Epicondylitis how to treat

The diagnosis of “epicondylitis of the elbow joint” is often made to adults whose professional activities are associated with physical activity in the upper limbs. The disease is accompanied by severe symptoms, in advanced cases, a person can completely lose the functionality of the hand. At the initial stages, epicondylitis can be cured conservatively, otherwise surgery cannot be avoided.

Causes

Elbow epicondylitis is a degenerative inflammatory disease in which there is inflammation of the muscles of the right or left elbow joint. Pathology affects the soft tissues that attach to the tendons of the forearm and in the place where the epicondyle of the humerus protrudes. With progression, an inflammatory complication extends to the bone tissue, periosteum, tendon apparatus, which is attached to the epicondyle, as well as the vagina. Inflammation affects not only the external or internal condyle, the tissue of the styloid process of the radial bone degenerates, as a result of which styloiditis begins to develop.

The disease affects the connective tissue of the joint.

The cause of ulnar epicondylitis may be:

  • physical activity, in which the elbow is more involved;
  • chronic injury to the joint;
  • impaired blood supply to the limb;
  • osteochondrosis, osteoporosis, spondylosis and spondylitis of the spine;
  • arthrosis and arthritis;
  • congenital weakness of the tendon-ligamentous apparatus.

Often diagnosed with bilateral epicondylitis of the elbow joint. As the disease progresses, a person begins to worry, the intensity of which increases.

Types of pathology

Given the location of a degenerative inflammatory disorder, there are:

  • Lateral or external epicondylitis. In such a situation, inflammation develops on the external site of attachment of tendon fibers, in the area of ​​the lateral epicondyle of the bone. In a different way, the pathology is called “tennis player’s elbow”, because often people involved in this kind of sport are diagnosed with such a subspecies of epicondylitis.
  • Medial or internal epicondylitis. In this case, the inflammation affects the tendons attached to the internal epicondyle of the bone. Such a diagnosis is most often found in people involved in golf, core throws.

Depending on the nature of the symptoms manifested, lateral or medial epicondylitis occurs:

Characteristic symptoms of elbow epicondylitis

Right-sided or left-sided epicondylitis is characterized by the following symptoms:

  • sudden, intense and sharp pains localized in the elbow joint;
  • exacerbation of pain after physical exertion or muscle tension of the forearm;
  • dystrophy of muscle tissue of the limb, due to which the functionality of the elbow, wrist and hand is impaired.

If lateral epicondylitis develops, the outer surface of the elbow joint hurts, while the symptoms worsen after trying to straighten the joint or rotate with a brush. With damage to the medial ligaments, soreness is localized on the inner surface of the joint. Symptoms are worse if you try to bend the limb in the forearm.

In the period of exacerbation of human pathology, acute, constant pain, accompanied by prolonged tension of muscle fibers, is disturbing. At the time of a subacute course, the symptoms become dull, and the soreness disappears when the patient provides peace to the arm. When the disease flows into a chronic form during the year, periods of remission alternate with exacerbations.

Aftermath

If the treatment of epicondylitis of the elbow joint was timely and adequate, complications do not develop. Otherwise, the risk of developing inflammatory bursitis is high, the elimination of which will require surgical intervention. Therefore, with characteristic symptoms, the use of drugs at its discretion is contraindicated. It is necessary to consult a doctor in a timely manner and treat the problem under his control.

Diagnostics

Before prescribing effective treatment, the doctor must establish an accurate diagnosis and conduct differential diagnosis. For this, instrumental research methods are used:

At advanced stages of the disease, atrophy of muscle tissue develops.

If the epicondylitis of the elbow joint develops for a long period, atrophy of muscle tissue occurs, and the patient develops such signs:

  • Symptom Thompson. If you ask the patient to keep the brush clenched in a fist in the position of the back flexion, in this state it will be possible to hold the limb for a short time, it will quickly drop and go into the state of palm flexion.
  • Symptom of Velta. To perform this test, the patient will be asked to simultaneously extend and supine a healthy and sick forearm. On the affected side, these actions are performed with a lag, which confirms the diagnosis.

Differential diagnosis will help to exclude the development of osteochondrosis, spondylosis, fracture of the epicondyle.

What treatment is prescribed?

Shishkevich Vladimir, orthopedic and traumatologistShishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews.

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Effective drugs

Conservative treatment is primarily aimed at relieving inflammation and eliminating pain. For these purposes, it is recommended to use ointments and gels belonging to the group of non-steroidal anti-inflammatory drugs. Well established themselves:

It is not effective to use NSAID tablets; injections are also prescribed during the period of exacerbation. If ointments do not help remove inflammation and pain, glucocorticosteroid blockade is prescribed. An injection is made directly into the elbow joint, where an inflammatory complication is localized. Use the drugs “Diprospan”, “Hydrocortisone” mixed with anesthetics, for example, “Lidocaine”, “Novocaine”. Such an injection completely relieves pain within 2-3 days. If you use only ointments and gels of the NSAID group, the pain disappears within 2,5-3 weeks.

