Epicondylitis: causes, symptoms, diagnosis, treatment

Epicondylitis is considered a degenerative process that is localized in the joint and leads to the destruction of the muscle attachment to the bone. As a result of its occurrence, inflammatory changes are observed in the surrounding tissues and structures.

The causes of epicondylitis are stereotypical movements in the joint, which are repeated very often, especially in some professions or sports. In addition, do not forget about traumatic damage: this can be a blow, a fall or lifting and carrying a heavy object.

The International Classification of Diseases includes classes and subclasses of nosological units, with the help of which it is possible to distribute all diseases depending on the specific system and organ involved in the process.

Thus, epicondylitis in ICD 10 refers to class 13, which implies diseases of the musculoskeletal system with connective tissue. Further, according to the classification, epicondylitis refers to diseases of soft tissues with the code M60-M79, in particular to other enthesopathies M77.

When diagnosing epicondylitis, ICD 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 encodes each nosological unit separately.

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Causes epicondylitis

The causes of epicondylitis are based on the presence of a constantly traumatic factor in the joint, resulting in inflammation of the structures and surrounding tissues of the joint. Most often, such changes occur in professional athletes, tennis players are especially at risk, as well as in people with such professions as massage therapists, builders, plasterers and painters. The list of professions can be added to those that require lifting weights.

The causes of epicondylitis confirm the fact that men suffer from this disease more often than women. Clinical manifestations may first appear after the age of 40. As for professional sports enthusiasts, their symptoms appear much earlier.

Traumatic epicondylitis

Traumatic epicondylitis itself is characterized by the presence of microtraumas at the site of attachment of muscles and tendons to the bone. The disease is most often observed in heavy workers or athletes. 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. Damaged structures cannot quickly regenerate, especially after 40 years, therefore microtraumas are replaced by connective tissue.

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Post-traumatic epicondylitis

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

Symptoms epicondylitis

The inflammation and destructive processes are based on small tears of muscles and tendons at the points of attachment to the bone. As a result, limited prevalence of traumatic periostitis is observed. Calcifications and bursitis of the joint bags are also common.

Epicondylitis of the joint, or rather its prevalence, has not been sufficiently studied due to the fact that people rarely seek help when the first clinical signs appear. They mainly use folk remedies and only in the absence of positive dynamics in treatment, they consult a doctor. In addition, the diagnosis of "epicondylitis of the joint" is not always made, since the symptoms and radiographic picture are similar to the clinical picture of most pathological processes in the joints.

The stages of the disease determine the clinical symptoms of epicondylitis. The main symptom of the disease is considered to be pain syndrome of varying intensity and duration. Sometimes the painful sensations can be of a burning nature. Later, when moving to the chronic stage, the pain becomes aching and dull. Its intensification is noted when performing movements involving the joint. In addition, the pain can spread along the entire muscle that is attached to the bone in the area of the affected joint. The symptoms of epicondylitis have a clearly localized pain focus with a sharp limitation of the motor activity of the joint.

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Chronic epicondylitis

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

Over time, the pain becomes aching, the hand gradually loses its strength. The degree of weakness can reach a level where a person cannot even write or take something in his hand. This also applies to the knee, when unsteadiness of gait and lameness appear.

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Forms

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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 essence, this is the appearance of an inflammatory process in the elbow area due to prolonged exposure to a provoking factor. As a result, traumatization and disruption of the muscle structuring at the site of attachment to the joint occur.

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

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Lateral epicondylitis

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

Despite this, in most cases it is those people who play tennis unprofessionally who suffer because they do not adhere to certain rules and recommendations for striking and handling a racket. During the game, the racket strikes the ball using extension movements of the forearm and hand. Thus, there is muscle and tendon tension in the extensors of the hand, which are attached to the lateral epicondyle of the humerus. As a result, minimal ligamentous ruptures occur, which provokes lateral epicondylitis.

Medial epicondylitis

"Golfer's elbow" is the so-called medial epicondylitis. In connection with such a name, it is not difficult to guess that the main cause of the disease is a sport - golf. However, this does not mean that medial epicondylitis does not have other causes of development. Among them, it is necessary to highlight regularly repeated stereotypical movements of other sports or professional features. For example, throws, shot put, as well as the use of various instrumental accessories and, of course, trauma. In general, absolutely any impact on the joint structures, which leads to a violation of the structure of muscles and tendons, can become a trigger for the development of a pathological process.

