Traumatic epicondylitis. Signs of ulnar epicondylitis - symptoms, diagnosis, home treatment and orthosis selection. Are complications possible and what is the prognosis

A disease of a degenerative-dystrophic nature, localized in the area of the elbow joint, originating at the points of attachment of the muscles to the epicondyle of the shoulder bone. Depending on the place of localization, it can be external and internal.

This disease is characterized by the presence of stable pain symptoms in the elbow and forearm, although there are no distinct functional disorders. Three-fourths of this disease occurs on the right hand.

Inflammation of the elbow joint, although it does not lead to a complete loss of a person's ability to work, but significantly worsens the quality of life.

With untimely treatment, the destruction of cartilaginous tissue and tendons occurs, and an inflammation process appears in nearby organs.

Causes

Epicondylitis - occupational disease, resulting from constant physical overload and stretching of the tendon, as a result of which microcracks form in its tissues, inflammation of the ligaments occurs, and the connective tissue replaces the damaged cells.

Gradually, the tendon increases in size, and becomes more sensitive to various loads.

The main factors provoking the elbow joint:

repeated ghosting and withdrawal of the forearm along with extension and flexion of the elbow (a typical practice for athletes, people involved in the game of musical instrument, seamstresses, painters and masons);
direct injuries or microtraumas in the elbow area;
inherited dysplasia connective tissue;
osteochondrosis of the cervical or thoracic regions and arthrosis of the elbow joint;
age-related changes in the skeletal tissue of the female and male population after 40 years;
disorders of blood circulation in the joint area;
one-time strong muscle strain.

Types of epicondylitis

There are several types of this disease:

Lateral epicondylitis of the elbow joint (external) - inflammation of the site of attachment of the tendons to the external epicondyle of the bone. characteristic of the occupation, in which a great tension of the extensor muscles located on the outer side of the forearm is performed.
Medial epicondylitis of the elbow joint (internal) - inflammation of the site of attachment of the tendons to the internal, with the involvement of the ulnar nerve. Monotonous, light movements that involve the flexor muscles of the wrist lead to this disease.
Traumatic epicondylitis is a systematic injury to the tendons when performing repeated actions of the same type. Companions of this disease are arthrosis of the elbow joint and damage to the ulnar nerve. This occurs after 40 years, due to a decrease in the regenerative capacity of tissues.
Post-traumatic. Occurs during rehabilitation after acquired sprains or dislocations of the joint, when medical requirements are ignored and the hasty resumption of enhanced actions by the affected joint.

Symptoms

At the beginning of the disease, unpleasant sensations are observed in the form of mild periodic pain radiating to the hand, as well as burning in the elbow and in the forearm.

Then the pain becomes continuous, there are difficulties in performing any activity.

No clinical bone changes can be detected on x-ray, there is no swelling or redness in the elbow area.

With physical exertion, the pain becomes more intense, with time active muscle strength is lost, although passive actions (extension and flexion) by another person do not give unpleasant sensations of pain. In addition, with this pathology, there are sensations of numbness and tingling in the elbow area.

Recognizing lateral epicondylitis of the elbow joint can be done with a simple handshake, which leads to severe pain. The focus of pain falls on the outer surface of the elbow joint, pain appears when the forearm is extended.

When you press on the painful area, detected during movement, there are not strong pain sensations. Feeling neighboring tissues does not lead to pain.

In the case of medial epicondylitis of the elbow, when pressing on the internal epicondyle, severe pain is detected, which increases with pronation of the forearm.

The sensation of pain is observed when bending in the elbow joint. The pain is exacerbated by bending the forearm and is localized on the inside of the elbow joint.

When imitating a movement similar to milking, there is a multiple increase in pain. The development of both external and internal epicondylitis very often has chronic features.

Stages of epicondylitis

Inflammation of the elbow joint is acute or subacute. The disease passes into the chronic form if the treatment was not started on time or is completely absent:

At the acute stage of the disease, severe, constant pain captures the forearm area, the arm becomes exhausted. If the patient tries to fold his fingers into a fist with a straightened arm, there is a strong pain.
At the subacute stage, the characteristic pain in the forearm occurs a month after the onset of the disease, the muscles become weak. The first pain manifests itself during physical exertion of the hand.
The chronic stage is characterized by constant aching pain that increases at night, depending on meteorological conditions. There is severe muscle weakness. From time to time, remission of this disease alternates with exacerbations.

Diagnostics

After the onset of characteristic symptoms of epicondylitis, a person needs to seek medical help. The decisive moments for establishing the diagnosis are the questioning and clinical examination of the patient.

The main distinguishing feature of this disease is pain in the joint only during active physical activity, with passive flexion and extension of the joint, pain is not observed.

An X-ray examination for epicondylitis is prescribed in extreme cases and is informative only in the chronic course of this and compaction bone tissue. With external epicondylitis of the elbow joint, there are no changes. In addition, the following tests are performed during the examination:

Mobility test. It is necessary to fix the patient's elbow, while turning the brush to the side. After turning the hand in the opposite direction, overcoming the resistance of the medical worker's hand, severe pain appears.
Welt test. The patient extends both arms forward while simultaneously turning the open palms up and down. An arm with an affected area will noticeably fail to keep up with a healthy limb.

Ancillary examinations are carried out in cases where there is a possibility of other diseases. To exclude a fracture of the epicondyle, an x-ray is taken. In the case of a fracture, there is swelling of the tissues in the articular zone.

With arthritis and arthrosis, there is a vague pain in the joint, and not in the epicondyle zone, passive movements in the joint are painful, there is swelling in the damaged area. To make a diagnosis, ultrasound and radiography of the joint are done, inflammatory components are determined by a blood test.

According to statistics, men suffer from elbow pain at least as often as women.

Most often they are middle-aged people from 35 to 54 years.

Not everyone associates the onset of symptoms with unusual or excessive exercise. It happens that epicondylitis starts on its own without any apparent reason. The truth is that we do not really know why this pathology appears.

In addition to the lateral (aka external), there is also medial (aka internal) epicondylitis of the elbow joint. It occurs in 10-20% (according to different authors) of cases from all epicondylitis. The only difference is that the pain does not appear from the outside, but from inside the elbow joint, since they are involved in this process on the extensors, and the flexors of the wrist.

Medial epicondylitis of the elbow is also called "golfer's elbow", but golfers in our latitudes are even rarer than tennis players.

The localization of the site of inflammation depends on which muscles were subjected to physical overload. There are 2 forms of pathology:

External epicondylitis (lateral). With this type of disease, the tendons that work during extension are affected. The place of attachment of the fibers to the lateral epicondyle becomes inflamed. Otherwise, this disease is called "tennis elbow". Its cause is a heavy and prolonged load on the hands. External lesions are the most common. This disease affects those people who, when working or playing sports, have to make extensor movements.
Internal epicondylitis (medial). This type of lesion is observed much less frequently, the disease occurs with a monotonous load on the forearm. This form of epicondylitis is called golfer's elbow. Pathological changes affect the tendons and muscles that work as flexors. The medial epicondyle becomes inflamed. If external epicondylitis usually occurs in people engaged in hard work, then the internal form, as a rule, affects people engaged in light but monotonous work.

