Epicondylitis is one of the diseases that develop mainly gradually. For the first clinical signs to occur, it sometimes takes years. It all depends on the degree of load on the elbow, the episodicity of the corresponding injuries, the individual characteristics of the patient.
Doctors distinguish the following traditional symptoms of epicondylitis:
- Local pain in the area of the affected epicondyle. It increases with palpation or physical exertion. The “handshake symptom” remains positive – an increase in the intensity of the pain syndrome with the corresponding action.
- Irradiation of discomfort up the shoulder or to the middle of the forearm. This symptom depends on the intensity of the load. The higher it is, the more pain spreads.
- Decrease in functional activity. Against the background of constant discomfort and pain, a person begins to spare the elbow and compensatoryly reduces the activity of movements that enhance the symptoms of pathology.
Externally, the elbow joint is unchanged. Its dimensions correspond to the norm. The volume of passive movements is not disturbed. They cause pain in the elbow joint only when resistance occurs.
Epicondylosis and its symptoms have a chronic course. It is almost impossible to completely cure the disease. It is realistic to achieve the complete disappearance of the corresponding signs, but only if the provoking factors are reduced or eliminated.
The disease is divided into several types. Depending on the location, doctors talk about external and internal epicondylitis. Tendons, respectively, are attached to the pathological process, which are attached to the lateral (lateral) and medial epicondyle.
External epicondylitis is also called the “elbow of a tennis player.” It can be diagnosed in a large number of relevant athletes due to the constant physical activity of the extensor muscles of the same type, fixed to the outside of the forearm.
This option for the development of pathology is the most common. It is also characteristic of lumberjacks, painters and other similar professions. To confirm the appropriate diagnosis, a simple test is performed. The patient is asked to shake the doctor’s hand. In the presence of epicondylitis, pain in the area of the external epicondyle is sharply increased. Discomfort also accrues when the hand is turned with the palm of the hand toward the sky or when the forearm is bent.
Internal epicondylitis develops 5 times less. The disease progresses against the background of the same type of movement of a lesser load. Unlike the previous variant of pathology, women employed in factories for sewing clothes, secretaries and the like more often suffer here.
This type of disease is also called the “golfer’s elbow.” A feature is its chronic course. The development of subacute epicondylitis is uncharacteristic. Often there is an involvement in the pathological process of the ulnar nerve.
In the classifications of epicondylitis, its post-traumatic type is sometimes distinguished. It develops after a serious injury with improper care for the patient, ignoring the doctor’s recommendations. Unauthorized reduction of the rehabilitation period with a quick return to great physical exertion leads to the progression of the disease.
Which doctor treats epicondylitis?
Epicondylitis is a disease that does not require emergency or urgent care. These patients are treated on an outpatient basis in the provision of medical services. If an appropriate clinical picture occurs, it is necessary to contact a traumatologist or orthopedist at the place of residence.
The patient’s first contact may be with a family doctor or local GP. In the absence of a narrow specialist, a general practitioner is able to provide the patient with proper medical support.
In the course of treatment, physiotherapeutic procedures are often performed. The patient is referred to the appropriate specialist. If the treatment remains ineffective for a long period of time, with an increase in the severity of the clinical picture, you can try to perform surgery.
Establishing the correct diagnosis for the doctor is not too difficult. Disease verification is based on the following points:
- Complaints of the patient.
- Medical history.
- The results of a clinical examination of the patient. The presence of traditional symptoms of epicondylitis allows the final diagnosis to be made without the use of specialized instrumental techniques.
An important feature of the disease is the nature of the pain. It has a clear localization. The patient can show with a finger where it hurts the most. Discomfort increases with physical exertion. Externally, the joint is unchanged.
These features allow you to differentiate epicondylitis with other diseases. Most often, the following pathology needs to be “screened out”:
In the presence of symptoms associated with impaired sensitivity of individual sections of the arm below the lesion area, differential diagnosis is carried out with tunnel syndrome. This is a pathology that develops due to local edema or compression of the nerve at the site of its passage through natural openings in the bones.
To exclude fractures, an X-ray examination of the corresponding area is used. A general blood test may be required to assess the presence of an inflammatory process.
Differential diagnosis with tunnel syndromes is sometimes carried out using magnetic resonance imaging.
How to treat epicondylitis? The choice of therapeutic tactics is based on the characteristics of a particular clinical case, the severity of symptoms, individual characteristics of the patient.
- Analgesia. The main complaint of patients is pain. Its cessation is always in the first place.
- Normalization of local blood circulation. Full microcirculation is the key to rapid regeneration.
- Restoring mobility in the elbow joint. Adequate treatment contributes to the patient’s return to a normal lifestyle.
- Prevention of the development of contractures and atrophy of the corresponding muscle groups.
How to cure epicondylitis? It is almost impossible to completely get rid of the problem. In the early stages, an effective method of preventing the progression of pathology is to change the nature of physical activity. The patient should exclude the provoking factor, which will prevent further tissue damage.
What to treat? Conservative therapy is the most common and justified option for healing a person with epicondylitis. In practice, mainly non-steroidal anti-inflammatory drugs in the form of ointments are used.
Oral administration of appropriate medications does not always bring the desired result. With low efficiency of these funds blockages are used. They provide for the simultaneous introduction of a glucocorticosteroid (hydrocortisone, prednisone) with an anesthetic (lidocaine) into the affected area. Injections are carried out 2-3 times every week.
A good therapeutic effect is demonstrated by physiotherapy. Treatment of epicondylitis can be carried out using the following methods:
- Paraffin baths and others.
How to treat epicondylitis if nothing helps? In extreme cases, surgery is performed to remove the affected tendon.
Preventing the disease is easier than curing it. In the case of epicondylitis, it is necessary to limit chronic stereotypical stresses that damage the tendons. If a person goes in for sports, he must from the very beginning develop the right habits, work position, equipment, and the like.
Epicondylitis is a disease that is easy to prevent. The main thing is to prevent overvoltage.
Shishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews.
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