Epicondylitis: causes, symptoms, diagnosis, treatment

Epicondylitis is considered a degenerative process, which is localized in the joint and leads to the destruction of the attachment of muscles to the bone. Due to its appearance, inflammatory changes in surrounding tissues and structures are observed.

The causes of epicondylitis are stereotypic movements in the joint, which are repeated very often, especially in some professions or sports. In addition, do not forget about the traumatic defeat: it can be a blow, a fall or a rise and the transfer of a heavy object.

The international classification of diseases includes classes and subclasses of nosological units, through which it is possible to distribute all diseases, depending on the system and organ involved in the process.

Thus, epicondylitis in μB 10 belongs to the 13th class, which implies diseases of the musculoskeletal system with connective tissue. Further on the classification of epicondylitis refers to soft tissue diseases with the code M60-M79, in particular to other enterosopathies M77.

In the diagnosis of epicondylitis, μB 10 uses a division into medial M77.0 and lateral M77.1 epicondylitis. In addition, depending on the localization of the process in a particular joint, the classification encrypts each nosological unit separately.

[1]

Causes of the epicondylitis

The causes of epicondylitis are justified by the presence of a permanently traumatic factor in the joint, as a result of which inflammation of the structures and surrounding tissues of the joint is observed. Most often, such changes occur in professional athletes, in particular at risk are tennis players, as well as people with such specialties as masseur, builder, plasterer and painter. In the list of professions you can add those that require lifting weights.

The reasons for epicondylitis are confirmed by the fact that male representatives suffer from this disease more often than women. For the first time, clinical manifestations may occur at the age after 40 years. As for fans of professional sports, their symptoms appear much earlier.

Traumatic epicondylitis

The traumatic epicondylitis itself is characterized by the presence of microtraumas in the place of attachment of muscles and tendons to the bone. The disease is most often observed in hard work or sportsmen. In addition, provoking factors include deforming arthrosis of the elbow joint, pathological conditions of the ulnar nerve or osteochondrosis of the spine in the cervical region.

Traumatization is observed in the process of constant performance of the same type of work with daily aggravation of the situation. The broken structures can not regenerate quickly, especially after 40 years, so the microtrauma is replaced with a connective tissue.

[2], [3], [4], [5]

Posttraumatic epicondylitis

Posttraumatic epicondylitis develops as a result of sprains, dislocations or any other pathological processes in the joint. Of course, the epicondylitis does not always accompany these conditions. However, if during the dislocation there is a slight traumatization of the tendon and the termination of the muscle in the joint region, then the risk of posttraumatic epicondylitis increases. The probability increases especially when the recommendations are not followed after dislocations during the rehabilitation period. If a person immediately after removing the joint fixer begins to work intensively with this joint, then posttraumatic epicondylitis can be considered as a complication of the underlying pathological process.

Symptoms of the epicondylitis

At the heart of the appearance of inflammation and destructive processes lie small tears of muscles and tendons in places of attachment to the bone. As a result, there is a limited periostitis of traumatic nature. Calcifications and bursitis of articular bags are also widely encountered.

Epicondylitis of the joint, more precisely its prevalence, is not sufficiently studied because people rarely address when the first clinical signs appear. Basically, they use alternative medicine and only if there is no positive dynamics in treatment, they turn to the doctor. In addition, the diagnosis of "joint epicondylitis" is not always given, since the symptomatology and the radiographic picture are similar to the clinical picture of the majority of pathological processes in the joints.

The stages of the disease course cause the clinical symptoms of epicondylitis. The main symptom of the disease is a pain syndrome of varying intensity and duration. Sometimes the pain can be burning. In the future, when going to the chronic stage, the pain becomes aching and dull. Its strengthening is noted when performing movements involving the joint. In addition, pain can spread throughout the entire muscle, which is attached to the bone in the area of the affected joint. Symptoms of epicondylitis have a clearly localized painful focus with a sharp restriction of the motor activity of the joint.

[6], [7]

Chronic epicondylitis

Chronic epicondylitis is a fairly common pathological condition. The acute phase includes pronounced manifestations with high intensity and constant presence. Subacute stage is characterized by the appearance of clinical signs in the process or after physical exertion on the affected joint. But chronic epicondylitis has a wavy course with periodic remissions and relapses. Its duration should exceed 6 months.

Over time, the pain becomes aching, the hand gradually loses its strength. Degree of weakness can reach a level when a person can not even write or something to take in hand. This applies to the knee, when there is a shaky gait and lameness.