The international classification of diseases classifies epicondylitis of the elbow joint as a disease of the musculoskeletal system and connective tissue. Further, ICD-10 classifies this pathology as enthesopathy (degenerative-inflammatory lesion). This is the code M77.ICD-10 differently encodes 2 forms of this pathology:

lateral epicondylitis - M77.0;
medial epicondylitis - M77.1.

Hand loading - main reason illness. Sometimes one awkward movement is enough for the development of pathology.

There is post-traumatic epicondylitis of the elbow joint, what is it? The inflammatory process in the epicondyle occurs after dislocation, stretching. Immediately after the injury, a person feels a sharp pain, which then subsides.

Other reasons for the development of pathology in the epicondyle can be:

inflammation of the tendons;
osteochondrosis.

In these cases, the disease is secondary.

Epicondylitis is sometimes localized in the area of the shoulder and knee. The causes of damage to these joints are similar.

Often patients ask which doctor treats epicondylitis. If you experience signs of this disease, contact an orthopedist, rheumatologist or surgeon.

Epicondylitis - how to treat this disease? If you experience pain in the forearm, you should consult a doctor as soon as possible. Before treating the pathology, it is necessary to ensure the rest of the damaged limb, avoid physical exertion. In some cases, a splint is applied to the sore spot and a handkerchief is tied up. Immobilization lasts from 7 to 10 days. In the chronic form of the disease, the limb is bandaged with an elastic bandage.

Other orthopedic devices for immobilization are also used. Orthoses in the form of wristbands are applied to the forearm area. They are worn at night. The elbow joint is taped using special fixing tapes that do not restrict movement, but help reduce pain.

Non-steroidal anti-inflammatory tablets: Ibuprofen, Indomethacin, Nise, Ortofen. They help reduce pain and inflammation.
Analgesics: Nimesulide, Analgin, Renalgan, Ketanov. These drugs are prescribed for mild pain syndrome.

In the subacute and acute stages of epicondylitis of the elbow, treatment with ointment helps to reduce heavy sensations. Gels based on non-steroidal anti-inflammatory drugs are shown. The following local remedies are used:

Nise;
Finalgel;
Ketonal;
Indomethacin.

In mild cases, treatment with ointment for epicondylitis of the elbow joint completely relieves inflammation and other unpleasant manifestations. At the subacute stage of the disease, sometimes it is not even necessary to prescribe additional tablet forms of drugs.

In advanced cases, if the use of anti-inflammatory tablets and creams does not work, they resort to blockades. Such treatment is carried out by the following groups of drugs:

Glucocorticoid hormonal agents: Diprospan, Prednisolone, Hydrocortisone. Injection forms are used for injection into the joint area. This has a powerful anti-inflammatory effect. Such therapy is used for persistent pain that does not disappear within a few weeks. Hormone treatment may cause a slight increase in symptoms after the injection.
Local anesthetics: Ultracaine, Lidocaine. Injections are made in the area of greatest pain.

Hormonal injections are usually done once, if necessary, the administration of drugs is repeated. Glucocorticoids are not used more than 2 times per course of therapy. They effectively relieve pain, but with prolonged use, they can worsen the condition of tendons and ligaments. The blockade is carried out with caution, as there is a risk of nerve damage.

Therapeutic exercises are very important in the treatment of epicondylitis of the elbow joint. It helps restore movement and develops weakened muscles. Exercise therapy is carried out only after the pain and all acute manifestations have subsided. The following exercises are helpful:

"Scissors". The patient stretches his arms in front of him and makes crossing movements. In this case, first the right hand should be above the left, and then the left - above the right.
Rotation of the forearms, first in one direction, and then in the other.
Connect the hands to the lock, and then unbend and bend the forearms.
With a healthy hand, slowly bend the wrist of a sore hand.
Bend your arms at the forearms and make flexion-extensor movements with the hands.

Exercise therapy must be prescribed by a doctor. Only a specialist can assess when the acute stage of the disease is completely stopped. Otherwise, a set of exercises will create an extra load on the tendons of the elbow joint with epicondylitis, and this will aggravate the situation.

Physical education with epicondylitis has limitations.

In such cases, you need to see a doctor. Physical activity should be increased gradually. The first time classes can be carried out for 2-3 minutes, then their duration can be increased.

It is possible to identify and establish the diagnosis of epicondylitis only through a medical examination. The doctor will easily identify the place of concern, whether it be the outer or inner surface of the elbow, since the pain is localized in one area and does not involve neighboring parts of the body. Additional tests based on resistance to active movement are performed to confirm the diagnosis.

Epicondylitis lesions are very superficial, so the use of ultrasound or MRI will be a waste of time and will not reveal any significant indications. There is no need to use laboratory tests. The only case when they are applicable is for ordinary trauma, in order to exclude damage to bone tissue. And clinical tests help to exclude an inflammatory disease.

If the disease has acquired the status of a chronic disease, then an x-ray is used. It will allow to identify characteristic changes: the cortical layer has acquired a loose structure, at the junction of the tendon with the bone, the bone tissue undergoes a cystic restructuring, the formation of a “connecting” place (enthesis) in the form of a “spur”.

The process of flexion or extension, unlike arthritis, does not cause particular pain. But if epicondylitis is confirmed, then a sharp pain will be a confirmation of this. In this case, the attending physician will appoint a list of necessary procedures to get rid of the disease.

Treatment of epicondylitis is prescribed only by a doctor. Methods are selected based on the neglect of the disease. If the pain is not particularly disturbing, then the recommendation would be to limit the movements carried out by the elbow.

The whole process of treatment, regardless of the neglect of the disease, should be aimed at compliance with the main tasks:

It is necessary to get rid of pain at the site of injury;
Normalize the blood circulation of the damaged area;
Completely "reanimate" the motor function of the joint;
Prevent muscle atrophy.

Traditional medicine is widely applicable for the treatment of various diseases. It is practically harmless, very effective, so its popularity is fully justified. Folk remedies can be used as additional methods of treatment, but before that, you need to consult a doctor. For the treatment of diseases of the elbow joint, in particular epicondylitis, there are means traditional medicine presented with ointments. Below are recipes that relieve or reduce the symptoms of the disease.

Epicondylitis of the elbow joint treatment folk remedies:

Ointment based on comfrey. Comfrey does an excellent job of relieving inflammation. To prepare an ointment based on it, you will need to take a spoonful of honey, a tablespoon of ordinary vegetable oil, a spoonful of grated root and a spoonful of crushed comfrey leaves. All components are mixed until a homogeneous slurry is formed. The resulting ointment is applied to the outside of the elbow and wrapped with a plastic bag, fixed with a plaster. A scarf or a warm scarf is tied over the compress and worn throughout the day. This type of compress is prepared and applied every other day, until the pain disappears.

