Will Brett Favre miss a game because of injury?

Minnesota Vikings quarterback Brett Favre has started a record 289 consecutive games in the NFL. But the 41 year old said on Wednesday that he would consider sitting out a week or two if his elbow continues to bother him. Favre has been plagued by tendinitis in his right elbow. He was also unhappy about some missed throws in Monday’s Vikings 29-20 loss to the New York Jets. “It hasn’t gotten any worse but it really hasn’t got better,” Favre said. “It’s kind of a funny injury. It could flare up and get worse. I don’t know if it’s necessarily just going to go away.” Favre did do some limited workout today, so we’ll just have to see whether he’ll play this weekend.

What Is Tendinitis? (Source: NIAMS)

Tendinitis is a common condition that involve inflammation of the soft tissue around muscles and bones, most often in the shoulder, elbow, wrist, hip, knee, or ankle. A tendon is a flexible band of fibrous tissue that connects muscles to bones. Tendons transmit the pull of the muscle to the bone to cause movement. They are found throughout the body, including the hands, wrists, elbows, shoulders, hips, knees, ankles, and feet. Tendons can be small, like those found in the hand, or large, like the Achilles tendon in the heel. Tendinitis is an inflammation of a tendon.

What Causes Tendinitis?

Tendinitis is most often the result of a repetitive injury in the affected area. These conditions occur more often with age. Tendons become less flexible with age, and therefore, more prone to injury. People such as carpenters, gardeners, musicians, and athletes who perform activities that require repetitive motions or place stress on joints are at higher risk for tendinitis .

An infection, arthritis, gout, thyroid disease, and diabetes can also bring about inflammation of a tendon.

Tendinitis causes pain and tenderness just outside a joint. Some common names for tendinitis identify with the sport or movement that typically increases risk for tendon inflammation. They include tennis elbow, golfer’s elbow, pitcher’s shoulder, swimmer’s shoulder, and jumper’s knee. Tennis elbow refers to an injury to the outer elbow tendon. Golfer’s elbow is an injury to the inner tendon of the elbow. These conditions can also occur with any activity that involves repetitive wrist turning or hand gripping, such as tool use, hand shaking, or twisting movements.
Carpenters, gardeners, painters, musicians, manicurists, and dentists are at higher risk for these forms of tendinitis. Pain occurs near the elbow, sometimes radiating into the upper arm or down to the forearm. Another name for tennis elbow is lateral epicondylitis. Golfer’s elbow is also called medial epicondylitis.

How is Tendinitis treated?

Treatment focuses on healing the injured tendon. The first step in treating this condition is to reduce pain and inflammation with rest, compression, elevation, and anti-inflammatory medicines such as aspirin, naproxen (Naprosyn1, Aleve), or ibuprofen (Advil, Motrin, or Nuprin). Ice may also be used in acute injuries, but most cases of tendinitis are considered chronic, and ice is not helpful. When ice is needed, an ice pack can be applied to the affected area for 15-20 minutes every 4-6 hours for 3-5 days. Longer use of ice and a stretching program may be recommended by a health care provider.

Activity involving the affected joint is also restricted to encourage healing and prevent further injury. In some cases (e.g., in tennis elbow), elbow bands may be used to compress the forearm muscle to provide some pain relief, limiting the pull of the tendon on the bone.

The doctor or therapist may use ultrasound (gentle sound-wave vibrations) to warm deep tissues and improve blood flow. Iontophoresis may also be used. This involves using an electrical current to push a corticosteroid medication through the skin directly over the inflamed tendon.

Gentle stretching and strengthening exercises are added gradually. Massage of the soft tissue may be helpful. These may be preceded or followed by use of an ice pack. The type of exercises recommended may vary depending on the location of the affected tendon.

If there is no improvement, the doctor may inject a corticosteroid medicine into the area surrounding the inflamed  tendon. While corticosteroid injections are a common treatment, they must be used with caution because they may lead to weakening or rupture of the tendon (especially weight-bearing tendons such as the Achilles [ankle], posterior tibial [arch of the foot], and patellar [knee] tendons). If there is still no improvement after 6-12 months, the doctor may perform either arthroscopic or open surgery to repair damage and relieve pressure on the tendons.

Can Tendinitis Be Prevented?

To help prevent inflammation or reduce the severity of its recurrence:

  • Warm up or stretch before physical activity.
  • Strengthen muscles around the joint.
  • Take breaks from repetitive tasks often.
  • Cushion the affected joint. Use foam for kneeling or elbow pads. Increase the gripping surface of tools with gloves or padding. Apply grip tape or an oversized grip to golf clubs.
  • Use two hands to hold heavy tools; use a two-handed backhand in tennis.
  • Don’t sit still for long periods.
  • Practice good posture and position the body properly when going about daily activities.
  • Begin new activities or exercise regimens slowly. Gradually increase physical demands following several well-tolerated exercise sessions.
  • If a history of tendonitis is present, consider seeking guidance from your doctor or therapist before engaging in new exercises and activities.
Mark Boguski, M.D., Ph.D. is on the faculty of Harvard Medical School and is a member of the Society for Participatory Medicine, "a movement in which networked patients shift from being mere passengers to responsible drivers of their health" and in which professional health care providers encourage "empowered patients" and value them as full partners in managing their health and wellness.

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