[8], [9], [10], [11], [12], [13], [14], [15],

Forms

[16], [17], [18]

Epicondylitis of the elbow joint

This disease can affect a large number of human joints, among which epicondylitis of the elbow joint is a very common pathology. In fact, this is the appearance of an inflammatory process in the elbow area due to a prolonged impact on it of a provoking factor. As a result, there is a traumatization and a violation of the structuring of the muscle at the place of attachment to the joint.

Epicondylitis of the elbow joint can be internal and external, as the inflammation develops in different places. The inflammatory process is not spontaneous, but has certain reasons for its development. The most susceptible people with the following specialties: professional athletes, for example, lifting barbells, weights, boxers and tennis players; working in agriculture - tractor drivers, milkmaids, as well as construction specialization - plasterer, painter and mason.

[19], [20], [21]

Lateral epicondylitis

Everyone knows a sport such as tennis. However, not everyone knows that regular training and competition can provoke lateral epicondylitis of the elbow joint. The disease has another name - the tennis player's elbow.

Despite this, in most cases, it is those people who are engaged in tennis not professionally, because they do not adhere to certain rules and recommendations for striking and playing racket. In the process of playing, a racket kick on the ball is applied due to extensor movements of the forearm and hand. Thus, there is a muscular and tendon strain of the extensors of the hand, which are attached to the lateral epicondyle of the humerus. As a result, minimal tearing of the ligamentous apparatus occurs, which provokes lateral epicondylitis.

Medial epicondylitis

"The elbow of a golfer" is the so-called medial epicondylitis. In connection with this name, it is not difficult to guess that the main reason for the appearance of illness is a sport game - golf. However, this does not mean absolutely that the medial epicondylitis does not have other causes of development. Among them, it is necessary to identify regularly repeated stereotyped movements of other sports or professional features. For example, throws, throwing the nucleus, as well as the use of various instrumental accessories and, of course, traumatization. In general, absolutely any impact on the joint structure, which leads to a disruption in the structure of muscles and tendons, can become a starting point for the development of the pathological process.

All of the above movements are performed due to the flexors of the wrist and fingers, the muscles of which are attached to the medial epicondyle of the humerus with the help of the tendon. In the process of exposure to traumatic factors, the appearance of microtraumas and, as a consequence, inflammation with swelling, pain syndrome and a decrease in motor activity are noted.

External epicondylitis

Depending on the localization of the inflammatory process, the disease is divided into internal and external epicondylitis. The main characteristic and clinical symptom is pain in the affected area of the joint. Due to certain properties of the pain syndrome, it is possible to make a differential diagnosis between epicondylitis and other destructive joint diseases.

The elbow joint starts to hurt only when physical activity appears in it, namely the extension of the forearm and the rotational movements of the forearm to the outside. If the doctor passively performs these movements, that is, he moves the person's hand without the involvement of his muscles, then the pain syndrome is not manifested. Thus, with passive performance of any movement during epicondylitis, pain does not appear, which is not observed with arthritis or arthrosis.

External epicondylitis may occur when performing a specific check. It is called "the symptom of the handshake." Starting from the name, it is already clear that the pain sensations appear with the usual handshake. In addition, they can be observed with supination (turning the palm up) and extension of the forearm, regardless of the load. In some cases, even raising a small cup of coffee can provoke the development of a pain syndrome.

[22], [23], [24], [25]

Epicondylitis of the shoulder

Epicondylitis of the shoulder is most often noted on the right arm, as it is more active (in right-handed people). The onset of the disease is associated with the appearance of aching, dull pain in the supracondylar area of the shoulder. Their constant character is observed only with active movements, and at rest pain is absent. In the future, it does not cease and accompanies every movement. In addition, even a slight palpation of the epicondyle becomes intolerable.

After this epicondylitis of the shoulder provokes an increase in weakness in the joint and arm, until there is no possibility to hold the mug. As a result, people are not able to use tools at work. The only position where the pain a little abates is a slight bending at the elbow at absolute rest.

When examining the affected joint, there is swelling and a slight swelling. When you try to feel the area, there is soreness. The same reaction is observed when trying to independently perform active movements.

[26], [27]

Internal epicondylitis

Internal epicondylitis is characterized by the presence of pain in the area of the medial surface of the humerus epicondyle. In most cases, a person can accurately indicate the localization of pain. Only sometimes it can spread in the direction of the affected muscle. Especially intense pains become when you try to turn the hand palm down and flex the forearm.

Internal epicondylitis can involve the ulnar nerve. Also, he is inclined to move into a chronic course with periodic exacerbations and remissions.