All the above movements are performed by the flexors of the wrist and fingers, the muscles of which are attached to the medial epicondyle of the humerus by a tendon. During the impact of traumatic factors, microtraumas appear and, as a consequence, inflammation with swelling, pain syndrome and decreased motor activity.

Lateral 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 conduct a differential diagnosis between epicondylitis and other destructive diseases of the joint.

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

External epicondylitis may manifest itself during a certain test. It is called the "handshake symptom." Based on the name, it is already clear that pain occurs during a normal handshake. In addition, they can be observed during supination (turning the palm up) and extension of the forearm, regardless of the load. In some cases, even lifting a small cup of coffee can provoke the development of pain syndrome.

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Epicondylitis of the shoulder

Epicondylitis of the shoulder is most often observed on the right hand, 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 area of the shoulder epicondyle. Their constant nature is observed only during active movements, and at rest there is no pain. Later, it does not subside and accompanies every movement. In addition, even slight palpation of the epicondyle becomes unbearable.

After this, epicondylitis of the shoulder provokes an increase in weakness in the joint and arm, up to the point of inability to hold a mug. As a result, a person is unable to use tools at work. The only position in which the pain subsides a little is a slight bend in the elbow at absolute rest.

When examining the affected joint, swelling and slight puffiness are noted. When trying to palpate the area, pain appears. The same reaction is observed when trying to independently perform active movements.

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Medial epicondylitis

Medial epicondylitis is characterized by the presence of pain in the area of the medial surface of the humeral epicondyle. In most cases, a person can accurately indicate the location of the pain. Only sometimes can it spread in the direction of the affected muscle. The pain becomes especially intense when trying to turn the hand palm down and bending the forearm.

Internal epicondylitis can involve the ulnar nerve. It also tends to become chronic 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 constant minimal trauma to muscle 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 cause of the disease is identified - this is professional sports. In this regard, epicondylitis of the knee joint is also called "swimmer's knee", "jumper's knee" and "runner's knee". In fact, each is based on one destructive process, but differs in some features.

Thus, "swimmer's knee", the pain in which develops as a result of the valgus direction of the knee movement during the process of pushing off the water with the leg during breaststroke swimming. As a result, there is a stretching of the medial ligament of the knee joint, which contributes to the appearance of pain.

"Jumper's knee" implies the presence of an inflammatory process in the patella. Basketball and volleyball players are most susceptible to the disease. Painful sensations occur in the lower part of the patella at the site 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.

"Runner's knee" is a very common pathological process, affecting almost a third of all athletes involved in running. The pain syndrome appears as a result of compression of the nerve endings of the subchondral bone of the patella.

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Diagnostics epicondylitis

In order to make a correct diagnosis, it is necessary to conduct a thorough examination, study the anamnestic data in detail, namely, ask how the disease began, how long ago these symptoms appeared, how they increased and how the pain syndrome was relieved. Thanks to a correctly collected anamnesis of the disease, the doctor can already suspect one or several pathologies at this stage.

Diagnosis of epicondylitis includes the Thomson and Welt tests. The Thomson symptom is performed as follows: the sore arm is placed vertically on the table, leaning on the elbow. Then the fist is moved away from oneself and when it returns to the initial position, the examiner resists this movement. As a result, pain begins to be felt in the elbow joint area.

Diagnosis of epicondylitis using the Welch symptom involves trying to turn the palm upward with the arm extended forward, as in fencing. Most often, it is not possible to even fully straighten the arm due to the appearance of painful sensations in the area of the lateral epicondyle of the humerus in the elbow joint.

X-ray for epicondylitis

In the case of a long-term course of the disease, especially associated with previous trauma to the elbow joint, epicondylitis must be differentiated from a fracture of the epicondyle. Its main manifestation is swelling in the fracture area, which is not present in epicondylitis.

X-rays are used for epicondylitis in rare cases, sometimes in several projections at the same time. You can even use computed tomography. However, these methods are not informative enough. Certain changes in the image are visible only after a long period of time, when osteophytes and other changes in the cortex are formed.

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Treatment epicondylitis

Treatment of epicondylitis should have a combined approach. To determine the required volume of therapy, it is necessary to take into account the degree of structural changes in the tendons and muscles of the hand and elbow joint, impaired motor activity of the joints and the duration of the pathological process. The main tasks of the treatment direction are to eliminate pain in the inflammation focus, restore local blood circulation, resume the full range of motor activity in the elbow joint, and prevent atrophic processes in the forearm muscles.

Treatment of epicondylitis with folk remedies

Treatment of epicondylitis with folk remedies should begin with a consultation with a doctor, since, despite the fact that natural substances and herbs are used to a greater extent, the risk of developing side effects is still always present.

