Epicondylitis is a degenerative-inflammatory lesion of tissues surrounding the elbow joint that accompanies reactive inflammation of neighboring tissues and intense pain syndrome. Clinically, this disease is divided into the outer epicondylitis of the shoulder (it is also called the "tennis elbow"), the most commonly encountered and the internal epicondylitis of the shoulder (epitrochleitis). External form of epicondylitis mainly occurs in individuals who, due to their professional activities, produce stereotyped repetitive flexion-extensor movements by the forearm (painters, tennis players, masseurs, carpenters, etc.). Most often, the outer epicondylitis affects the right arm, since it is usually dominant and, as a result, is loaded much more left. In women, this disease is much less common than in men. The average age of development of the disease varies between forty and sixty years
Epicondylitis - causes of development
Epicondylitis occurs and subsequently develops as a result of microtraumatism and overstrain of the muscles, which attach to the epicondyle of the humerus. Sometimes the disease manifests itself after a direct traumatism of the elbow (ulnar epicondylitis), or is caused by intense single muscle tension. Some researchers noted a direct link between epicondylitis and osteochondrosis of the cervical spine. An aggravating factor is the presence of a patient with dysplasia syndrome of connective tissue.
In the pathogenesis of epicondylitis, the importance of microtrauma has long been recognized, but it can not be denied that the violation of local circulation and the developing degenerative processes play a significant role in the development of this disease. This is evidenced by concomitant humeropathy periarthritis , osteochondrosis of the spine and gradual onset of the disease. About the trophic factor (violation of local blood circulation) is evidence of osteoporosis, which has developed in places of attachment of tendons
Epicondylitis - symptoms
Often, the epicondylitis begins after an episode of overload, and of great importance are repeated flexions in the elbow joint and repeated movements of the brush in the retracted position of the arm. It is often enough pain in the elbow joint, even with the usual rhythm of life. This is due to the development of gradual involutive changes in the musculoskeletal system, which are manifested by degenerative processes arising in the region of the humerus sublattice without visible external causes. Once appearing, epicondylitis-induced pain may not subside for weeks or even months. Epicondylitis caused pain quite clearly localized - with the internal epicondylitis patients confidently point to the internal, and with external epicondylitis on the outer surface of the elbow joint. Often observed irradiation of pain on the inner or outer surface of the forearm. At rest, pain is absent. The appearance of the elbow joint does not change, passive movements are not limited.
With external epicondylitis, the appearance of pain with its subsequent strengthening is provoked by extension and supination of the bone; with an internal epicondylitis - a provocateur is flexion in the wrist joint. Sometimes pain with epicondylitis is localized in the adjacent areas of the tendons.
Adjacent epicondylitis is chronic. After resting the corresponding muscles, after a few weeks (less often months) the pain subsides. In the case of renewed loads, relapses of pain are observed very often.
In contrast to the external form, the inner epicondylitis is more often observed in women performing monotonous light physical exercises (assemblers, seamstresses, typists). In most cases, the patient is concerned about the pain that arises in the process of pressing on the inner podchischelok, which also occur and then intensify when flexing the forearm. Along the inner edge of the forearm is characterized by the irradiation of pain. Internal epicondylitis is also characterized by its chronic course
Epicondylitis - diagnosis
The diagnosis of epicondylitis is based solely on the findings of a clinical examination. Confirming diagnosis additional information is obtained by conducting special tests that determine the resistance to active movement. Laboratory and instrumental methods in diagnosing this disease are usually not used, only if there is a clear trauma to exclude bone lesions is radiography. Differential diagnosis is performed with the following diseases: ulnar nerve injury, infringement of the median nerve, septic necrosis of articular surfaces, arthritis
Epicondylitis - treatment
Treatment of epicondylitis is necessarily complex, taking into account the degree of changes in the tendons and muscles of the hand and forearm, the degree of disruption of the elbow joint function, and the duration of the disease. The main tasks of epicondylitis treatment are: elimination of lesions in the focus of the lesion; improvement and / or restoration of regional circulation; restoration of the full volume of movements in the elbow joint; prevention of atrophic changes in the muscles of the forearm.
Elimination in the focus of lesion pain is solved using both conservative and radical methods of treatment. In the acute period of lateral epicondylitis for seven to eight days immobilization of the upper limb is carried out with the forearm bent in the elbow.
In the case of chronic epicondylitis, bandaging of the elbow joint and forearm with elastic bandage is shown (at night the bandage should be removed). A good anesthetic effect is ultrasound with hydrocortisone (phonophoresis). Ozokerite and paraffin applications, Bernard's currents, are widely used. To reduce local trophism and for analgesia, blockades (4-5 blockades, 2-3 days interval) of lidocaine and novocaine of the attachment of fingers and extensors of the hand are shown. After removing the gypsum langs, warming compresses with borax vaseline, camphor alcohol or simply vodka are shown. In order to improve the regional blood circulation in the affected area, electrophoresis with novocaine, potassium iodide, acetylcholine, or UHF therapy is indicated. To prevent and treat muscle atrophy, as well as to restore adequate functioning of the joint, the use of forearm and shoulder massage, exercise therapy, dry air baths, mud therapy is shown.
In the absence of the result of conservative treatment for three to four months, resort to radical (surgical) methods of treatment. Today, the operation of Homan is quite widely used, which suggested back in 1926 to excise a part of the tendon of the extensors of the finger and hand.
Prophylaxis of epicondylitis consists in the mandatory prevention of the presence of chronic overstrain of the above-described muscle groups, in the rational technique of sports or working (professional) movements, in the proper selection of the necessary equipment and the choice of working posture. In chronic epicondylitis with frequent relapses and unsuccessful complex treatment, the patient is recommended to change the nature of the work.