Epicondylitis of the knee joint

Epicondylitis of the knee joint develops due to the same reasons as in the elbow joint. Pathogenesis is based on a constant minimal trauma of the muscular structures at the site of attachment to the bone. As a result, inflammation and destructive phenomena are observed in the affected joint.

Basically, the main reason for the appearance of the disease is a professional sport. In connection with this, the epicondylitis of the knee joint is also called "the swimmer's knee", "the knee of the jumper" and "the knee of the runner". In fact, at the core of each one is a destructive process, but it differs in some features.

So, the "swimmer's knee", the pain that develops as a result of the valgus direction of the knee in the process of pushing away from the water when swimming breaststroke. As a result, the medial ligament of the knee joint is stretched, which contributes to the appearance of pain.

"Knee jumper" implies the presence of an inflammatory process in the patella. The most affected are basketball players and volleyball players. Painful sensations arise in the lower part of the patella in the place of attachment of the ligaments. The disease appears as a consequence of a constantly acting traumatic factor, after which the tissue does not have time to regenerate and restore the original structure.

"Knee runner" - a very common pathological process, covering almost a third of all athletes involved in running. Pain syndrome occurs as a result of compression of the nerve endings of the subchondral bone of the patella.

[28], [29], [30], [31]

Diagnostics of the epicondylitis

In order to correctly diagnose it is necessary to conduct a thorough examination, to thoroughly investigate the anamnestic data, namely, to ask how the disease began, how long the symptoms have appeared, how they grew and how they stopped the pain syndrome. Due to correctly collected history of the disease, the doctor can already at this stage suspect one or more pathologies.

Diagnosis of epicondylitis includes the testing of Thomson and Velta. Thomson's symptom is performed as follows: a sore arm is placed vertically on the table, leaning on the elbow. Then the fist is withdrawn in the direction away from itself and when it returns to its initial position, the inspector gives this movement a confrontation. As a result, the pain begins to be felt in the area of the elbow joint.

Diagnosis of epicondylitis with the help of Welsh's symptom consists in trying to turn the palm up with the arm extended forward, as in fencing. Most often, one can not even completely straighten the hand due to the appearance of painful sensations in the region of the external epicondyle of the humerus in the area of the elbow joint.

X-ray in the epicondylitis

With a prolonged course of the disease, especially associated with the suffered trauma of the elbow joint, it is necessary to differentiate the epicondylitis with a fracture of the epicondyle. Its main manifestation is puffiness in the fracture region, which is not present with epicondylitis.

X-rays in epicondylitis are used in rare cases, sometimes simultaneously in several projections. You can even use a computer tomography. However, these methods are not sufficiently informative. Certain changes in the image are visible only after a long period of time, when osteophytes and other changes in the cortical layer are formed.

[32], [33]

Treatment of the epicondylitis

Treatment of epicondylitis should have a combined approach. To determine the necessary volume of therapy, it is necessary to take into account the degree of structural changes in the tendons and muscles of the wrist and elbow joint, the disturbance of the motor activity of the joints, and the duration of the pathological process. The main objectives of the therapeutic direction are to eliminate pain in the inflammatory focus, restore local circulation, restore the full volume of motor activity in the elbow joint, and prevent atrophic processes in the muscles of the forearm.

Treatment of epicondylitis by alternative means

Treatment of epicondylitis by alternative means should begin with a doctor's consultation, since, although natural substances and herbs are used to a greater extent, there is always a risk of side effects.

Milk compresses with propolis are prepared by dissolving 5 grams of pre-crushed propolis in one hundred milliliters of warm milk. After that, a napkin from several layers of gauze should be soaked with this mixture and wrap it with the affected joint. After making a compress with cellophane and a layer of cotton wool, leave it for 2 hours.

Restorative ointment for ligaments and periosteum is made from natural fat. First, it (200 g) is melted in a water bath, the fat is separated and used for the basis of the ointment. Further 100 g of fresh comfrey root should be crushed and mixed with warm fat. The mixture should be mixed until a uniform, thick mass is obtained. Store the resulting ointment should be in the refrigerator. One procedure requires approximately 20 grams of the drug mixture. Before use, it should be heated in a water bath and soaked a napkin from several layers of gauze. Further, as a usual compress treatment lasts about 2 hours. Treatment of epicondylitis by alternative means can both relieve the main clinical symptoms of the disease, and restore the structure of the damaged joint.

Gymnastics with epicondylitis

Gymnastics with epicondylitis is directed to the gradual extension of the formed connective tissues to restore the functioning of the joint. Of course, without medication, exercise will not be as effective as when combined, but still the result will be noticeable.

