential causes of their elbow pain and typically move on to a physical examination or the use of medical imaging from there.

Physical examinations for flexor tendonitis are simple. Doctors use a technique known as palpation where they apply pressure to certain areas of the elbow while it is in various states of flexion in order to pinpoint the origin of a patient’s elbow pain. Once the location is established, medical imaging does the rest.

MRIs, X-Rays, and CAT scans can give doctors an inside view of the soft tissues and bones within the elbow. From there they can examine the health of the soft tissue structures and identify points of damage in order to develop a treatment plan. 

Conventional Treatments for Flexor Tendonitis of the Elbow
Conventional treatment options are used to help manage a patient’s pain. While these treatment options may not fully cure a patient’s flexor tendonitis, they can improve the patient’s range of motion, reduce pain, and mitigate the chances of continued degradation of the soft tissues within the elbow.

The following conventional treatments are some of the most popular methods of controlling the progression of flexor tendonitis and are typically used in unison with one another to improve the quality of the treatment plan.

Physical Therapy
Physical therapies are simply those treatment options by physical means. Massage, guided stretching, hot/cold therapy, compression, and exercise are some of the most commonly applied physical therapies for those with flexor tendonitis. 

These treatments help patients work within their physical limitations and can provide temporary relief from elbow pain due to tendonitis. While they are not cure-alls, these methods are valuable as they are the most economical and easily applied to most soft tissue problems. 

Medication
If the symptoms of flexor tendonitis are still relatively minor, doctors will often recommend simple over the counter medications such as naproxen, ibuprofen, and acetaminophen. If the effects of these medications are too mild to treat a patient’s pain, doctors may prescribe larger doses or can move on to stronger medications which block the pain receptors in the brain.

Medication can be a valuable tool to help combat a patient’s elbow pain but should be used sparingly and only within the doctor’s restrictions. Some of these medications have harmful side-effects and may even pose a risk of addiction if use isn’t controlled. It is best to talk to your doctor with any concerns you may have moving forward with any medication regimen.

Steroidal Injections
At one point thought to be a miracle cure to soft tissue pains, in recent years steroidal injections have come to be known as a dangerous treatment tactic among the medical community. While these treatments may provide immediate relief from soft tissue related pain, overtime they have been shown to worsen the health of the soft tissue structures they aim to treat, increasing the severity and presence of symptoms within patients.

Steroidal injections should be met with an err of caution and be heavily researched before being applied. 

Surgery
If the conservative treatments mentioned above do not seem to be helping a patient, doctors may recommend surgical intervention for a patient’s flexor tendinitis. This is typically a doctor’s last option as the side-effects can be severe and the results minimal. 

Surgical intervention typically involves long recovery periods, strong medication, and the use of extensive physical therapy. While this treatment may reduce a patient’s pain, it may also drastically reduce a patient’s range of motion and nullify any functional goals the patient would hope to reach. 

Conventional treatment options are the most commonly recommended by doctors, but they may not be the most effective when dealing with flexor tendonitis. While they can help patients reduce their pain, the results are minimal compared to some of the alternative treatment options available today.

Regenerative Therapy for Flexor Tendonitis of the Elbow
Regenerative therapies are those treatment options which not only help reduce pain, but also repair damaged tissues. These treatment options are typically minimally invasive and have been shown to have better results in certain instances of soft tissue damage. Recent advancements in the field of regenerative therapy have led to the discovery of new application methods as more effective active ingredients. The most popular of these therapies are Platelet Rich Plasma (PRP) and Stem Cell injections.

PRP Therapy
Platelet rich plasma is a special fluid designed to help improve the body’s natural healing processes. Platelets are one of the tools the body uses in order to treat damage. When a person is injured, the blood releases platelets to the impacted area. From there, the platelets clump together around the injury and send out chemical impulses to attract fresh tissues to repair the injury.

By extracting blood from a patient and isolating the platelets within it, doctors can amplify their effects and provide added support to the body’s healing process. Upon reinjection, these platelets work the same way they would if released by the blood, but the increased density of platelets being injected creates a larger impact than if the body were left to its own devices.

Stem Cell Therapy
Stem cell science has come a long way in the last decade. New research has led to the development of what are known as mesenchymal stem cells – stem cells derived from the fat and bone marrow within the patient’s own body. These mesenchymal stem cells behave the same way as typical stem cells and are able to surround an injury then provide the tissues necessary to repair the damage.

The added benefit of regenerative therapies over conventional treatment options is that they not only treat the symptoms of flexor tendonitis, they can also help repair the damaged tissues which cause the symptoms. Overtime, regenerative therapies can return function and range of motion to an elbow suffering from tendonitis. Though these treatments don’t exactly reverse the effects of tendonitis, they are a powerful driving force to curb its progression and development.

Conclusion
Flexor tendonitis can have a severe impact on a person’s lifestyle. From chronic pain to reduced function, flexor tendonitis may leave a person’s elbow out of commission. While conventional treatment options may be the most recommended treatments, they may not be the most effective for meeting a patient’s functional goals. In specific cases, alternative methods such as regenerative therapies may be the most appropriate for a patient’s lifestyle.

If you would like to learn more about regenerative therapies and how they may be able to help reduce your elbow pain, contact the CELLAXYS offices today to set up a consultation. With a combined 40 years’ experience in the field of regenerative medicine, our doctors are some of the most well versed in it’s underlying complexities and will be able to provide you with the most up to date research as well as best picture of what a treatment plan may look like.

Dr. Matthew HC Otten

Dr. Matthew HC Otten

Director of Orthopedic & Orthobiologics
Fellowship-trained & Board Certified in Sports medicine
Director Angiography at Harvard Clinical Research Institute
Michigan Stage University Alumni