EPICONDYLITE

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

Epicondylitis is a dystrophic process in the places of attachment of muscles to the epicondyle of the humerus, accompanied by reactive inflammation of neighboring tissues. There are external epicondylitis of the shoulder (the so-called tennis elbow), which is more common, and the inner epicondylitis of the shoulder. External epicondylitis occurs predominantly in individuals who produce repetitive, stereotypical movements (extensor and supination of the forearm), such as masseurs, painters, carpenters, tennis players, and are usually right-handed. Sometimes it is the result of a direct elbow injury. Men suffer more often than women.

In the clinical picture of external epicondylitis, the leading place is occupied by local pain in the region of the external epicondyle, which can irradiate upward along the outer edge of the arm and down to the middle of the forearm. At rest, pain is absent and appears when palpation or certain movements - extension and supination of the forearm, and especially when combined with these movements. Passive movements of the forearm are painful only when they resist them. The pain increases when the hand is compressed into a fist and simultaneously bent in the wrist joint. The pain is usually progressive, it appears even with a slight muscle strain, for example, holding a thing in the hand. The appearance of the elbow joint with epicondylitis is not. Changed, passive movements, as a rule, are not limited. With palpation, you can find the point of greatest soreness. It can be located both in the tendons of the extensor, and in the muscles. Most often it is the arch support, but it can also be one of the extensor extensors of the hand. Depending on this, the tendon-periosteal, muscular, tendon, and supra-capillary forms of epicondylitis are isolated. In some cases, as a result of compression of the deep branch of the radial nerve by the arch support, mark the paresis of the muscles of the extensors of the hand and fingers. To clarify the diagnosis, ultrasound, electrophysiological and radiographic studies are performed.

The course of external epicondylitis is chronic. A few weeks after the creation of rest, the muscles fade, the pain subsides, sometimes it takes several months. When the load is renewed, relapses of pain are often noted.

In contrast to the external, the internal epicondylitis is usually observed in persons with mostly light physical labor - typists, seamstresses, assemblers, etc., more often in women. Clinically, it is manifested by pain when pressing on the inner epicondyle, as well as when flexing and pronating the forearm. Pain radiates along the inner edge of the forearm. The course of internal epicondylitis, as well as external, is chronic. Treatment of epicondylitis is conservative in most cases. Assign peace for the muscles, the tension of the tendons which is accompanied by the appearance or intensification of pain. In severe pain syndrome impose a plaster bandage for 3-4 weeks. Assign anti-inflammatory and analgesic medications ( butadione , orthophene , indomethacin , etc.). A course of physiotherapy - electrophoresis of a solution of novocaine, amplipulse therapy, hydrophorrhizone phonophoresis, etc. is carried out. For pain relief, laser therapy, cryotherapy (including cryomassage) are used. In some cases, effective reflexotherapy. A good therapeutic effect is provided by a combination of local cooling (irrigation of the painful area with a refrigerant, for example chloroethyl) with the introduction of a local anesthetic (novocaine, lidocaine, etc.) or hydrocortisone to the point of maximum pain. After this, pass a slow passive stretching of the muscles, attached to the external (with external epicondylitis) or internal (with internal epicondylitis) epicondyle. In some cases, for example, with ineffective conservative treatment or increasing compression of nearby nerves, an operation is performed to cut out the radiused extensor of the hand at the site of its proximal attachment, a deep incision to the bone in the painful area, dissection of the fascia covering the extensor muscles, distal to the epicondyle, excising the tendon And peri-tendon tissues in the painful zone, etc.

In the vertebrogenic syndrome of epicondylitis, the main disease is treated - massage of the collar zone, therapeutic gymnastics, according to indications, traction therapy, etc.

Prevention is to prevent chronic overstrain of the appropriate muscle groups, rational technique of professional or sports movements, working posture, the correct selection of equipment, for example, tennis rackets. In some cases, use elbow pads or apply a bandage of elastic bandage in the form of a figure-eight.