Epicondylitis is a lesion of the elbow joint with the formation of the so-called “tennis elbow” – a progressive dystrophic process in the joint, where the muscles are attached to the protrusions on the humerus.
The process leads to severe inflammation of the surrounding tissues and dysfunction of the hand, often the professional trauma of athletes whose activity is associated with active hand movements – tennis, golf, baseball.
The main cause of epicondylitis are constant loads and microtraumas in the elbow area, associated with professional or sports activities. Usually this happens when playing with active involvement of hands, when lifting and carrying weights, with inadequate loads on the elbows.
Mostly, epicondylitis occurs as a result of monotonous actions in flexion-extension of the elbows, with simultaneous loading on the arm in the area of the hand and forearm.
Provoke epicondylitis professional actions by twisting or untwisting hands (repairmen, car mechanics, athletes), blows to the elbow.
Mostly this condition develops in people with congenital connective tissue dysplasia and “loosening” of the joints, often epicondylitis is combined with osteochondrosis in the area of the cervical or thoracic spine.
Men suffer more often than women. Epicondylitis is widespread in athletes, massage therapists, carriers, and painters. More often it is right-hand, for left-handers it is the opposite.
Depending on the location of the lesions and tenderness, there are three types of epicondylitis:
Lateral (external) epicondylitis
- This form is also called “tennis elbow”, with a lesion mainly localized on the outer part of the elbow.
- An overwhelming sensation arises over bones entering the joint area and tendon sprains.
- Such a movement of the arms as carrying, grabbing or lifting objects with a hand is disturbed.
Medial (internal) epicondylitis
- It is also called the “golfer’s elbow,” with damage localized on the inside of the joint, where the tendons tend to stretch and bone discomfort occurs.
Inflammation of the back of the elbow
In this condition, bursitis develops, the mucosa of the bag is affected.
Usually occurs when falling on the elbow, with excessive extension of the arm, when making sharp movements.
The most initial and main symptom of external epicondylitis is pain – this is a local pain in the outer part of the elbow.
The pain may give up the shoulder and on the outer edge of the arm, may radiate to the forearm. There is also pain when moving, it can occur when feeling the elbow area on the outer part of it, as well as when twisting the arm inward with bending it in the elbow, the arm does not hurt alone. Passive movements in the elbow are also not painful, pain occurs only with active resistance, with muscle tension.
The pains can be aggravated by clenching the fist and flexing the wrist, and pain gradually intensifies, manifesting already with slight movements or holding small weights in the hand.
Externally, the hand is not changed, the range of movements in it is not limited, while probing, the doctor can determine the point of maximum pain, which is located both in the area of tendon attachment and in the area of muscle attachment.
Sometimes tissue swelling in the area of damage squeezes the branches of the radial nerve, which is manifested by paresis of the muscles that unbend fingers and hand.
Usually, external epicondylitis occurs chronically, when creating rest and rest for injured muscles and tendons, the pain disappears, but with significant exertion or resumption of training, it recurs. Increased load provokes severe pain attacks.
Internal epicondylitis usually occurs in those who are exposed to mild, but prolonged and monotonous physical exertion (machinists, seamstresses, assemblers, golfers). This form is not uncommon in women.
Pain in the 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 inside of the shoulder to the armpit and the forearm to the thumb. This form also occurs chronically.
The basis of the diagnosis is clinical manifestations, as well as a thorough examination and clarification of the type of activity of the patient.
In the future, apply X-rays of the joint in several projections, and if necessary, computed tomography . Changes in the joint can be identified only in chronic long-term course.
Blood tests and biochemistry with epicondylitis do not change.
Persistent epicondylitis must be distinguished from an epicondyle fracture , rheumatic and other damage to the elbow joint, intra-articular fracture of the humerus.
The treatment is dealt with by a traumatologist-orthopedist. The treatment is mostly conservative, primarily carried out:
- external use of anti-inflammatory drugs based on ibuprofen or diclofenac,
- for pain, administration of a mixture of corticosteroid hormones with anesthetics is indicated,
- in advanced and difficult cases, extracorporeal shock wave therapy is used,
- hirudotherapy (use of medical leeches),
- acupuncture, acupuncture,
- postisometric relaxation of the zone of tense muscles,
- tincture of horse sorrel root, oil solution of bay leaf on the affected area,
- rest on the joint area with immobilizing bandages (bandage in the form of a figure eight using protective elbow pads).
The load on the arm must be given gradually, first applying the methods of physiotherapy exercises and small amounts of movement.
With timely diagnosis, you can 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.