Additionally, you can supplement the therapy with painkillers such as Aspirin, Butadion. As a local anesthetic, Dimexideum is prescribed, or rather, compresses based on it. A bandage with “Dimexide” is recommended to be applied to the affected area, capturing the surrounding healthy tissue. In addition to the analgesic effect, the medicine helps to remove inflammation.

Physiotherapy and massage

With such a disease, physiotherapy procedures are necessarily prescribed as adjunctive therapy, for example, such:

  • electrophoresis;
  • magnetotherapy;
  • laser therapy;
  • phonophoresis;
  • shock wave therapy;
  • paraffin or ozokerite applications;
  • hirudotherapy, in which leeches are applied to the inflamed area.

At home, for the treatment of epicondylitis, you can use the physiotherapy apparatus Retona-Forte. Using the device, you can take courses of ultrasound therapy, magnetotherapy, heating with infrared rays. Along with physiotherapy, a manual massage is prescribed, which equally effectively treats epicondylitis of the elbow joint. With the help of massage manipulations, it will be possible to restore blood supply and nutrition of atrophied muscle tissues, due to which the functioning of the limb is normalized and restored.

Exercises and restorative gymnastics

Exercise therapy with epicondylitis of the elbow joint helps restore blood circulation and regeneration of the affected areas. Therapeutic exercises should be carried out regularly, while performing exercises, the patient should not feel discomfort. To speed up recovery, it is recommended to use the Bubnovsky method, which has developed such useful exercises:

  • To bend a sick hand in an elbow and to put on an opposite shoulder. With a healthy limb, slowly pull the other hand, but do not allow feelings of discomfort.
  • Stand in front of the table with your palms on it. Slowly lean forward, resting on both limbs.

When the condition normalizes, and the risk of developing negative consequences is over, physical education expands, more intense workouts, agreed with the doctor, are added.

When can’t you do without an operation?

If medications, physiotherapy and therapeutic sports have not brought the desired effect, surgical treatment is prescribed – the operation of Goman. During therapy, tendons are excised in the area where they join the muscle extensors. The modified version provides for resection of the tendon apparatus in the place where it is attached to the bone itself. Thanks to such manipulations, it will be possible to get rid of muscle tension and pain. After surgery, stitches are placed, for 10-15 days, to relieve the condition, it is recommended to make compresses with Dimexidum.

Nontraditional methods

Treatment with folk remedies will help relieve pain and inflammation in the initial stages of epicondylitis. Well proven:

  • horse fat ointment;
  • compress with blue clay;
  • applications based on propolis tincture.

Orthopedics

In order to avoid negative consequences during the treatment period, it is recommended to immobilize the diseased limb using:

Prevention

To prevent the development of epicondylitis, it is recommended to dose the load on the elbow joint, treat degenerative-dystrophic diseases of the spine and joints in a timely manner, seek medical help for characteristic signs, and not self-medicate at home.

Elbow joint epicondylitis – symptoms and treatment, a description of the disease and its types

Acute piercing pain in the elbow is able to permanently limit the mobility of the arm, cause significant discomfort and reduce motor activity of a person. A rare person has not encountered such a phenomenon at least once in his life. There can be many causes of pain in the elbow, one of them is epicondylitis.

Elbow joint epicondylitis is an inflammatory process that occurs in the elbow, affecting the area of ​​tissues located near the joint. The disease is always characterized by acute piercing pain and the inability to bend / straighten the arm at the elbow during a pain attack. Inflammation with epicondylitis can be localized both from the external and internal sides of the elbow, depending on this, two types of disease are known in medicine:

  • External, or external (lateral);
  • Internal (medial) epicondylitis.

Types of disease

  1. External epicondylitis is a disease accompanied by inflammation of the muscles attached to the shoulder epicondyle. Cases of inflammation of this part of the muscles occur most often in those people who play tennis and constantly strain the muscles of the shoulder and forearm.
  2. Internal epicondylitis is an elbow disease characterized by inflammation of the muscles responsible for flexion / extension of the hands. Medial epicondylitis is much more common than external, it is most often affected by people working in the field of animal husbandry (milkmaids), construction and repair (painters, joiners, stucco) and sports (boxers, weight lifters).

The disease most often occurs after damage to the ligaments and tendons, and the field of activity alone cannot be the culprit of the onset of inflammation. The profession only makes you work and over-strain a certain muscle group, provoking the disease. Most often, it is the working hand that is affected, the one that is leading, and it is primarily affected from the outside. The disease is very common among other diseases, but the total percentage of patients with epicondylitis is difficult to determine, because instead of going to the doctor, the sufferer uses painkillers, anti-inflammatory or warming ointments.

Forms of the disease

Epicondylitis of the elbow joint has several phases of the course:

  • Acute is characterized by intense and persistent onset of symptoms;
  • Subacute manifests itself when a load is applied to the joint, and it is set in motion;
  • Chronic stage – when all the symptoms of inflammation last from 3 months or more, and the pain persists even at rest of the joint.

The disease is dangerous because in the absence of treatment serious complications arise, entailing complete atrophy and contract of the elbow joint.

