Epicondylitis is when degenerative inflammatory changes in the place of attachment to the humerus (in the elbow joint) of tendons of the muscles of the outer and inner areas of forearm happen. The lateral epicondyle is most often affected (the place of attachment of the extensors of the hand), in this case, the diagnosis of lateral epicondylitis is made, and tendons of flexors of the hand (medial epicondylitis) are much less involved. The cause of epicondylitis is overload (against the background of professional activity, carrying weights, performing repairs, home canning, playing tennis) of the indicated entheses (places of attachment of tendons or ligaments to the bone) with their microtrauma and secondary development of the inflammatory reaction. In some cases, the disease is preceded by direct injury. The preexisting state of the ligamentous apparatus also matters. Thus, hypermobile individuals (with signs of congenital weakness of ligaments) tend to develop this disease; they also have a more severe course of it. The disease affects middle-aged people (40-60 years). The process mainly involves the dominant limb (right hand).
The disease can begin after an episode of overload, with repeated movements of the hand in the abduction position and flexion in the elbow joint. However, often a pain in the elbow joint occurs against the background of the usual rhythm of life. In the latter case, we are talking about gradual involution changes in the musculoskeletal system, which are manifested by degenerative processes in the epicondyle of humerus without apparent lateral causes. Once appeared, the pain caused by epicondylitis can last for weeks and months. Pain caused by epicondylitis is well localised – patients confidently indicate lateral (with lateral epicondylitis) or medial (with medial epicondylitis) surface of the elbow joint. Pain can radiate distally along the outer or inner surface of forearm or up to the lower third of the shoulder. At rest, there is no pain. The appearance and intensification of pain (at the place of attachment of muscles in the elbow joint – lateral or medial epicondyle) with the lateral epicondylitis it is provoked by extension of the hand, an extension of the fingers and supination of the hand (especially with resistance), with medial epicondylitis – it is provoked by flexion in the wrist joint (especially with resistance). Epicondylitis pain (unlike lesions of the elbow joint) is absent with active and passive flexion-extension in the elbow joint. In some cases, pain in epicondylitis can be localized (in addition to entheses) in adjacent areas of tendons.
Diagnosis of epicondylitis is based on clinical examination. Additional information confirming the diagnosis is obtained using tests for resistance to active movement. The list of diseases with which differential diagnosis of epicondylitis is carried out includes lesions of the elbow joint itself (arthritis, aseptic necrosis of the articular surfaces) and tunnel syndromes in this area (pronator teres syndrome – strangulation of the median nerve, cubital canal syndrome – strangulation of the ulnar nerve). Instrumental (including ultrasound, magnetic resonance imaging) and laboratory methods in the diagnosis of epicondylitis, as a rule, are not used. Only in cases of obvious trauma, conventional radiography eliminates bone damage (fracture of the lateral epicondyle is possible).
Treatment of epicondylitis is extremely conservative. The main treatment method is shock wave therapy. The complex includes performing therapeutic applications of kinesio tape.
Kinesiotherapy for lateral epicondylitis
In case of severe pain, short-term immobilization is used – a light splint on a scarf bandage. With the development of epicondylitis after an injury, local cold is effective – applying ice several times a day to the painful area. The effectiveness of therapeutic exercises aimed at stretching the connective tissue structures was shown – in case of lateral epicondylitis, these are daily courses of short-term extensions in the wrist joint. Non-steroidal anti-inflammatory drugs (NSAIDs) in the form of ointments or gels (effective due to superficial location of epicondyles) and/or NSAIDs in tablets are also used. In case of persistent pain syndrome that does not respond to topical use of NSAIDs, the method of choice is the local injection of microcrystalline glucocorticoids (betamethasone dipropionate) in a mixture with an anaesthetic.
Injection of a hormonal drug into the lateral epicondyle of shoulder
The procedure is carried out once, in rare cases, repeated administration after 7-10 days is necessary. The injection is not repeated more than 2 times. In persistent cases of epicondylitis, the use of a relatively new treatment method is also indicated – extracorporeal shock wave therapy. The basis of this method is the impact on the affected structure of high-power ultrasound.
Shockwave therapy for epicondylitis
Separate cases of successful surgical treatment of epicondylitis using excision of the revealed ossification of entheses are described. For the prevention of recurrence of epicondylitis (in case of its successful treatment), it is important to explain to a patient the need to comply with the optimal motor regimen, which eliminates overload of the epicondyle of the humerus.