There is another version of the ointment based on comfrey. The recipe is as follows: fresh leaves and comfrey root are taken in equal proportions, ground to a homogeneous consistency. To the resulting slurry add the same portion of olive oil and melted beeswax. After thorough mixing, set to brew for 2 hours. The finished ointment is rubbed on the sore elbow and wrapped with a bandage. Apply this ointment for 1 month, morning and evening.
Garlic compress. To prepare it, take grated garlic, squeeze the juice. The place of concern is smeared with a greasy cream in order to avoid possible skin burns. Next, a cloth bandage soaked in garlic juice is applied, polyethylene is wound over it and, finally, the compress is fixed with an elastic bandage. The maximum allowable time for wearing a compress bandage is 2 hours. It is enough to repeat this method of treatment once a day, until the final recovery.
Epicondylitis of the elbow is treated with blue clay ointment. This will require clay mixed with boiled water in equal proportions. The resulting ointment is cooled to a tolerable temperature, and then the place of the disease is smeared and covered with a cloth bandage. Wrap with a scarf or handkerchief and wear until the clay cools completely. The ointment is applied during the week, in the mornings and evenings.
Milk and propolis compress. To do this, take 100 ml of milk, with a temperature of 60 °. A teaspoon of bee propolis is dissolved in this milk. Next, a towel is soaked with this mixture and applied to a sore spot. Wrap the compress with polyethylene, fixed with a plaster. Top tied with a scarf or a warm scarf. Hold the compress for a couple of hours 2 times a day until the healing effect is achieved.

Ankle
Carpal
Knee
Elbow
Brachial
Hip
Spine

Burning pain that occurs in the elbow joint may well be a sign of such an unpleasant disease as gout. This disease speaks of various disorders of the body, in particular in the metabolic process of purines. As a result, a person has a strong accumulation of uric acid in the blood, and salt deposits are deposited in the joints.
In such cases, if a person in any way damages the joint, he experiences severe and burning pain, which is very excruciating. It is noticed that the pain can begin with discomfort in the fingers and give to the forearm. As the disease develops, it can easily develop into another pathological process - polyarthritis.
How does this disease manifest itself, except for unpleasant burning pain? Firstly, most of the discomfort occurs precisely at night, secondly, you can notice a significant reddening in the place where the pain manifests itself, and thirdly, a person has a fever in the place where gout exists. The area of the body becomes palpably hot and painful

elbow pain, causes of elbow pain, how to treat elbow pain?

Since pain in the elbow joint can have completely different causes, different doctors will be able to treat them. However, for the initial examination, it is worth contacting a general practitioner - a general practitioner. Only he is able to fully diagnose your primary condition and refer you to the necessary specialist.
Different pain requires different treatment and therefore it is not worth dwelling on any one doctor. If the cause of your pain is a disorder present in the cervical or dorsal spine, only a professional neurosurgeon or neurologist can help you. He can rule out inflammatory diseases in your body and improve your well-being
However, if the disease is inflammatory in nature, then only a real doctor with a specialization in rheumatology can diagnose this. If your elbow joint is visually enlarged, swelling is observed on it and you experience pain, then you need to contact a traumatologist

Rational nutrition (foods with a high content of vitamins and minerals);
Reduced load on the joint;
Regular exercise;
Injury prevention;
Active lifestyle;
Treatment of concomitant diseases;
Regular visits to the bath and sauna;
Timely treatment of infectious diseases and inflammatory processes.

What is epicondylitis

Epicondylitis (tennis elbow, tennis elbow) is a disease that is based on a degenerative lesion of the muscles at their attachment to the bone. Epicondylitis is a chronic disease that, if not properly treated, can progress and increasingly cause excruciating symptoms of exacerbation.

Muscles and tendons are involved in the pathological process in the place where they are attached to the bone. This disease is quite common, especially people after 35 years of age suffer from it. But many patients do not go to the doctor, because the inflammation is mild and usually disappears quickly. According to statistics, both men and women are equally prone to such inflammation. Moreover, epicondylitis of the right elbow is most common, since there are more right-handers than left-handers, and the disease develops from increased loads.

In fact, ulnar epicondylitis is a microtrauma. There is a small rupture of the tendon in the elbow area, which later becomes inflamed. Most often this happens due to an unsuccessful or abrupt movement of the hand, as well as due to the constant load on this muscle group. The patient may not even notice the injury itself, sometimes there is not even pain at that moment. But over time, swelling increases, this place becomes inflamed. This is how epicondylitis develops.

But not all doctors recognize that the disease appears as a result of injury to the muscles and tendons. Many believe that such inflammation may be due to osteochondrosis. But in any case, this disease never develops on its own, inflammation is always secondary, so for effective treatment it is important to understand what caused it. After the elimination of provoking factors, the disease passes faster.

Symptoms and factors of occurrence

Symptoms of epicondylitis depend on the form and stage. In the subacute period, pain occurs only with a load on the brush. The pain above may appear in a month. There is a feeling of "weak hand".

In the acute stage, discomfort practically does not go away. They begin to spread to the entire forearm. When you try to collect your fingers into a fist, severe discomfort appears. Holding an object with a light weight becomes impossible.

In the chronic form, pain is predominant at night, when the weather changes. The pain is dull, rarely passing. Serious degenerative changes begin in the muscles.

Other symptoms may appear, which include redness of the skin, fever, vasospasm. Sometimes patients note that there is a feeling of numbness in the affected limb, a tingling sensation.

The main manifestation of the pathology is the occurrence of pain in the muscle tissues in the shoulder and forearm area. The type of pain in this case is different - the muscles ache, there is a burning sensation, the pain is either dull or sharp, and at the same time it can be given to the hand. If the epicondylitis is external, then the pain appears when you try to straighten the forearm. If internal - then with the bend of the elbow.

Symptoms do not appear immediately - they first appear when the limb is loaded, and then already in a calm state. It happens that severe pain occurs abruptly, without previous discomfort, and manifests itself in the form of "shooting" painful sensations.

Sometimes the pain is so severe that the patient is not able to lift a cup, hold a spoon, shake hands at a meeting, not to mention doing any work.

According to the nature of the course of the disease, acute, chronic, and subacute inflammation of the elbow joint is distinguished. In the acute period of the disease, discomfort occurs both at rest and during any actions. If pains appear only during exertion, and in a calm state they do not happen, then this is typical for a subacute form of the disease. If the manifestations of the disease are present for 90 days, and the treatment was not carried out or started late, then a chronic form occurs.

In addition to pain, the pathology is characterized by sensations of numbness in the diseased limb, the appearance of a tingling sensation. Patients also noted a feeling as if goosebumps were crawling up the arm. It is difficult to perform active actions with a diseased limb, but relatively calm movements in the form of bending and unbending the forearm with the help of another person or using the other hand do not cause discomfort in the patient.

The main signs characterizing epicondylitis are manifested in painful sensations in the forearm and shoulder surface. To verify this, you can take a cup or shake someone's hand. That is, every slight movement is accompanied by severe pain.

With progressive lateral epicondylitis, the pain becomes constant, radiates to the forearm, which is accompanied by difficulties in performing official or household duties. Any slight movement causes unbearable suffering.