Symptoms

Symptoms of the onset of epicondylitis are usually manifested in people with an age category of 40 to 60 years. Most often, patients complain of:

  1. Burning, piercing pain in the arm from the elbow to the hand, which occurs for no reason during flexion.
  2. Sometimes the focus of pain is located in the epicondyle and flows into the elbow and hand.
  3. Redness is observed in the elbow area, the area is hot to the touch.
  4. Strengthening pain in the joint when trying to squeeze / unclench the hand, raise the cup, bring it to the lips.
  5. The pain is acute during the onset of inflammation and aching, dull – in an advanced stage.
  6. In the area of ​​the joint, a growth is formed.

Treatment

Elbow joint epicondylitis is a serious disease, and if you do not start treating the elbow area on time, you can remain disabled.

Treatment of epicondylitis of the elbow joint begins with the patient’s visit to the clinic, a preliminary examination and a correct diagnosis made by the orthopedic surgeon.

During the examination, the doctor carefully examines the places where the pain occurs, feels them, extends and bends the arm, asks to squeeze the hand into a fist. If you suspect epicondylitis, an X-ray analysis is prescribed to study the condition of the elbow joint, a computer tomogram. After confirming the diagnosis, the doctor prescribes treatment.

Even “neglected” joint problems can be cured at home! Just remember to smear it once a day.

Epicondylitis begins to be treated immediately, determining the degree of pain and disease. Treatment consists of several stages:

  1. Removal of the inflammatory process. In such cases, non-steroidal anti-inflammatory drugs (Orthofen, Diclofenac, Ibuprofen, Nise, Indomethacin) are used in tablets. If the inflammation is very pronounced, then injections, which are prescribed by the doctor, are added to the tablet form.
  2. Removal of pain in the elbow joint. The pain syndrome is relieved by the use of analgesic drugs and ointments, creams, gels based on diclofenac or ibuprofen.
  3. Shock wave therapy, physiotherapy, acupuncture, paraffin wrap, electrophoresis. The method is prescribed after removing inflammation and pain, after 7-14 days. Therapy involves exposure to the lesion by applying current, needles, paraffin and other auxiliaries.
  4. Massotherapy. It is prescribed after stopping the main symptoms of the disease, it is performed by experienced masseurs by massaging the elbow joint, shoulder and forearm, shoulder blade.
  5. Physiotherapy. It implies exercises aimed at relaxing the injured muscle, relieving the feeling of stiffness and pain.
  6. Relapse prevention The stage consists of a set of actions aimed at eliminating the symptoms and their further occurrence.

For the prevention of epicondylitis, it is recommended to abandon excessive physical exertion on the shoulders, elbow joints and neck, you should also abandon bad habits, swimming and physiotherapy exercises, observing the regime of work and rest. Athletes should pay attention to the conformity of sports equipment with the basic technical requirements; when stretching muscles, elastic bandages and wristbands should be worn.

If the disease is already running in advanced form, then surgery is performed to remove muscle atrophy.

You can treat the disease with folk remedies at home, using ointments and performing certain exercises.

Treatment of epicondylitis with folk remedies at home

At home, the treatment of diseases of the elbow joints with folk remedies is widely used.

  1. For example, root and leaves of comfrey are used, from which ointment is prepared. To do this, take the roots and leaves of the plant in a ratio of 1 to 1, grind, honey and sunflower oil (also in equal quantities) are added to the mass and mix thoroughly until the leaves and roots are ground into dust. Ointment is impregnated with cotton tissue and wrapped around a sore joint for a day, a plastic bag is tied on top, then another layer of warm tissue is wound. The course of treatment is one month.
  2. Valdai blue clay is another way to get rid of elbow pain. Dissolved clay in hot water is applied to gauze, which is wrapped around the elbow. Fix with a bandage on top, warm with a soft cloth for 30 minutes.
  3. The remnants of green tea in a teapot are a great way to relieve inflammation of the elbow joint and relax the muscles with external epicondylitis. To prepare a tea compress, the used tea leaves are frozen in the freezer and the resulting pieces of ice are driven around the elbow joint in circular motions.

Symptoms of epicondylitis with folk remedies are best removed when the main treatment has been completed, the inflammation has been removed, and the doctor has allowed it.

Physiotherapy exercises for epicondylitis

Special exercises also help to cope with pain, eliminating the symptoms of the disease. To do this, you need to do exercises twice a day (morning and evening), including the following exercises:

  1. Slow circular hand movements in the muscle area in one, then the other side.
  2. Circular movements of the hand first in one direction and then in the other direction.
  3. Stroking and tingling the elbow joint.

Conclusion

Thus, the main symptoms of the disease are acute piercing pain and growth in the area of ​​the elbow joint. Treatment of epicondylitis is carried out with anti-inflammatory non-steroid drugs, folk remedies. Special exercises consolidate the result and are the prevention of relapse. Only a doctor can determine which method of treating the disease can be determined, so self-medication is not worth it.

Unfortunately, if inflammation has occurred in the area of ​​the musculoskeletal system, it is completely impossible to cure, however, in the absence of provocative factors and the right approach to treatment, observing all the requirements prescribed by the doctor by doing regular special exercises, you can completely remove the symptoms of epicondylitis and get rid from pain in the elbow joint, achieving stable remission.