Gymnastics with epicondylitis is performed with active movements and passive with the use of a healthy hand. All exercises should be sparing to avoid aggravation of the situation and even more damage to the joint. In addition, the special complex does not include force exercises, as they are not indicated for the treatment of epicondylitis. Especially the use of gymnastics is allowed only after consulting a doctor and extinction of the acute stage of the disease.

Exercises in the epicondylitis

For the purpose of treatment and rehabilitation of the disease, special exercises were developed for epicondylitis. So, it is necessary to perform flexion and extension of the forearm with a fixed shoulder girdle; with bent at the elbows, you need to clench your fists; alternating arms, you should perform circular movements with shoulders and forearms in opposite directions; combining the brushes of both hands, it is necessary to perform flexion and extension in the elbow joint.

In the absence of contraindications and doctor's permission, it is possible to perform such exercises with epicondylitis, as a "mill" or "scissors".

[34], [35]

Ointment with epicondylitis

Ointment with epicondylitis has a local effect, due to which it is possible to exert an anti-inflammatory, analgesic and anti-edema effect on the affected joint. Ointments can have in their composition, as non-steroidal anti-inflammatory components, and hormonal drugs.

Ointment with epicondylitis based on corticosteroids has a powerful effect in reducing edema and inflammatory response. For example, ointments with betamethasone and anesthetic. This combination relieves a person at the same time from a pain syndrome and a bursting sensation in the affected area of the forearm.

Nonsteroidal anti-inflammatory ointments with epicondylitis

Non-steroidal anti-inflammatory ointments with epicondylitis are used to reduce the activity of the inflammatory reaction of the body to damage the tendon at the point of attachment to the bone. Among the most common and used can be identified: ointment orthophene, ibuprofen and indomethacin. In addition, there are a large number of gels based on non-steroidal anti-inflammatory drugs such as diclofenac, nurofen and piroxicam.

Nonsteroidal anti-inflammatory ointments with epicondylitis are fairly simple to use. During the day, it is necessary to apply a certain amount of funds to the affected area of the joint. However, as monoterie, these ointments are not recommended, since the disease requires combined treatment.

Therapy of epicondylitis

Vitafon is a vibroacoustic apparatus that uses microvibration for therapeutic purposes. The principle of influence on the affected area is due to the influence of different sound frequencies. As a result, local blood circulation and lymph drainage are activated. Treatment of epicondylitis with a vitaifone is possible even in the acute stage. It helps to reduce the pain syndrome, which improves the quality of human life.

The treatment of epicondylitis with a vitaifon has certain contraindications. These are oncological neoplasms in the joint region, pronounced atherosclerosis, thrombophlebitis, acute stage of infectious diseases and fever.

Diprospan with epicondylitis

Despite the widespread use of non-steroidal anti-inflammatory drugs, diprospan with epicondylitis remains the drug of choice. Due to the presence in the composition of betamethasone in the form of sodium phosphate and dipropionate, the therapeutic effect is achieved quickly and for a fairly long time. The effect of diprospan is due to its belonging to hormonal means.

Diprospan with epicondylitis provides strong anti-inflammatory, immunosuppressive and anti-allergic action. The administration of the drug should correspond to the desired effect. If total exposure is required, then the drug is administered intramuscularly, if local - then into the surrounding tissue or inside the joint. There are also ointments, however they do not have the name "diprospan", but include the main component - betamethasone.

[36]

Bandage with epicondylitis

Immobilization of the joint is one of the main conditions for the complex treatment of epicondylitis. There are many ways to immobilize the affected area, one of which is considered a bandage with epicondylitis.

It is used in the upper third of the forearm and provides a strong immobilization. The bandage provides unloading of the place of fixation of the inflamed tendon to the bone with the help of directed compression action on the muscles. Thanks to a special fastener, you can adjust the degree of compression.

Bandage with epicondylitis has a tight-elastic body, which provides the necessary redistribution of pressure. It is very convenient to use and does not cause uncomfortable sensations.

[37], [38]

Shockwave therapy with epicondylitis

Shockwave therapy with epicondylitis is considered a modern method of treatment of the disease, since it has long been proven its effectiveness in restoring the lost function of the joint. This type of therapy provides a shorter period of treatment for epicondylitis, which is based on damage to the tendons at the site of their attachment to the bone.

Of particular importance is shock wave therapy in athletes, as they must quickly recover from injuries. The essence of the effect of the method is based on the supply of acoustic waves of a certain frequency to the affected area of the joint. In addition, thanks to her many times increased local blood flow. As a result, normal metabolism is restored, activated synthesis of collagen fibers, local circulation, tissue metabolism, and the regeneration of the cellular composition of the affected area is initiated.