But when the elbow is extended, the pain syndrome is almost absent, in contrast to cases associated with hand injuries, when the limb hurts continuously. The strength of the extensor muscles of the hand and fingers decreases. The range of motion is maintained, and on examination, neither redness nor swelling in the elbow area, as a rule, is observed.

When palpating the outer surface of the elbow, especially at a point located slightly outward and anterior to the outer epicondyle, pain is determined. Absence of pathological changes on the radiograph.

The greatest risk of developing lateral epicondylitis is noted in people over 40 years of age and in those who have a congenital pathology - a weakened ligamentous apparatus.

A factor in the development of the disease can be not only the profession, but also the constant wearing of heavy objects and bags. Also, monotonous movements, for example, monotonous housework, contribute to the appearance of the disease.

To prevent the appearance of pathology, it is not necessary to overstrain the muscular system. Therefore, returning home from the store, the burden must be divided into both hands. And you should not try to transfer a large number of bags at a time, because it is better to do it in two stages than after experiencing discomfort in your elbow.

Overstrain of muscles and tendons in the elbow region is the main cause of epicondylitis. Repetitive power movements in the elbow joint can contribute to overstretching of the tendons of the elbow region.

It doesn't have to be the ultimate load in professional tennis. Hammering nails, carrying buckets of water in the country, trimming bushes - all this can lead to the development of tennis elbow.

For example, inflammation of the tendons is called tendonitis. Accordingly, inflammation of the tissues near the lateral epicondyle is called lateral epicondylitis.

In such a tendon, the arrangement of collagen fibers is disturbed. The tendon cells begin to be replaced by fibroblasts - cells that produce a slightly different type of collagen, not as strong and without an ordered arrangement of fibers. Gradually, the tendon degenerates: it becomes thicker due to the growth of defective connective tissue. Naturally, such a tendon can be damaged even with minor injuries.

The exact mechanism by which epicondylitis develops is still unknown. According to one popular hypothesis, microtears appear in the tendon attached to the lateral epicondyle due to overload.

When doing repairs or household chores, you should take breaks as often as possible. After all, muscles that are not accustomed to heavy loads need to be given rest. Therefore, do not lift weights and move large objects on your own.

As a rule, the disease develops gradually. At first, the pain is mild and intermittent, but over several weeks or months it gradually progresses and may become permanent. Often the onset of pain is not preceded by any trauma. The most common symptoms of lateral epicondylitis are:

Pain or burning sensation on the outside of the elbow;
Decreased strength of the muscles of the forearm, extending the hand and fingers.

These symptoms are aggravated by stress on the muscles attached to the lateral epicondyle of the humerus (holding a racket, tightening screws with a screwdriver, etc.). More often, pain occurs on the leading side (right-handed in right-handed people and left-handed in left-handed people), but the disease can also occur on both sides.

When tissues are damaged, inflammation develops, which is a protective reaction of the body. Leukocytes migrate to the focus of inflammation, clearing it of damaged tissues and promoting healing. In medical terminology, diseases accompanied by inflammation end in -it. For example, inflammation of the tendons is called tendonitis. Accordingly, inflammation of the tissues near the lateral epicondyle is called lateral epicondylitis.

In such a tendon, the arrangement of collagen fibers is disturbed. The tendon cells begin to be replaced by fibroblasts - cells that produce a slightly different type of collagen, not as strong and without an ordered arrangement of fibers. Gradually, the tendon degenerates: it becomes thicker due to the growth of defective connective tissue. Naturally, such a tendon can be damaged even with minor injuries.

The exact mechanism by which epicondylitis develops is still unknown. According to one popular hypothesis, microtears appear in the tendon attached to the lateral epicondyle due to overload. Restoration of the integrity of the tendon is hampered by continued loading, which can also lead to the formation of new injuries. The proliferation of connective tissue at the site of injury leads to weakening of the tendon and pain.

Diagnostics

The doctor should deal with pain in the elbow joint. At the first reception, it will produce:

survey on occupation, diseases, injuries, etc.
testing with various movements.

Testing is usually enough to make a diagnosis, but in some cases an x-ray, ultrasound, or very rarely an MRI may be ordered.

Very often, even an experienced doctor, after collecting an anamnesis and examining the patient, cannot correctly diagnose. To do this, it is necessary to conduct a number of additional examinations, which include laboratory samples and methods of radiation diagnostics. Every patient with pain in the elbow joint should be tested for motor activity upper extremity and evaluate symptoms on palpation of the elbow joint.

Methods of instrumental diagnostics:

Ultrasound of the elbow joint;
arthroscopy;
radiography;
CT scan;
Nuclear magnetic tomography;

General blood analysis;
General urine analysis;
blood sugar;
Biochemistry of blood;
Rheumatic tests;
specific tests.

To recover faster, you need to know which doctor treats epicondylitis. Usually, for pain in the elbow, patients turn to a traumatologist or surgeon. A specialist can make a diagnosis only on the basis of a conversation and an external examination.

When making a diagnosis, the doctor may ask the patient to run several tests. The Thompson test goes like this: you need to put your hand on the table with your palm up and try to make a fist. In a patient with epicondylitis, the palm quickly unfolds. For the Welt test, you need to raise your hands to the level of the chin and bend-unbend them at the elbow.

Additional diagnostic methods are not usually used. Only if the doctor suspects another disease, he can refer the patient for examination. An x-ray is done if there is a suspicion of a fracture or osteoporosis, an MRI in order to exclude carpal tunnel syndrome. If acute arthritis or bursitis is suspected, a blood chemistry test may be done.

Tell your doctor about how the disease developed, how you think it started, how quickly the pain or other symptoms progressed. Pay special attention to the peculiarities of your physical activity - who you work for, what sports and how often you do it.

To diagnose lateral epicondylitis, your doctor will ask you to perform special arm movements (diagnostic tests). Typically, these special tests allow you to establish a diagnosis without any doubt, however, in some cases, it may be necessary ultrasonography, radiography or even magnetic resonance imaging.

In arthritis, pain occurs in the elbow joint itself, rather than in the epicondyle, and it is more “blurred” rather than localized in a well-defined area. Flexion contracture of the elbow joint may develop.

When the nerves are pinched, neuritis and its characteristic neurological symptoms are observed - sensitivity disorders in the innervation zone and a decrease in the strength of the innervated muscles are noted.
If epicondylitis develops in people young age, joint hypermobility syndrome (HMS) due to congenital weakness of the connective tissue should be excluded.
To do this, the doctor examines the history of life, paying attention to the frequency of sprains, tendonitis, acute and chronic arthralgia and back pain.
In addition, the presence of HMS may be indicated by longitudinal and transverse flat feet, as well as an increase in joint mobility.

Additional research methods for the diagnosis of epicondylitis are usually not used. In some cases, to exclude traumatic injury (fracture of the epicondyle), X-ray is performed.

If it is difficult to differentiate between epicondylitis and tunnel syndrome, MRI may be prescribed. If inflammatory joint disease is suspected, a blood test is performed to rule out signs of acute inflammation.