Lateral epicondylitis: treatment

Elbow joint epicondylitis is a common occurrence, however, it is difficult to give accurate statistics, because often the symptoms are erased and the sick do not seek medical help. The lack of treatment leads to the progression of pathology and the aggravation of tissue damage.

Causes

The lateral epicondyle is a small bone formation, the main role of which is the attachment of the tendon connecting the extensor muscles. With a constant load, microtraumas form, inflammation develops, the affected areas are replaced by connective tissue. As a result, the tendon gradually degenerates, increases in volume, becomes vulnerable. Ongoing workloads interfere with tissue repair and contribute to the formation of new microtraumas.

At risk: professional tennis players, painters, artists, gardeners, other people employed in work related to monotonous movements. Lateral epicondylitis can also occur as a result of a one-time load on the arm. This occurs in people engaged in arm wrestling, working with a screwdriver or wrench.

Therefore, a number of reasons can be identified that contribute to the development of lateral epicondylitis:

  • playing sports;
  • professional activities related to hand pressure;
  • age changes.

Symptoms

Lateral epicondylitis has a gradual development. As a rule, the patient cannot remember the history of a traumatic factor. The first manifestation of the disease is discomfort or pain of small intensity in the elbow. As inflammation develops, the discomfort intensifies, the pain becomes constant, and radiates to the forearm.

When performing active movements of the affected limb, the pain becomes sharp, burning, especially strongly manifested during flexion and extension. Unpleasant sensations interfere with professional activities. The functioning of the extensor muscles of the fingers and hand is impaired, but the movements can be preserved in full.

In some cases, epicondylitis is complicated by arthritis. Then, pronounced edema and redness are noted in the elbow, joint mobility is very limited. Over time, muscle weakness, fatigue develops.

Which doctor treats lateral epicondylitis?

If you find the first symptoms of the disease, you should contact a traumatologist or surgeon – these are the specialists who treat epicondylitis.

Diagnostics

Diagnosis of the disease begins with a survey of the patient, clarification of his complaints, determination of belonging to a risk group and the presence of a traumatic factor in the history. Upon examination of the patient, the doctor assesses the presence of redness of the joint, muscle weakness, pain during palpation in the absence of discomfort in the surrounding tissues.

As a rule, a typical clinical picture is sufficient to confirm the diagnosis.

If there are doubts about the presence of lateral epicondylitis or it is necessary to conduct differential diagnostics in case of suspected other diseases of the ulnar region, additional studies are carried out:

  • X-ray in two projections to exclude arthritis and fracture;
  • ultrasonography;
  • computed and magnetic resonance imaging.

Treatment

Treatment of lateral epicondylitis has the following goals:

  • relief of pain;
  • normalization of blood circulation;
  • restoration of motor function;
  • muscle strengthening.

Conservative treatment should be comprehensive, it includes the use of medicines, physiotherapy, physiotherapy. By agreement with the doctor, it is possible to use traditional medicine.

Regime and physiotherapy exercises

In most cases, lateral epicondylitis can be treated conservatively. First of all, it is necessary to limit activity for several days. The sparing mode involves the exclusion of any brush movements: the limb is placed on a kerchief bandage and is fixed with a bandage, fixative or orthosis.

During immobilization, inflammatory processes in the lesion are reduced, tissues are restored. When the first signs of pathology occur, a gentle regimen is indicated for 7 days, but in each case its duration is determined individually. After this period, you can gradually return activity. It is better to start with passive movements: with a healthy hand, smooth flexion and extension of the affected limb are performed.

Further, within 7 days, the patient must perform rotational movements with the brush, capturing a heavy (about 1 kilogram) object. A return to the usual rhythm is possible after 2 weeks, while the elbow is necessarily strengthened by compression devices.

Physiotherapy

In the acute stage of the process, cold treatment is indicated – the use of compresses or an ice pack for 1-2 days. Thermal procedures are performed for chronic epicondylitis or after relief of an acute process. UHF therapy, electrophoresis with novocaine, acetylcholine, magnetic field therapy are used, compresses with dimexide, paraffin-ozocerite applications, shock wave therapy are used.

Medication Therapy

For the treatment of epicondylitis, medications are prescribed:

  • non-steroidal anti-inflammatory drugs (ointments Ibuprofen, Diclofenac);
  • injections of glucocorticosteroids to stop the inflammatory process in the outbreak (Diprospan, Prednisolone).

With lateral epicondylitis of the elbow joint, treatment lasts about 2-3 weeks. During this period, the pain disappears. When glucocorticosteroids are included in the treatment, acute symptoms stop in 1-3 days. However, even the use of hormones may not bring a positive result. As a rule, this happens with chronic recurrent lateral epicondylitis.

Surgery

With the preservation of symptoms and the lack of effectiveness of conservative treatment, the question of surgical intervention is resolved. During the operation, the affected tendon tissue is removed at the junction with the epicondyle.

