Flexor Tendinopathy

Flexor tendinopathy starts as pain in the inside of the elbow and underside of the forearm. The pain usually develops gradually. Initially it may only be painful with activity and may disappear as you warm up, then return once you have stopped activity.

What you might be feeling

You may notice initially that the elbow and forearm feel a bit stiff and that this discomfort will disappear with some gentle stretching and heat (e.g. a hot shower). As the condition progresses it becomes painful with most arm, wrist and hand movements and as the tendinopathy worsens it may become painful all the time.

What’s going on inside

Flexor tendinopathy or as its most commonly know “golfers elbow” is pain on the inside of the elbow that comes from inflammation and degeneration of some of the tendons on the inside of the elbow. The tendons are part of the muscles that control movements of the wrist, hand and fingers.
Flexor tendinopathy is usually caused by activities that require repetitive use of the muscles that control the wrist, hand and fingers. The problem/pain is felt in the tendons of these muscles, on the inside of the arm. The overuse of these muscles can cause tiny tearing and degeneration or breakdown of the tendon.

How a physio can help

Flexor tendinopathy generally doesn’t get better on its own. It will feel a little bit better with rest but once you start doing the aggravating exercise or activity again it will become painful again. Continuing to do aggravating activities may advance the process and may significantly pro-long the recovery time.
The goals of treatment are to identify any predisposing factors, reduce pain and inflammation and promote healing to restore the muscle and tendon.
Early treatment may include:

  • Rest from provocative activities.
  • Ice or heat (as directed by your physiotherapist).
  • Physiotherapy electrotherapy modalities.
  • A gentle stretching and strengthening program.
  • Massage and soft tissue therapy.
  • Posture education- posture and position of the wrist and general up-right posture (especially for people who have a sedentary job and who use the computer a lot).
  • Bracing or taping may be used to unload the muscle and tendon.
  • Acupuncture and dry needling.

Once your pain has settled it is vital that physiotherapy is progressed to ensure complete healing of the area. Treatment may include:

  • Harder and more specific exercises. Once you have mastered basic muscle contractions your physiotherapist will progress you on to eccentric exercises which will help to restore the integrity of the tendon.
  • Correction of any predisposing or unusual biomechanics.
  • Other things that may be used if the condition doesn’t settle are:
    – Corticosteroid injection.
    – Nitric Oxide therapy.
    – Surgery.

Your physiotherapist will guide you through your rehabilitation and refer you on to the appropriate specialist if the condition does not improve.

When can you return to sport or activity?

It is important that you return to sport or aggravating activities slowly. Depending on the severity of the initial condition and the length of rehabilitation, a graduated return may take 3 weeks or 3 months, your physiotherapist will guide you through this.

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