Milk compresses with propolis are prepared by dissolving 5 g of pre-crushed propolis in one hundred milliliters of warm milk. After this, a napkin made of several layers of gauze should be soaked in this mixture and wrapped around the affected joint. Then make a compress using cellophane and a layer of cotton wool, leave it for 2 hours.

Restorative ointment for ligaments and periosteum is made from natural lard. First, it (200 g) is melted in a water bath, the fat is separated and used as the base of the ointment. Next, 100 g of fresh comfrey root should be crushed and mixed with warm fat. The mixture should be stirred until a homogeneous thick mass is obtained. The resulting ointment should be stored in the refrigerator. One procedure requires approximately 20 g of the medicinal mixture. Before use, it should be warmed up in a water bath and soaked in a napkin made of several layers of gauze. Then, like a regular compress, the treatment works for about 2 hours. Treatment of epicondylitis with folk remedies can both relieve the main clinical symptoms of the disease and restore the structure of the damaged joint.

Gymnastics for epicondylitis

Gymnastics for epicondylitis is aimed at gradual stretching of the formed connective tissues to restore the functioning of the joint. Of course, without drug intervention, physical exercises will not be as effective as with their combination, but the result will still be noticeable.

Gymnastics for epicondylitis is performed using active movements and passive ones using the healthy hand. All exercises should be gentle to avoid aggravating the situation and further damaging the joint. In addition, the special complex does not include strength exercises, since they are not indicated for the treatment of epicondylitis. Moreover, the use of gymnastics is allowed only after consulting a doctor and the fading of the acute stage of the disease.

Exercises for epicondylitis

Exercises for epicondylitis have been specially developed for the treatment and rehabilitation of the disease. So, it is necessary to flex and extend the forearm with the shoulder girdle motionless; with the arms bent at the elbows, you need to clench your fists; alternating arms, you should perform circular movements with the shoulders and forearms in opposite directions; having connected the hands of both hands, you need to flex and extend the elbow joint.

In the absence of contraindications and with the doctor’s permission, you can perform exercises for epicondylitis such as “mill” or “scissors”.

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Ointment for epicondylitis

Ointment for epicondylitis has a local effect, due to which it is possible to have an anti-inflammatory, analgesic and anti-edematous effect on the affected joint. Ointments can contain both non-steroidal anti-inflammatory components and hormonal drugs.

Ointment for epicondylitis based on corticosteroids has a powerful effect in reducing swelling and inflammation. For example, ointments with betamethasone and anesthetic. This combination relieves a person from pain syndrome and a bursting sensation in the affected area of the forearm.

Nonsteroidal anti-inflammatory ointments for epicondylitis

Nonsteroidal anti-inflammatory ointments for epicondylitis are used to reduce the activity of the body's inflammatory response to tendon damage at the site of its attachment to the bone. Among the most common and used are: orthofen ointment, ibuprofen and indomethacin. In addition, there are a large number of gels based on nonsteroidal anti-inflammatory drugs, such as diclofenac, nurofen and piroxicam.

Nonsteroidal anti-inflammatory ointments for epicondylitis are quite easy to use. During the day, it is necessary to apply a certain amount of the product to the affected area of the joint. However, such ointments are not recommended as monotherapy, since the disease requires combined treatment.

Treatment of epicondylitis with Vitaphone

Vitaphone is a vibroacoustic device that uses microvibrations for therapeutic purposes. The principle of action on the affected area is determined by the influence of different sound frequencies. As a result, local blood circulation and lymph flow are activated. Treatment of epicondylitis with Vitaphone is possible even in the acute stage. It helps to reduce pain, which improves the quality of life of a person.

Treatment of epicondylitis with Vitaphone has certain contraindications. These are oncological neoplasms in the joint area, severe atherosclerosis, thrombophlebitis, acute stage of infectious diseases and fever.

Diprospan for epicondylitis

Despite the widespread use of nonsteroidal anti-inflammatory drugs, diprospan remains the drug of choice for epicondylitis. Due to the betamethasone in the form of sodium phosphate and dipropionate, the therapeutic effect is achieved quickly and for quite a long time. The effect of diprospan is due to its belonging to hormonal agents.

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

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Bandage for epicondylitis

Joint immobilization is one of the main conditions for complex treatment of epicondylitis. There are many ways to immobilize the affected area, one of which is a bandage for epicondylitis.

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

The bandage for epicondylitis has a tight-elastic body, which provides the necessary redistribution of pressure. It is very convenient to use and does not cause discomfort.