For the treatment of lateral epicondylitis, 4 surgical procedures are used:

  • Goymann operation (tendon incision);
  • excision of the affected tissue with fixation of the tendon to the bone;
  • removal of the synovial bag;
  • tendon lengthening.

Treatment with folk remedies

For the treatment of lateral epicondylitis, traditional medicine methods are used. Among them:

  • compresses from frozen green tea;
  • laurel oil;
  • blue clay compresses;
  • compresses with alcohol tincture from horse sorrel root.

It should be noted that, despite the effectiveness and safety of treatment with folk remedies, they are not recommended for all patients. You should not choose a method of therapy yourself. Features of the pathological process and the possibility of an individual reaction to the components can lead to a deterioration in the patient’s condition. In addition, even in the case of good tolerance of folk remedies, they should be used only in conjunction with traditional methods of treatment.

Complications

External epicondylitis of the elbow joint can lead to dysfunction of the affected limb. As a result, the patient’s disability is impaired. In addition, complications during surgical treatment of epicondylitis may develop: trauma to nerves and blood vessels, decreased muscle strength, infection, and decreased flexibility of the arm.

However, it should be noted that in most cases (more than 90%), conservative and surgical treatment can almost completely restore the function of the upper limb and return to the usual level of load.

Prevention

Prevention of external epicondylitis is primarily aimed at eliminating the pathogenetic factor, especially this applies to people at risk. In addition, the principles of a healthy lifestyle should not be neglected. Moderate physical activity, proper nutrition and rejection of bad habits are non-specific prevention of many diseases.

The basis for preventing epicondylitis is to reduce the load on the muscle apparatus of the upper limbs. Tennis players should practice the impact technique, use suitable equipment and fix their elbows with an elastic bandage.

It is recommended that individuals whose professions involve monotonous hand movements optimize ergonomics of the workplace, observe breaks and limit the load on extensor muscles. In the case of chronic recurrent epicondylitis, poorly responding to therapy, patients are encouraged to consider the possibility of changing professional activities.

Lateral epicondylitis is a common disease that can significantly impair the patient’s quality of life and limit their ability to work. The first symptoms may be minor, but this does not mean that delay is acceptable – treatment should be started as soon as possible. Full compliance with the doctor’s recommendations regarding the regimen and tactics of therapy allows you to fully restore the function of the upper limb and return to the usual rhythm of life.

Posted by: Ksenia Khazieva, Doctor,
specially for Ortopediya.pro

Useful video about epicondylitis

Epicondylitis

Epicondylitis – damage to the elbow joint with the formation of the so-called “tennis elbow” – a progressive dystrophic process in the joint area, where muscles are attached to the protrusions on the humerus.

The process leads to severe inflammation of the surrounding tissues and impaired function of the hand, it is often a professional injury to athletes whose activities are associated with active hand movements – tennis, golf, baseball.

The main cause of epicondylitis is constant stress and microtrauma in the elbow, associated with professional or sports activities. Usually this happens when playing games with the active involvement of the hands, when lifting and carrying weights, with inadequate loads on the elbow area.

Basically, epicondylitis occurs due to the uniform actions of flexion-extension of the elbows, with simultaneous load on the area of ​​the arm in the area of ​​the hand and forearm.

Professional actions for twisting or untwisting of the arm provoke epicondylitis (repairmen, car mechanics, athletes), blows in the elbow.

For the most part, this condition develops in people with congenital dysplasia of the connective tissue and “loose” joints, often epicondylitis combined with osteochondrosis in the cervical or thoracic spine.

Men suffer more often than women. Epicondylitis is common among athletes, masseurs, carriers, painters. More often it is right-handed, but for left-handed people, on the contrary.

Three types of epicondylitis can be distinguished depending on the location of injuries and soreness:

Lateral (external) epicondylitis

  • This form is also called a “tennis elbow”, with it the lesion is mainly localized on the outside of the elbow.
  • A pressing feeling arises above the bones that enter the joint area and tendons.
  • Disrupted hand movement such as wearing, grabbing, or raising objects with your hand.

Medial (internal) epicondylitis

  • It is also called the “golfer’s elbow”, and the damage is localized along the inside of the joint, where tendons are stretched and discomfort in the bone area occurs.

Inflammation of the back of the elbow

In this condition, bursitis develops, the mucous membrane of the bag is affected.

Usually occurs when falling on the elbow, with excessive extension of the arm, when making sudden movements.

The most initial and main sign of external epicondylitis is pain – this is local pain in the area of ​​the outer part of the elbow.

Pain can be given up the shoulder and along the outer edge of the arm, and may radiate in the forearm. There is pain also when moving, it can occur when feeling the elbow area along its outer part, as well as when twisting the arm inward with bending it at the elbow, the arm does not hurt at rest. Passive movements in the elbow are also not painful, pain occurs only with active resistance, with muscle tension.

Pain can be aggravated by clenching the fist and flexing the wrist, gradually the pain intensifies, manifesting itself even with slight movements or while holding small weights in the hand.

Externally, the arm is not changed, the range of motion in it is not limited, when probing, the doctor can determine the point of maximum pain, located both in the area of ​​tendon attachment and in the area of ​​muscle attachment.