Before deciding how to treat epicondylitis, the doctor conducts diagnostic measures. First, an examination is carried out, an anamnesis is examined. The orthopedist will find out the time when the illness began, how the symptoms increased. Thanks to this information, the doctor determines the presence of one or more pathologies.

The Thomson test is performed. The patient's hand is placed vertically on a flat surface so that the elbow acts as a support. The fist is retracted in the opposite direction. The patient must return it to its original position, overcoming the resistance of the doctor. As a result, the pain is localized in the area of the elbow joint.

To get a complete picture, it is advisable to conduct a Welt test. In this situation, you need to turn your palm up when outstretched hand. It is not possible to do this with epicondylitis due to pain.

Other diagnostic manipulations in this disease are not carried out. In rare cases, an x-ray is prescribed for a differentiated diagnosis to rule out fractures. If inflammation is suspected, a blood test is taken.

When symptoms of this disease appear (most often these are severe pain in the elbow area), a person seeks help from qualified specialists - orthopedists.

On palpation in the area of the pronator flexor tendons (5-10 mm and distal to the middle part of the medial epicondyle), there is induration and tenderness. In addition, the pain worsens when the wrist resists flexion of the forearm and pronation at an angle of 90°. Flexion contractures can develop in professional athletes due to muscle hypertrophy.

However, sometimes there is a need for instrumental diagnostics (visualization) for diff. diagnosis with other diseases. It has been noted that 5% of people with a primary diagnosis of lateral epicondylitis have radial tunnel syndrome.

The diagnostic process takes place in several stages:

Visual inspection of the hand and area of inflammation:

localization of the pain syndrome;
amplitude of movements such as "flexion-extension" of the elbow, hand, fingers.

Feeling the outer surface of the elbow for specific injuries.

X-ray of the elbow area (the procedure is necessary so that when diagnosing, the doctor can exclude diseases similar in symptoms - arthritis, neuropathy, osteochondropathy).

Ultrasound (determines the localization of the inflamed area).

MRI (shows specific damaged areas of ligaments and muscle tissue).

Additionally, you may need to consult a neurologist. This specialist will usually order an EMG or ENG and x-rays. cervical spine to identify possible pathological changes from the peripheral nervous system.

In most cases, a questioning and inspection is enough.

Usually, appearance the hands do not change, with rare exceptions, you can notice a slight swelling or discoloration of the skin (this is more likely from repeated injections with glucocorticoids).

The most characteristic symptom of epicondylitis is soreness in the region of the protruding epicondyle of the humerus - these are the bones on the sides of the elbow joint, on the outside and on the inside.

Lateral and medial epicondylitis of the elbow joint or brachial epindicolitis is a pathology that is inflammatory in nature.

The disease affects the elbow joint at the point of attachment of the muscles to the bone of the forearm. The humerus in the elbow area has special bone formations (epicondyles or epicondyles). They are the place where the tendons of the flexor and extensor muscles, as well as the articular ligaments of the wrist and fingers, are attached.

Reasons for the development of pathology

Epicondylitis of the shoulder is a secondary disease and therefore does not develop suddenly, but gradually. The exact causes of the pathology are not known, experts only identify the main risk groups.

These are construction workers, whose activities are connected with monotonous work with their hands (painters, plasterers), athletes (weightlifters, boxers, kettlebell lifters).

However, these activities alone do not lead to the development of epicondylitis. The disease occurs as a result of constant monotonous flexion and extension of the elbow joint during the exercise of the load on the arm.

The humerus has two epicondylus, medial (inner) and lateral (outer). Therefore, there is lateral epicondylitis and medial.

Muscle tendons are attached to the medial epicondyle, which are responsible for inward rotation (pronation) of the hand and forearm, flexion of the fingers and hand at the wrist joint. The extensor muscles are attached to the lateral, which allow you to rotate the hand and forearm outward.

The developmental process and causes of brachial epicondylitis have not been fully elucidated. Some experts believe that the causes of it are damage to the tendons as a result of their friction against the bone. Others believe that the disease is preceded by an inflammatory process in the periosteum of the epicondylus.

There is also a theory that epicondylitis of the shoulder and elbow joint develops due to osteochondrosis. This theory is confirmed by the fact that in the treatment of osteochondrosis, pain in the elbow decreases.

Most often, lateral epicondylitis of the dominant arm develops. At the same time, aching pains occur when trying to active physical movements, flexion or extension of the elbow and hand. Passive movements do not cause discomfort. Pain occurs when the extensor muscles are felt and radiates to the outer part of the shoulder.

Medial epicondylitis is diagnosed less often and is the result of repeated monotonous flexion movements. The pain is sharp, gives to the inner surface of the forearm. It occurs during rotation of the forearm and during flexion movements.

Symptoms

Epicondylitis of the shoulder is acute, subacute and chronic. Initially, the pain is accompanied by a sharp overstrain of the muscles, then it becomes constant and at the same time the muscles of the hands quickly get tired.

In the subacute stage with epicondylitis of the shoulder joint, the intensity of pain decreases, at rest they disappear. The chronic course is characterized by alternating relapses and remissions, which last from 3 months to six months.

The most obvious sign is a pain sensation of a aching nature in the wrist and elbow joint, difficulty in active movements. Symptoms of pain become stronger with the most common movements, for example, when shaking hands, trying to clench the hand into a fist, while extending the arm.

In the initial stages, pain disappears at rest. And then they become permanent.

Types of epicondylitis

Lateral

Inflammation develops at the site of attachment of the bone to the lateral epicondyle. Lateral epicondylitis of the elbow joint is called "external" or "tennis elbow" because it is typical for players involved in this sport.

But this does not mean that only tennis players have the disease. A factor in the development of the disease is excessive tension of the muscles of the elbow joint at the place of their attachment to the epicondyle of the shoulder bone.

Such a disease often occurs in tennis players, but in ordinary people it can also manifest itself when performing monotonous hard work, for example, when chopping firewood.

Interior

Internal epicondylitis is called "golfer's elbow" or "medial". The disease occurs as a result of injuries, unsuccessful movements with a sharp straightening of the arm and the use of a number of hand tools.

Diagnostics

Before treating epicondylitis of the elbow joint, the doctor asks the patient about complaints, examines the symptoms, and examines the diseased joint. Sometimes x-rays are ordered to rule out an old injury. A number of tests are being carried out.

Coffee cup test

The patient is asked to pick up a cup of liquid from the table. When he tries to do this, the painful symptoms increase several times over. This indicates lateral epicondylitis.

Thomson test

A sick person is offered to clench the hand, which is palm down, into a fist. Then quickly turn it palm up.

Welt test

It is necessary to raise the forearms to the level of the chin, begin to bend and unbend both arms at once.
When conducting tests of Welt and Thomson, the actions performed by a healthy and diseased hand differ significantly in speed. In addition, there are pronounced pain symptoms in the diseased limb.

Therapy

It is necessary to treat lateral and medial epicondylitis in a complex.

It all depends on the stage of development of the disease, the cause of the occurrence, changes in the tendons and muscles in the area of the hand and elbow, the level of disruption of the joint.