Despite its high efficiency, shock wave therapy with epicondylitis has some contraindications. Among them is the period of pregnancy, the acute phase of infectious diseases, the presence of exudate in the lesion, osteomyelitis, the disruption of the coagulated function of the blood, the various pathologies of the cardiovascular system and the presence of an oncological process in the field of application of this type of therapy.

Elbow cushion with epicondylitis

The elbow pouch under the epicondylitis provides moderate strength fixation and compression of the tendons of the extensor and flexor muscles of the hand. In addition, he carries out massage movements on the muscular structure of the forearm.

The elbow structure includes a resilient frame with a cushion of silicone, fixing the strap, which evenly distributes the pressure on the muscles. It is universal, since it is suitable for right and left arms of various diameters.

The epicondylitis elbow is very convenient, because it prevents excessive lability of the joint, which adversely affects the treatment process.

Orthosis with epicondylitis

The orthosis with epicondylitis is used to reduce the load on the tendons of the muscles at the point of attachment to the bone. Thanks to it, the pain syndrome is removed and the functioning of the affected joint is normalized.

Orthosis in the epicondylitis has its contraindications, namely ischemia (insufficient blood supply) of the sites of the injured limb. Its use is effective both separately and in combination with glucocorticosteroids. Due to the contraction of the muscles of the forearm, there is a redistribution of the load on flexors and extensors of the hand, and also the tension of the tendon at the place of attachment to the humerus decreases. Orthosis is used in the acute phase of epicondylitis.

Operation with epicondylitis

Conservative treatment in most cases leads to persistent remission and long periods without exacerbation. However, there are some conditions in which an operation is performed in the epicondylitis.

Indications for its conduct are frequent relapses of the disease with vivid clinical manifestations and long acute periods, inadequate or complete inefficiency of drug treatment. In addition, it is necessary to take into account the degree of muscular atrophy and compression of the surrounding nerve trunks. When the symptoms of these conditions increase, an operation is indicated for epicondylitis.

Physiotherapy with epicondylitis

Physiotherapy with epicondylitis refers to the main methods of treating the disease. It includes: 

• ultraphonophoresis of hydrocortisone, during which ultrasonic waves make the skin more permeable for medicinal substances, as a result of which hydrocortisone penetrates deeper layers of the skin; 
• cryotherapy, implying exposure to the affected joint with a cold factor, usually with a temperature of -30 degrees. Due to low temperatures, painful pain and partial swelling are removed due to inflammation; 
• pulsed magnetotherapy uses a low-frequency magnetic field, as a result of which the activation of the blood supply of the inflamed area is observed with the acceleration of the metabolic process and regenerative possibilities; 
• diadynamic therapy is characterized by the action of low-frequency monopolar impulse currents, as a result of which the blood is delivered to the tissues, the supply of oxygen and nutrients is increased; 
• shock-wave physiotherapy with epicondylitis implies the impact of an acoustic wave on the affected areas of the joint tissue, due to which there is increased blood supply to the affected joint, a reduction in the pain syndrome and resorption of fibrotic foci. This type of therapy is used as a physiotherapy with epicondylitis in the absence of the effect of other treatments.

Prevention

Epicondylitis refers to those diseases that can be prevented by adhering to certain recommendations. In addition, they help not only prevent the appearance of epicondylitis, but also reduce the risk of relapse. Prevention of epicondylitis is as follows: 

• before you start any work, you must first warm up the joints; 
• compliance with the rules for the performance of professional movements in sports and stay at work in a comfortable position; 
• Do not forget about the daily massage and exercise in the presence of a coach.

Medication prophylaxis of epicondylitis consists in the regular intake of vitamin and mineral complexes, as well as the treatment of chronic inflammatory foci. With regard to measures to prevent the development of relapses, the most effective use of fixatives and elastic bandages on the damaged joint. During the working day, it is necessary to create the most favorable conditions to avoid loading the affected joint.

[39]

Forecast

The prognosis of epicondylitis is favorable, since it does not threaten life. If the rules of prevention are observed, long-term remission of the disease can be achieved. When the first symptoms of the disease appear, it is recommended to consult a specialist for consultation, diagnosis and treatment of epicondylitis. In addition, the disease can be avoided if from the first day of doing sports or work pay attention to certain recommendations. Epicondylitis is not an unexplored pathological condition, and its treatment in our time is quite effective, so do not delay this.