Sometimes tissue edema in the area of ​​damage compresses the branches of the radial nerve, which is manifested by paresis of the muscles that extend the fingers and hand.

Usually, external epicondylitis occurs chronically, with the creation of rest and rest, the damaged muscles and tendons of the pain disappear, but with significant exertion or the resumption of training, they reappear. Strengthening the load provokes severe pain attacks.

Internal epicondylitis usually occurs in those who are subjected to light, but prolonged and monotonous physical exertion (drivers, seamstresses, installers, golfers). This form is not uncommon in women.

Pain with medial epicondylitis occurs in the inner part of the elbow, with pressure on the internal epicondyle. The pains are aggravated by bending the arm and twisting it inward, giving it to the region of the inner part of the shoulder to the armpit and along the forearm to the thumb. This form is also chronic.

The basis of the diagnosis is clinical manifestations, as well as a thorough examination and clarification of the patient’s type of activity.

In the future, x-rays of the joint are used in several projections, and, if necessary, computed tomography. Changes in the joint can be detected only in chronic long-term course.

Blood tests and biochemistry for epicondylitis do not change.

Persistent epicondylitis must be distinguished from a fracture of the epicondyle, rheumatic and other injuries of the elbow joint, intraarticular fracture of the humerus.

The treatment is performed by an orthopedic trauma surgeon. The treatment is mainly conservative, primarily carried out:

  • external use of anti-inflammatory drugs based on ibuprofen or diclofenac,
  • for pain, the introduction of a mixture of corticosteroid hormones with anesthetics is indicated,
  • in advanced and complex cases, extracorporeal shock wave therapy is used,
  • rest on the area of ​​the joint with immobilizing dressings (bandage in the form of a figure of eight using a protective elbow).

Hand loads should be given gradually, first applying the methods of physiotherapy exercises and small volumes of movements.

With timely diagnosis, it is possible to achieve complete healing of epicondylitis in a few weeks, on average, relief comes in 3-5 days, but rehabilitation lasts about a month.

The process is prone to recurrence, so it is necessary to carry out prophylaxis with dosing loads on the arm, avoiding stereotypical movements.

Elbow epicondylitis (elbow joint)

What is epicondylitis

Epicondylitis is a tissue lesion in the elbow joint, which is inflammatory and degenerative in nature. The disease begins to develop at the attachment of the tendons of the forearm to the epicondyles of the humerus, on the outer or inner surface of the joint. Its main cause is chronic overload of the muscles of the forearm.

With epicondylitis, the pathological process affects the bone, periosteum, tendon attached to the epicondyle, and its vagina. In addition to the external and internal condyle, the styloid process of the radial bone is affected, which leads to the development of styloiditis and the appearance of pain at the site of attachment of the tendons of the muscles that divert and extend the thumb.

Elbow joint epicondylitis is a very common disease of the musculoskeletal system, however, there is no accurate morbidity statistics, as the disease often proceeds in a fairly mild form and most potential patients do not go to medical facilities.

According to localization, epicondylitis is divided into external (lateral) and internal (medial). Lateral epicondylitis occurs 8-10 times more often than medial, and mainly in men. Moreover, right-handed people mostly suffer from the right hand, while left-handed people have the left.

The age range in which this disease is observed is 40-60 years. The risk group includes people whose occupation is associated with the constant repetition of the same uniform movements (drivers, athletes, pianists, etc.).

Causes of Epicondylitis

In the development of the disease, degenerative changes in the joint precede the inflammatory process.

Provoking factors in this case are:

The nature of the main work;

Regular microtrauma or direct injury to the elbow joint;

Chronic joint overload;

Local circulatory disorders;

The presence of osteochondrosis of the cervical or thoracic spine, shoulder-shoulder periarthritis, osteoporosis.

Epicondylitis is often diagnosed in people whose main activity is associated with repetitive hand movements: pronation (turning the forearm inward and palm down) and supination (turning outward with the palm up).

The risk group includes:

agricultural workers (tractor drivers, milkmaids);

builders (masons, plasterers, painters);

athletes (boxers, weightlifters);

doctors (surgeons, masseurs);

musicians (pianists, violinists);

service workers (hairdressers, ironers, typists), etc.

By themselves, these occupations do not cause epicondylitis. The disease occurs with excessive overload of the forearm muscles, when systematic microtrauma of the periarticular tissues occurs against its background. As a result, the inflammatory process begins to develop, small scars appear, which further reduces the resistance of tendons to stress and high muscle tension and leads to an increase in the number of microtraumas.

In some cases, epicondylitis occurs due to:

Received direct injury;

Congenital weakness of the ligamentous apparatus in the elbow joint;

A single intense muscle overstrain.

As mentioned above, there is a connection between epicondylitis and diseases such as:

Osteochondrosis of the cervical or thoracic spine;

The role of local circulatory disorders and degenerative phenomena in the onset of the disease is evidenced by the often diagnosed bilateral nature of the lesion and the slow, gradual development of the disease.