Treatment helps to relieve pain symptoms, unload muscles, and eliminate inflammation. Apply drug therapy, treatment with folk remedies. In order to unload the muscles used:

Gentle mode and bandage

Treatment involves a temporary abandonment of professional activities that led to the development of epicondylitis. Also, in order to immobilize the joint, a special bandage is used.

It allows you to immobilize the diseased limb, relieve severe pain. Professional athletes regularly wear a brace to prevent joint overload.

A bandage is a special device that is fixed in the upper part of the forearm. It prevents the inflamed muscles from contracting and thereby relieves them of the load. The orthopedic bandage is worn only during wakefulness, it is removed during sleep.

The principle of its use is simple. The bandage firmly fixes the elbow joint, preventing excessive range of motion. His choice must be approached thoroughly, it is better that the bandage is selected by an orthopedist, taking into account the anatomical features of the joint.

Gymnastics

It helps to restore the motor functions of the elbow joint. Gymnastics involves performing simple movements that stimulate the muscles. Exercises are performed aimed at stretching the tendons with maximum abduction of the hand.

Wrist trainers are used to help perform three-dimensional exercises. Classes begin to perform with simulators maximum rigidity. Exercises are selected in such a way that the muscles do not overstrain.

Elimination of pain

To relieve pain, tablets are prescribed: analgin, ketanov, renalgin. Local treatment is also carried out, injections of glucocorticoids, such as Diprospan, Betamethasone, are used.

Anti-inflammatory drugs are prescribed in the form of tablets or ointments, which include Indomethacin, Diclofenac, Ibuprofen. Apply compresses with Dimexide.

For anesthesia, improvement of local tissue trophism, blockades are made at the point of attachment of the hand and fingers with lidocaine or novocaine in combination with hydrocortisone.

4 blockades with an interval of two days will be enough. Injections of B vitamins are prescribed.

Physiotherapy

Carry out physiotherapy treatment:

magnetotherapy;
phonophoresis;
cryotherapy;
mud treatment;
paraffin therapy;
Bernard currents;
electrophoresis with anti-inflammatory drugs (with acetylcholine, potassium iodide, novocaine);
shock wave therapy.

These procedures improve metabolic processes in the tissues of tendons and muscles, restore blood microcirculation in muscle tissues, eliminate pain and inflammation.

Cooling of the painful area is carried out. Cold accumulators or chlorethyl irrigation are used. You can use ice cubes wrapped in a towel. The procedure is carried out once a day.

Perform massage every day for 15 minutes. Knead the points where the muscle seals are located. The course is 12 days. Massage should not give the patient discomfort.

If all of the above procedures do not bring positive dynamics and the expected result, the disease progresses, then surgical treatment is used.

Operational impact

It includes the following techniques:

tendoperiostomy;
dissection of the tendon of the short extensor of the hand;
arthroscopy;
lengthening of the tendon of the short extensor of the hand.

Prevention

In order for epicondylitis of the shoulder and elbow joint not to become chronic, a number of rules should be observed:

warm up the muscles before physical activity;
correctly distribute physical activity without overstraining the muscles;
before heavy physical exertion, the elbow joints are fixed by putting on a bandage;
when carrying out monotonous monotonous movements, it is necessary to constantly take breaks.

Treatment with folk remedies

Ointment from comfrey

For cooking, you need to take the leaves and roots of the plant (1: 1). Heat vegetable oil and honey, combine them in a deep container. The volume of this mixture should be equal to the volume of the plant material taken.

Comfrey is gradually added to the bowl with honey and butter, stirring constantly. As a result, it should be homogeneous mixture in the form of an ointment. It is impregnated with fabric and wrapped around the affected joint. Secure with an elastic bandage and insulate with a woolen scarf. The compress is kept on the joint for a day, then replaced with a new one.

Treatment of such folk remedies as a mixture of comfrey and lard will help restore damaged ligaments. A glass of fat is mixed with half a glass of comfrey root. Make a compress to the affected joint for 2 hours until the pain disappears completely.

Blue clay

It is used after acute inflammation has been removed. Take clay and hot water in equal proportions, mix and spread on gauze folded in half.

Apply to the diseased joint and fix. Warm, leave for half an hour. You can do three such compresses a day. Clay warms up a sore joint and relaxes tense muscles.

Sleeping green tea treatment

It is necessary after drinking tea, collect what is left in the teapot and freeze. Then wipe the diseased joint with the resulting ice in a circular motion.

This method treats external epicondylitis well. Rub grass ice the affected joint needs about a minute, but the procedure can be repeated several times a day.

The above ointments and compresses are not difficult to make at home, but it is worth remembering that the treatment of folk remedies can be unsafe, so you should consult your doctor.

There is a certain similarity between shoulder (elbow) and knee epicondylitis. Epicondylitis knee joint is called the "knee of the jumper or runner" and develops according to a similar principle.

That is, damage to the joint capsules, ligaments, as well as lumbar osteochondrosis. The treatment of both diseases is also largely similar.

Epicondylitis is a chronic degenerative disease, so there is no cure for it.

However, if you use all of the above methods of treatment, take care of the elbow joint, wear a bandage, do gymnastics, use folk remedies, then you can achieve a stable remission, forget about the feeling of discomfort without changing your usual life and professional activities.

The most varied articulations in human body, due to various negative factors, can be subjected to inflammatory and destructive processes. The most susceptible to them are the joints of the elbow, hips, knees and ankle.

Degenerative and inflammatory processes that affect the periarticular structures in the elbow articulation area are called epicondylitis.

The disease is based on the processes of destruction of cartilage tissues as a result of prolonged inflammatory reactions, subsequently leading to deformation of the periarticular structures - the muscular-ligamentous apparatus of the elbow joint. In a short time, such processes sharply reduce the function of the joint, limiting its movement.

It is generally accepted that epicondylitis is a disease of professional athletes, although practice has shown that everyone whose professional activity associated with monotonous work causing chronic overstrain of the muscles of the forearm and joints.

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How does the disease develop?

To understand the genesis of the disease, let us briefly consider the chain of development of epicondylitis of the elbow. Because the versions of many clinical observations differ. The main version says that degenerative processes in the joints precede inflammatory ones, giving prerequisites for the development of the disease.

The leading factor in the formation of pathology are the processes leading to chondrodystrophy (pathology of cartilaginous tissue) of the articular capsule, covering the surface of the bone heads that form the articulation of the elbow - the radius, the top of the ulna and forearm.

The elastic structure of the cartilage, covering the rounded tops of the bones, has the property of absorbing and returning the articular exudate (synovial fluid) into the joint cavity.

When exposed to a load on the cartilage, it releases exudate like a sponge, lubricating the joints, thereby regulating articular movements, ensuring their mobility and smoothness under conditions of stable pressure inside the joint.

Any pathological processes that contribute to the disruption of the production and circulation of articular exudate (synovial) lead to cartilage deformation (destruction and abrasion of cartilage tissues), nullifying their shock-absorbing function.

