ELBOW & SHOULDER INJURIES 
The usual tendon problems are a painful change of tendon tissue referred to as tendinitis; although it is more appropriately called tendinosis, a tissue degenerative disorder. This spectrum of elbow and shoulder problems may vary widely from a simple inflammatory irritation to a major degeneration of the tendon, even rupture. Levels of Tennis Elbow Tendinitis/ Tendinosis Nirschl System. Level Evident Damage I Pain or chemical inflammation No permanent tendon change II Permanent tendon change = less than 50% tissue injury in cross section III Permanent tendon change = greater than 50% tissue injury in tendon cross section. Permanent tendon injury. IV Complete rupture of tendon These levels may be applied to any tendon, muscle attachment including the shoulder rotator cuff tendons and the biceps tendon, etc. LOCATION AND SYMPTOMS OF INJURY Pain and tenderness come on gradually in all these disorders. Occurs most commonly in people 35-50 years of age for both males and females. Heavy forearm use such as constant tennis, meat cutting, typing and high repetition factory assembly or tool use is common among tendon injury suffers. Location of these problems is as follows: Lateral Tennis Elbow = outside elbow. (Illustration #1) Medial Tennis Elbow = inside elbow. (Illustration #2) Posterior Tennis Elbow = located back of elbow, triceps muscle area. (Illustration #3) Rotator Cuff = muscles about the shoulder. (Illustration #4) Sometimes elbow problems occur along with shoulder problems. This is referred to as "mesenchymal syndrome". This multiple site tendinitis can be particularly difficult to treat. Most importantly, the whole body must be considered when treating these disorders. Weakness of the elbow and shoulder muscles associated with sport or occupational verses often overload these weak muscles. Also systemic factors such as gout, low estrogen levels in females and an unexplained predisposition to tendinitis/tendinosis (mesenchy mal syndrome) may all be factors causing these problems. PAIN PHASES Phase I - Mild stiffness or soreness after activity usually clears up in 24 - 48 hours. Phase II - Mild stiffness or soreness that last beyond 48 hours. Phase III - Same as phase II except pain only partially relieved with warm-up. Minimally present during activity. Activity bracing alteration of activity as well as mild anti inflamatories are needed as well as therapy. Phase IV - Pain Similar to Phase III but more intense. Must avoid abusive activity. Mild pain with ADL's as well. Anti inflamatories and therapy a must to avoid tendon damage. Phase V - Harmful pain, significant during and after exercise. Must stop activity due to pain. Pain occurs regularly with ADL's. Phase V reflects permanent tendon damage. Phase VI - This is phase V pain that persists at even complete rest. Disrupts even simple ADL's and household chores must be eliminated. Phase VII - Phase VI pain but also causes sleep disruption. Pain is aching in nature and intensifies with activity. TREATMENT The way to heal tendons is restoring blood supply helping the body produce new tendon collagen protein. Restoration of flexibility, endurance and strength are critical in accomplishing these healing goals. The basic concepts are in six different steps. SIX STEPS FOR HEALING Relief of pain and chemical inflammation Promotion of healing Condition exercises Control of abusive producing overload activities Surgery if conservative treatment fails FINAL HIGHLIGHTS The concepts of treatment include: Relief of pain Promotion of healing of the tendon tissue Rehabilitative resistance exercise program Stretching the affected tissues Avoid abusive activities which cause and worsen pain Fitness exercise which is healthy exercise such as biking, jogging, and other aerobic exercise which circulates the blood and increases oxygen to the tissues. GOALS OF TREATMENT Heal injured tendon tissue by encouraging new blood vessel and collagen formation. Also restoring strength, endurance and flexibility to normal levels. This is accomplished by rehab resistive exercises (therapy) with medications/modalities which provide comfort to tolerate the therapy. Use of rest and anti inflamatories and or cortisone injections may comfort but they do not directly heal or strengthen injured tissue of tendons. Most tendon problems are tendinosis which is the degeneration of the tendon tissue, not tendonitis. Ice can be used immediately following activities at work, home or play to relieve pain. Use a moist towel and ice for 20 to 25 minutes. Have a great Holiday Season and a Happy New Year! |
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