Symptoms of Epicondylitis

Common symptoms of epicondylitis include:

Spontaneous intense, sometimes burning pains in the elbow joint, which over time can become dull, aching;

Increased pain during physical exertion on the elbow or with muscle tension of the forearm;

Gradual loss of muscle strength in the arm.

With lateral epicondylitis, the pain spreads along the outer surface of the elbow joint. It intensifies with the extension of the wrist, with resistance to its passive bending and rotation of the brush outward. In the latter case, muscle weakness is also observed on the outside of the elbow. The test “coffee cup” gives a positive result (the pain intensifies when you try to lift a cup filled with liquid from the table). The intensity of the pain syndrome increases with supination (turning outward) of the forearm from the extreme point of pronation.

With medial epicondylitis, the pain is localized on the inner surface of the elbow joint, intensifies with flexion of the forearm and resistance to passive extension of the wrist. The pain may give down along the inner muscles of the forearm towards the hand. There is a sharp limitation on the range of motion in the joint.

There are acute, subacute and chronic stages of the disease. First, the pain syndrome accompanies a sharp or prolonged muscle tension, then the pains become constant, and fast muscle fatigue appears. In the subacute stage, the intensity of pain decreases again, at rest they disappear. They say about the chronic course of the disease when the periodic alternation of remissions and relapses lasts from 3 to 6 months.

Types of Epicondylitis

Depending on the localization, epicondylitis is divided into two main types: external, or external, which affects the tendons attached to the external epicondyle, and the internal, in which the tendons coming from the internal epicondyle are inflamed.

Lateral (external) epicondylitis

In this case, the attachment point of the muscle tendons to the lateral epicondyle of the bone is inflamed. External epicondylitis is often called the “elbow of a tennis player” because this problem is typical of people who are fond of this sport. When playing tennis, there is an overstrain of extensor muscles located on the outside of the forearm. A similar overload on specific muscles and tendons is also observed with such a monotonous work as sawing firewood, painting walls, etc.

Lateral epicondylitis is detected during a screening test called a “handshake symptom”. The usual handshake in this case causes pain. Also, pain can appear when the hand is turned upside down, when the forearm is extended.

Medial (internal) epicondylitis

With internal epicondylitis, the site of attachment of muscle tendons to the medial epicondyle of the bone is affected. Other names for this type of disease are epitrochleitis and “golfer’s elbow”, which indicates its prevalence among golf lovers. Also, sports such as throws, throwing nuclei lead to medial epicondylitis.

Unlike lateral, this type of epicondylitis is more common with lighter loads, therefore it is observed mainly in women (typists, dressmakers, etc.). The uniform stereotypical movements that they perform are made due to the flexor muscles of the wrist, which are attached by the tendons to the medial epicondyle of the humerus.

Usually, in this case, pain occurs when pressure is applied to the internal epicondyle, increases with flexion and pronation of the forearm, and also radiates along its inner edge. In most cases, the patient can accurately determine the localization of pain. The chronic course, as well as the involvement of the ulnar nerve, is especially characteristic of internal epicondylitis.

Traumatic Epicondylitis

Traumatic epicondylitis is a systematic minor trauma in the process of constant execution of the same type of action. Usually it is accompanied by deforming arthrosis of the elbow joint, damage to the ulnar nerve and cervical osteochondrosis. At the age of over 40, the ability of tissues to regenerate decreases, and damaged structures are gradually replaced by connective tissue.

Post-traumatic epicondylitis

This type of epicondylitis develops as a result of the received sprains or dislocations of the joint, with poor compliance with medical recommendations during the rehabilitation period and too hasty transition to intensive joint work.

Chronic epicondylitis

The chronic course is very characteristic of a disease such as epicondylitis. Over a long time, when exacerbations are replaced by relapses, the pain gradually acquires a weak, aching character, and the muscles lose strength, to the point that a person can not sometimes write or just take something in his hand.

Diagnosis of epicondylitis

Diagnosis is based on a patient survey, medical history and visual examination. The difference between epicondylitis and other destructive lesions of the elbow joint is determined by the specificity of the pain syndrome. With this disease, pain in the joint appears only with independent physical activity. If the doctor himself makes various movements with the patient’s hand without the participation of his muscles (passive flexion and extension), pain does not occur. This is the difference between epicondylitis and arthritis or arthrosis.

Additionally, tests are performed for the symptoms of Thomson and Welt. Thomson’s test is as follows: the patient must clench a brush in the back position. At the same time, it unfolds rather quickly, moving into a position with the palm up. When a Velta symptom is detected, it is necessary to keep the forearms at the level of the chin, and at the same time to straighten and bend the arms. Both actions performed by a sick hand noticeably lag behind those performed by a healthy hand. Carrying out these tests is accompanied by severe pain. Also, this disease is characterized by pain in the area of ​​the articular tendons when the arm is abducted.

Epicondylitis must be differentiated from:

Epicondylitis and its treatment

Treatment of epicondylitis, causes and diagnosis of epicondylitis

Epicondylitis

The inflammation that occurs in the epicondyles and associated tendons and muscles is called epicondylitis. The treatment of epicondylitis is long. In some human skeletal bones, for example, the humerus or femur, close to the joints there are small-sized bone formations and the so-called condyles, which take part in the formation of joints. The condyle, being the protrusions of the bones for fastening the muscles, have epicondyluses (epicondyluses) on their surface, which also represent bone elevations. They are not needed for the formation of the joint, but are the place to which adjacent muscles can be attached.