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Shock wave therapy for epicondylitis

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

Shock wave therapy is especially important for athletes, as they must recover quickly from injuries. The essence of the method is based on the delivery of acoustic waves of a certain frequency to the affected area of the joint. In addition, thanks to it, local blood flow is increased many times. As a result, normal metabolism is restored, collagen fiber synthesis, local blood circulation, tissue metabolism are activated, and the process of regeneration of the cellular composition of the affected area is launched.

Despite its high efficiency, shock wave therapy for epicondylitis has some contraindications. Among them, it is worth highlighting the period of pregnancy, the acute phase of infectious diseases, the presence of exudate in the lesion, osteomyelitis, impaired blood coagulation function, various pathologies of the cardiovascular system and the presence of an oncological process in the area of application of this type of therapy.

Elbow pad for epicondylitis

The elbow pad for epicondylitis provides moderate fixation and compression of the tendons of the extensor and flexor muscles of the hand. In addition, it performs massage movements on the muscular structure of the forearm.

The elbow pad includes an elastic frame with a silicone pad, a fixing belt that evenly distributes pressure on the muscles. It is universal, as it fits the right and left hands of different diameters.

An elbow pad for epicondylitis is very convenient, as it prevents excessive joint lability, which has an adverse effect during the treatment process.

Orthosis for epicondylitis

An orthosis for epicondylitis is used to reduce the load on the muscle tendons at the point of their attachment to the bone. Thanks to it, pain is relieved and the functioning of the affected joint is normalized.

An orthosis for epicondylitis has its own contraindications, namely ischemia (insufficient blood supply) of the damaged limb. Its use is effective both separately and in combination with glucocorticosteroids. Due to its compression of the forearm muscles, there is a redistribution of the load on the flexors and extensors of the hand, and the tension force of the tendon at the attachment to the humerus decreases. The orthosis is used in the acute phase of epicondylitis.

Surgery for epicondylitis

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

Indications for its implementation are frequent relapses of the disease with vivid clinical manifestations and long acute periods, insufficient or complete ineffectiveness of drug treatment. In addition, it is necessary to take into account the degree of muscle atrophy and compression of the surrounding nerve trunks. With an increase in the symptoms of these conditions, surgery for epicondylitis is indicated.

Physiotherapy for epicondylitis

Physiotherapy for epicondylitis is one of the main methods of treating the disease. It includes:

• hydrocortisone ultraphonophoresis, during which ultrasonic waves make the skin more permeable to medicinal substances, as a result of which hydrocortisone penetrates into the deeper layers of the skin;
• cryotherapy, which involves the impact of a cold factor on the affected area of the joint, usually with a temperature of -30 degrees. Thanks to low temperatures, pain syndrome and partially swelling due to inflammation are relieved;
• pulsed magnetic therapy uses a low-frequency magnetic field, which results in activation of the blood supply to the inflamed area with acceleration of the metabolic process and regenerative capabilities;
• Diadynamic therapy is characterized by the action of low-frequency monopolar pulsed currents, as a result of which a greater blood supply to tissues is achieved, and the supply of oxygen and nutrients increases;
• shock wave physiotherapy for epicondylitis involves the impact of an acoustic wave on the affected areas of joint tissue, due to which there is increased blood supply to the affected joint, a decrease in pain syndrome and the resorption of fibrous foci. This type of therapy is used as physiotherapy for epicondylitis in the absence of the effect of other treatment methods.

Prevention

Epicondylitis is one of those diseases that can be prevented by following certain recommendations. In addition, they help not only prevent the occurrence of epicondylitis, but also reduce the risk of relapse. Prevention of epicondylitis consists of the following:

• Before starting any work, you must first warm up your joints;
• compliance with the rules for performing professional movements in sports and staying in a comfortable position at work;
• Don't forget about daily massage and exercise in the presence of a trainer.

Medicinal prevention of epicondylitis consists of regular intake of vitamin and mineral complexes, as well as treatment of chronic inflammatory foci. As for measures to prevent relapses, the most effective here is the use of fixators and elastic bandages on the damaged joint. During the working day, it is necessary to create the most favorable conditions to avoid stress on the affected joint.

Forecast

The prognosis for epicondylitis is favorable, as it is not life-threatening. If you follow the rules of prevention, you can achieve long-term remission of the disease. 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 you pay attention to certain recommendations from the first day of playing sports or working. Epicondylitis is not an unstudied pathological condition, and its treatment is quite effective these days, so do not delay it.