and Treating Left Elbow Pain: Insights from Rehabilitation

Left elbow pain?

Hello Dr.
Wang: I have been experiencing pain in my left elbow for about 2 to 3 months.
During this time, I have visited a rehabilitation department at the hospital and undergone approximately 8 sessions of therapy (infrared, laser, and electrical stimulation), but there has been no significant improvement.
Previously, my wrist and shoulder (both had tendonitis) healed quickly with rehabilitation, but this time, my left elbow shows no signs of improvement.
My daily activities include: 1.
Weight training at the gym.
2.
My work requires me to internally rotate my left wrist thousands of times.
Symptoms: 1.
When internally rotating my left forearm, I feel pain in the muscles near the lateral epicondyle of the humerus.
2.
With my left palm facing up, when I intentionally exert force to fully extend or flex it inward (like in a bicep curl), I feel a pulling pain in a tendon located in the middle of the left humerus (on the triceps side) near the elbow.
After researching online, my symptoms resemble both tennis elbow and golfer's elbow.
I would like to seek your advice on how to improve this condition.
Thank you.

Mr. Wang, 20~29 year old female. Ask Date: 2018/08/08

Dr. Wang Zhaomin reply Rehabilitation

In terms of symptoms, it is indeed possible to have tennis elbow or golfer's elbow, but other pathologies cannot be ruled out.
It is important to continue consultations and discuss in detail with your physician.
Additionally, undergoing only eight physical therapy sessions over two to three months is not sufficient, which naturally leads to limited effectiveness.
It is also advisable to suspend weight training to allow the injured tissues to rest, especially since repetitive internal rotation movements during work can occur thousands of times.
This excessive use not only hinders recovery but may also worsen the condition.
Therefore, it is essential to rest as much as possible, avoid heavy and repetitive motions, and consider using braces or supports.
Regular medical treatment, including oral or topical medications, is necessary for gradual recovery to health.

Reply Date: 2018/08/08

More Info

Left elbow pain, particularly when associated with activities such as weight training and repetitive wrist movements, can be indicative of conditions like lateral epicondylitis (tennis elbow) or medial epicondylitis (golfer's elbow). Given your symptoms, it seems you may be experiencing a combination of both, especially since you mention pain near the lateral epicondyle during forearm rotation and discomfort in the triceps area when performing bicep curls.

Understanding Your Condition
1. Tendinopathy: The pain you are experiencing is likely due to tendinopathy, which is a condition characterized by the degeneration of the tendon due to overuse. This is common in individuals who engage in repetitive motions, such as those involved in weight training or manual labor.

2. Muscle Imbalance: Engaging in heavy lifting without proper warm-up or muscle balance can lead to overuse injuries. The muscles around the elbow, including the biceps and triceps, may become imbalanced, leading to increased strain on the tendons.

3. Inflammation: The pain you feel when extending or flexing your elbow could be due to inflammation in the tendons, which can result from micro-tears that occur during repetitive activities.

Treatment Options
1. Physical Therapy: Since you have already undergone some rehabilitation without significant improvement, it may be beneficial to reassess your physical therapy approach. A physical therapist can provide targeted exercises to strengthen the muscles around the elbow, improve flexibility, and reduce strain on the tendons. Focus on eccentric strengthening exercises for the forearm muscles, which have been shown to be effective in treating tendinopathy.

2. Activity Modification: It is crucial to modify your activities to avoid exacerbating the pain. This may involve reducing the weight you lift, changing your grip, or altering your workout routine to include more rest days. Gradually reintroducing activities can help prevent further injury.

3. Pain Management: Over-the-counter anti-inflammatory medications (like ibuprofen) can help manage pain and reduce inflammation. However, it is essential to use these medications as directed and not rely on them as a long-term solution.

4. Injections: If conservative treatments fail, corticosteroid injections may be considered to reduce inflammation. However, these should be used judiciously, as repeated injections can weaken the tendon.

5. Alternative Therapies: Techniques such as ultrasound therapy, dry needling, or even acupuncture may provide relief for some individuals. These therapies can help reduce pain and improve function.

6. Surgery: In cases where conservative management fails and the pain significantly impacts daily activities, surgical options may be explored. This typically involves removing degenerated tissue or repairing the tendon.

Prevention Strategies
1. Warm-Up and Stretching: Always warm up before engaging in physical activities. Incorporate stretching exercises for the forearm and elbow to maintain flexibility.

2. Strengthening Exercises: Focus on strengthening the muscles around the elbow, including the forearm flexors and extensors. This can help provide better support to the elbow joint.

3. Ergonomic Adjustments: If your work involves repetitive wrist movements, consider ergonomic adjustments to your workspace to minimize strain on your elbow.

4. Gradual Progression: When returning to weight training or any physical activity, gradually increase the intensity and volume to allow your body to adapt without overloading the tendons.

Conclusion
Your situation requires a comprehensive approach that includes reassessing your rehabilitation strategy, modifying activities, and possibly exploring further medical interventions if conservative measures do not yield results. It is essential to work closely with your healthcare provider to monitor your progress and adjust your treatment plan as needed. Remember, patience is key in recovery from tendinopathy, and with the right approach, you can achieve significant improvement in your elbow pain and overall function.

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