As a result of this pathology, the bone tissue of the heads of the articulation bones is exposed, causing their friction and destruction, followed by its replacement with dense connective strands or spongy bone substance.

The process of negative transformation in the elbow joint is due to regular traumatic influence - bruises, or great physical exertion, which worsens the process of regular blood supply.

epicondylitis photo

According to numerous facts of clinical observations, many physicians put forward a different version due to the fact that epicondylitis of the elbow joint is a consequence of periostitis (inflammation of the periosteum), or its exfoliation caused by extensive osteochondrosis.

Epicondylitis has been found to be associated with various diseases - humeroscapular periotritis, connective tissue dysplasia, disorders in the blood circulation system and osteoporosis.

Internal and external epicondylitis - symptoms and features

The two main types of epicondylitis - internal and external - are determined by the location of the pathological manifestation.

1) External epicondylitis (lateral) characterized by inflammatory reactions in the area of the outer superficial protrusion (epithelium) of the spherical tip of the humerulnar bone (condyle) at the point of attachment of muscles and ligaments.

Pain symptoms appear on the outer ulna (lateral epicondyle), where the long muscles of the carpal and digital extensor muscles are attached by means of tendons. This epicondylitis is also called tennis elbow.

The disease is preceded by excessive loads on the muscular-ligamentous apparatus of the forearm. Frequently repeated monotonous movements can cause inflammatory processes in the structure of the muscles and tendons of the carpal extensors.

And this does not have to be associated with sports loads. Sometimes, the cause of the disease lies in the very structure of the tendons. For example, tissue wear leads to their degeneration and disruption of the normal structure of tendon tissues.

The development of the disease occurs slowly, accompanied by a gradual decrease in the extensor abilities of the fingers and hand, burning and pain in the outer zone of the ulnar surface.

2) Internal epicondylitis (medial) called golfer's elbow or epitrochleitis. It manifests itself as a result of damage to the zone of the medial epicondyle at the site of attachment of the tendons of the muscles responsible for the processes of extension of the elbow, hand and fingers, providing pronation of the hand and forearm.

It can also develop at low loads, in particular in women performing monotonous movements - seamstresses, typing operators, etc.

With this pathology, the pain syndrome manifests itself due to a slight pressure on the place of the muscular-ligamentous attachment and increases with pronation and flexion of the forearm with pain radiating along its inner edge.

The pathology is characterized by a tendency to a chronic course and the involvement of the ulnar nerve in the inflammatory process.

Among the forms of development of the disease, it is noted:

Traumatic, developing under the influence of minor trauma, due to systematic movements of the same type, against the background of concomitant articular pathologies and damage to the nerve of the elbow. With age, tissue regeneration decreases and there is a gradual replacement of damaged tissues with connective structures.
Post-traumatic form of epicondylitis, which is the result of not fully cured articular dislocations and sprains, and an early transition to load-bearing movements of the joints.
Chronic, due to a long course, alternating with periods of exacerbation and relapse. The pain acquires a weak or aching character, there is a significant or complete decrease in muscle strength.

The main symptomatology of epicondylitis of the elbow joint is pain, with signs of growth during flexion and extension movements of the limb. Painful manifestation, when muscle activity is not involved (passive movements) is the main distinguishing feature in differential diagnosis, which allows to exclude various forms of arthritis.

At the moment of rotational movements of the limb in the area of the ulnar plexus, without the participation of the patient (passive movement), pain is not felt. With self-straightening or an attempt to bend the arm (with the involvement of muscles in the process), the pain returns.

Second distinctive feature, is the pain focus area. The pain syndrome is not concentrated in the area of the articular lesion, but is projected onto the side of the superficial zone of the forearm and shoulder.

In the process of external damage (lateral), localization of pain along their outer surface is noted. With the medial variety of the disease - on their inner side, sometimes occurring with the slightest movements of the fingers and hand.

With a simple handshake, the pain syndrome can increase significantly.

The severity of symptoms depends on the stage of the clinical course of the disease - acute, subacute, or chronic.

The symptomatology of an acute course is characterized by intensity and constancy.
Severe symptoms in the subacute stage are noted only with loads on diseased joints. In their absence, signs of severe symptoms do not appear.
If the duration of the disease, with the manifestation of signs and symptoms, exceeds three months, the stage of the chronic course is diagnosed.

Treatment of epicondylitis of the elbow - means and preparations

In the stage of developing symptoms of epicondylitis of the elbow joint, treatment and differential diagnosis should be carried out without delay.

With early treatment, you can get by with medication and physiotherapy and avoid surgery. First of all, it is necessary to ensure peace of mind for the hand - to immobilize the hand for a short time with special orthoses, splints, or in another way.

In the treatment of epicondylitis, drug therapy is selected depending on the ongoing clinical stage.

In the stage of acute inflammatory processes, anti-inflammatory drugs are prescribed, the groups "Ortrofen", "Ibuprofen", "Indomethacin" or "Diclofenac" with a course of treatment of up to ten injections (depending on the severity of the disease).
In addition - intramuscular injections of "Baralgin", 5 injections of 5 ml. in one day.
Complexes of vitamin therapy - 10 injections of "nicotinic acid" 1 ml each. every other day subcutaneously "B6 - B12".
To restore cartilage, a course of treatment with chondroprotectors is prescribed - Aflutop, Artrovita, Chondrotinin, etc. - 20 intramuscular injections, twice a year (autumn-spring).
Severe pains are stopped by oral anti-inflammatory drugs - Neproxen, Strepfen, Ketanol, Nimesil, Movalis, etc.
Good dynamics is observed with the introduction of corticosteroid drugs - Novocaine or Ledocaine - up to 2 injections with an interval of one or two weeks into the site of inflammation.
In the treatment of epicondylitis of the lateral form, immobilization should be complete, for the entire course of treatment, and not short-term. Hormonal anti-inflammatory agents may be added.
As a local treatment, external agents are used - ointments, creams, gels and patches, based on hormonal drugs, with anesthetics and "Betamethasone", which have a powerful effect, relieve swelling and inflammatory reactions.

Positive dynamics is provided with the inclusion of methods of physiotherapy treatment:

shock wave therapy;
acupuncture;
electrophoresis and cryotherapy;
laser therapy and parofinotherapy.

After relief of acute symptoms, exercises are selected therapeutic gymnastics. Complex cases that are not amenable to conservative treatment are subject to surgical treatment. Today, it is based on less traumatic arthroscopic surgery techniques.

Are complications possible and what is the prognosis?

Epicandylitis, in most cases, responds well to therapeutic treatment and complications occur in exceptional cases. Basically, with a long absence of drug treatment, manifesting as synovial bursitis, which may require surgical treatment.

In general, if all the prescriptions and recommendations of the doctor are followed, the disease is characterized by a favorable prognosis with a long absence of exacerbations.

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Article publication date: 05/30/2016

Date of article update: 01/24/2020

Epicondylitis of the elbow joint - inflammation of the attachment site of the tendons of the muscles of the forearm to the humerus. As a result of the action of adverse factors, the periosteum of the humerus becomes inflamed in the region of the epicondyles (one or two), and later the tendon and cartilage tissue is destroyed.