Causes of the onset and development of epicondylitis disease

Epicondylitis often affects the elbow joint.

The so-called condyle, together with the epicondyle, which form the joint of the elbow, are located at the end of the humerus. The epicondyle, located outside the elbow, is called lateral, and the one inside is called medial. Epicondylitis may also have appropriate names.

The medial eicondylus is used to fasten the muscles, allowing you to bend the elbow and wrist joint, fingers. Using those very muscles, you can make rotational movements with the hand or forearm in the inside. The literal muscle group is attached to the corresponding epicondyle – the external. They serve to extend the elbow, arm and fingers, help them rotate outward.

Elbow joint epicondylitis occurs when a constant injury to the tendons of the joint occurs with not very intense loads with frequent and prolonged repetition. The entire process of the development of diseases has not yet been studied. It is only known that with a long constant load on the muscles, tendon friction occurs on the surface of the epicondyle. It is believed that this can cause microtrauma with ruptures in individual tendon fibers. Scars may appear in the gap zone. At the same time, pathological changes begin in the periosteum of the epigastrium and adjacent tendons. Tissue degeneration leads to an inflammatory process.

Who is affected by epicondylitis?

The risk group includes people who engage in activities that are most susceptible to the causes of this disease.

External (lateral) inflammation is usually characteristic of those whose work is inextricably linked to intense physical exertion (painters, plasterers, loaders, masseurs) or athletes (tennis players, rowers). Internal (medial) inflammation affects the joints and muscles of people in professions such as a seamstress, programmer, etc. It is often inherent to golf lovers. The resulting inflammatory process of the epicondyles can be the result of injuries, for example, detachment of the ulnar process, or damage to the ligaments.

The mechanism of occurrence and development of knee epicondylitis is in many ways similar to ulnar epicondylitis. The reasons are also very similar, which are also related to occupation and sports. Elbow epicondylitis is sometimes caused by cervical osteochondrosis, knee often occurs due to lumbar osteochondrosis.

Symptoms of the disease epicondylitis

Epicondylitis is more likely to occur in people belonging to a fairly broad age category of 30-60 years. Much more often you can find the external form of the disease. The disease often has a protracted chronic nature with periodically alternating exacerbations. The symptoms in the acute stage of the disease are most pronounced.

Pain originates in the epicondyle, undergoing an inflammatory process. Severe pain is localized when making movements in the elbow or wrist joint. If the lateral alkalis is inflamed, the rotation and extension of the arm and fingers can provoke pain. Medial epicondylitis provokes severe pain at the time of flexion of the hand and its rotation inward. On palpation of the sore spot, the pain intensifies sharply. Redness or swelling in the affected area is not detected.

For patients with epicondylitis, such actions as raising a cup of tea, shaking hands, clenching your fingers into a fist are often difficult. Such movements of a grasping nature can cause terrible pain in inflammation of the epicondyle. This pain can often also spread to the muscles. A characteristic feature of the disease is the occurrence of pain only if active movements are performed, and passive actions are completely painless. Chronic epicondylitis changes the nature of the pain, which can become continuously aching over time. Restrictions on movement caused by such pain can cause muscle atrophy, as well as decreased sensitivity.

Diagnosis and treatment of epicondylitis

The diagnosis of epicondylitis (diagnosis of epicondylitis) is usually made based on the patient’s complaints related to characteristic pains and the examination. In the most difficult cases, other methods of medical research are used: X-ray, CT of the elbow joint. The information content of such methods is justified only at the stage of the chronic form, in which pathological changes already begin to develop in the epicondyle.

The initial stage of the disease requires the limitation of any load on the affected joint, for which it, first of all, is immobilized with the help of an ordinary scarf dressing or orthopedic devices and devices. Non-steroidal anti-inflammatory drugs such as Voltaren, Diclofenac, etc. are used for drug treatment.

epicondylitis

Sometimes administration of a steroid agent directly to the area of ​​the resulting inflammation is required: Diprospan, Betamethasone, etc. In severe pain, Novocain or Lidocain injections are indicated in order to create a local blockade.

An excellent and indispensable supplement in the treatment of epicondylitis is exercise therapy. Power loads when performing exercises are contraindicated, movements should have a weak sparing nature. It is required to make light rotational movements, flexion and extension of the arms at the elbows, clenching the fingers into a fist. When severe pains pass, and the patient’s condition improves, they begin physical procedures (magnets, electrophoresis, paraffin), and shock-wave therapy is successfully used.

Muscle massage is used to improve local blood circulation and finally get rid of pain.

It will not be possible to completely defeat chronic epicondylitis, it will periodically remind of itself, but a long remission will allow you to continue to do normal activities and live a full life.

Shishkevich Vladimir

Shishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews. It specializes in the treatment of diseases in orthopedic, traumatological, vertebrological profiles

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