In 80% of cases, the disease has a professional origin (that is, people of certain professions who constantly load the shoulder are sick), and in 75% of cases it captures the right hand. Because of severe pain in the area of the forearm and elbow and muscle weakness, a person loses his ability to work, and without timely treatment, the muscles atrophy.

Therapy for epicondylitis of the elbow joint is quite long (from 3-4 weeks to several months), but usually the disease is successfully treated. The main methods of treatment are physiotherapy and lifestyle adjustments. This disease is handled by an orthopedist or surgeon.

Reasons for development; what happens when you get sick

At the lower end of the humerus there are epicondyles - places where muscle tendons are attached, and which do not enter directly into the joint. With constant overstrain or microtraumatization of these areas, inflammation occurs in them - epicondylitis.

Epicondylitis usually means an inflammatory process. However, a number of studies have shown that more often degenerative (destructive) changes develop in the armpits and tendons: for example, collagen is destroyed, tendon fibers loosen. Therefore, it is more accurate to call epicondylitis the initial stage of the disease, in which inflammation of the periosteum and tendons in the region of the epicondyles is observed. Further processes, many authors call epicondylosis.

Frequently repetitive movements, such as adduction and abduction of the forearm with simultaneous flexion and extension of the elbow, are the most common cause of the disease. These actions are typical for masons, plasterers, musicians, athletes ("tennis elbow"). Therefore, epicondylitis of the elbow joint is classified as an occupational disease.

Also, the development of ulnar epicondylitis is facilitated by:

cervical osteochondrosis,
deforming arthrosis of the elbow joint,
conduction disorder (neuropathy) of the ulnar nerve,
elbow injury.

Two types of pathology

Epicondylitis of the elbow is external (lateral) and internal (medial). The external one develops 15 times more often, takes a longer and more difficult course.

Symptoms and stages of development of epicondylitis of the elbow

Epicondylitis of the elbow may have an acute or subacute onset. With ineffectiveness or lack of treatment, the disease can go into a chronic stage. The symptoms of these three forms of the disease are described in the table:

(if the table is not fully visible, scroll to the right)

Stage of the disease	Characteristic symptoms
Subacute stage of epicondylitis	Pain first occurs with a load on the brush
	Pain in the armpits and forearm appears a month after the onset of the disease
	Muscles are weak
Acute stage of epicondylitis	The pain is constant, intense, spreads along the forearm
	When you try to collect your fingers into a fist with a straightened arm, pain occurs (Thomson's symptom)
	Weakness in the hand, inability to hold the load (a symptom of fatigue)
Chronic stage of epicondylitis	Pain is dull, constant
	Pain worsens at night, reacts to changing weather conditions
	Severely weakened muscles

Other possible symptoms of epicondylitis include:

redness of the skin (cyanosis),
increased local temperature in the elbow and forearm,
decreased sweating,
spasms of capillaries.

Differential Diagnosis

Symptoms of epicondylitis are similar to myositis (muscle inflammation) of the forearm, deforming arthrosis,. Therefore, before prescribing treatment, differential diagnosis is carried out.

(if the table is not fully visible, scroll to the right)

	Epicondylitis	Bursitis	Def. arthrosis	Myositis
Soreness of the epicondyle	Yes	No	No	No
Pain when bending a joint	No	Yes	Yes	No
Pain in the muscles of the forearm	Yes	No	No	Yes
Edema	No	Yes	No	Small

Conservative treatment

Conservative treatment of epicondylitis of the elbow joint is only complex. 3 methods are used:

putting a splint on the elbow and taking medications (medications are taken according to indications),

physiotherapy,

lifestyle modification.

Massage and physiotherapy exercises are not used for therapy.

In the case of the development of epicondylitis, as a complication of osteochondrosis of the cervical spine, the underlying disease is treated.

1. Splinting and medicines

In order not to injure the joint, during treatment, a splint is applied to the injured arm, slightly bent at the elbow joint at an angle of 25–30 degrees. At the same time, a novocaine blockade is placed in pain points.
To relieve inflammation and eliminate pain, non-steroidal anti-inflammatory drugs (NSAIDs: ibuprofen, indomethacin and others) are prescribed.
In the acute period, with very severe pain and inflammation, hydrocortisone injections with painkillers (novocaine or lidocaine) are used, which are given at intervals of 3-4 days. In the subacute stage, hydrocortisone ointment is used instead of injections (for phonophoresis).

2. Physiotherapy

In the acute and subacute period of the disease, physiotherapy methods will differ.

The list below shows the methods that are used in the acute stage of epicondylitis (all procedures are done daily, the number of sessions required is indicated in brackets):

high-intensity pulsed magnetotherapy (5–8),
diadynamic therapy (6–7),
transcutaneous electroanalgesia (8–10),
infrared laser radiation (10–15).

Methods used in the subacute stage:

(if the table is not fully visible, scroll to the right)

Let us consider in more detail 2 effective and interesting methods of therapy for epicondylitis.

Extracorporeal shock wave therapy

At the core this method treatment - the use of acoustic waves: shock waves directed with a special applicator to the site of inflammation eliminate pain without damaging the tissue.

Doctors have been using this therapy for more than 20 years, but its mechanism of action on tissues has not been fully understood. At the same time, the results of treatment speak unambiguously: the impact of waves leads to the resorption of dead tissues, the growth of new blood vessels, and the restoration of muscle and joint functions. Epicondylitis of the elbow joint responds well to this treatment.

The use of papain

Good results in treatment are obtained by the use of electrophoresis with a plant enzyme - papain (this enzyme is found in a significant amount in the papaya tree). Under the influence of current, this compound contributes to the splitting of dead areas of tendons and cartilage, which reduces the likelihood of pinching of nerves and blood vessels. Such therapy significantly reduces pain and stops destructive processes.

Treatment with papain is long and requires 2–3 courses per year (one course is 30 days). This is very effective method treatment of epicondylitis of the elbow joint.

3. Lifestyle change

In the process of treatment, follow the 5 rules for lifestyle:

dose the load on the muscles of the forearm, rationally combine the load and movements in the elbow joint;

daily massage the forearm and elbow - if your work is related to the load on these areas;

choose a comfortable posture for work;

athletes: use elbow pads and fixing bandages on the elbow, choose the right equipment (for example, a tennis racket);

in a timely manner of the spine (if any).

Follow the same measures for the prevention of the disease: after treatment, or if you are predisposed to epicondylitis (for example, you are a tennis player or suffer from arthrosis of the elbow joint).

Surgical treatment

If conservative treatment does not give adequate results, an operation is performed.

Four types of surgery:

myofasciotomy (removal of the part of the periosteum to which the tendon is attached);

tenotomy (dissection of the tendon attached to the epicondyle);

lengthening or cutting off the tendon of the radial extensor or flexor of the wrist;

neurotomy (transection) of the branch of the radial nerve.

Operations for epicondylitis of the elbow joint are rarely performed, due to the high probability of recurrence, the development of adhesive processes in the tissues and increased pain.

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