How to treat epicondylitis. Medial epicondylitis of the elbow joint: what is it and how to treat Bilateral epicondylitis

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Often during training I hear very similar complaints from guys - “it hurts somewhere in the elbow, it gets worse when moving...”, “... I can’t do push-ups...”, “... I can’t do pull-ups - it hurts...”, “... the hand is weakened...”. It is not always possible to understand what the problem is without additional examination, but most often fighters are tormented by one common ailment. When visiting a doctor, you may hear the scary, incomprehensible words “epicondylitis of the elbow joint” or even worse, “medial or lateral”!!! Let's figure out what this terrible beast is.

Let's translate these words from medical into Russian - epicondylus- in Latin, epicondyle of the humerus, i.e. the protrusion of the humerus in the area of the elbow joint to which the flexor and extensor muscles of the hand are attached. The ending -it in the word means an inflammatory process. Those. inflammation in the area of the protrusions of the humerus. Medial is internal, and lateral is external. In other words, elbow epicondylitis is an inflammatory condition in the elbow joint, where the muscles attach to the protuberances of the humerus. Depending on the location where the inflammation occurs, the disease can be external (lateral) or internal (medial).

Lateral epicondylitis is a disease in which inflammation occurs at the site of muscle attachment to the lateral (internal) epicondyle of the bone. Often this disease is called “tennis elbow”, as it was first described in tennis players, but this problem is quite typical for wrestlers, boxers, and weightlifters. The cause of lateral epicondylitis of the elbow joint is overstrain of the muscles at the point of their attachment to the epicondyle of the shoulder bone. This disease occurs with constant monotonous flexion and extension of the elbow joint, when this puts stress on the arm, in particular when holding a grip, throwing and striking. The dominant hand suffers the most. In other words, the main version of the reasons for the development of epicondylitis is overload of the tendons, as well as some microtraumas of the tissues that provoke inflammation. The disease usually appears between the ages of 30 and 50 years.

Medial epicondylitis known as golfer's elbow. However, this does not mean that only golfers can suffer from this disease. The cause is the same as for lateral epicondylitis. The only difference is that the pain is on the inner surface of the elbow joint.

External epicondylitis is more common. Both types of epicondylitis often occur in wrestlers and weightlifters.

How does epicondylitis manifest?

The main manifestation of epicondylitis is pain in the muscles of the shoulder and forearm. The pain is of a different nature - burning, aching, pulling, dull or sharp, and radiates to the hand. With external epicondylitis, pain occurs when trying to straighten the forearm, and with internal epicondylitis, pain occurs when bending the elbow joint.

Symptoms, as a rule, appear gradually - first, unpleasant sensations and discomfort arise when exerting stress on the affected limb, and then at rest. Sometimes intense shooting pains occur suddenly, without previous discomfort. Often the pain syndrome is so severe that the patient finds it difficult to shake a friend’s hand, take a glass, hold a spoon when eating, or perform other household functions.

In other words, the main symptoms of epicondylitis are:

Pain or burning sensation on the outside, inside, or both sides of the elbow;
Decreased strength of the forearm muscles that extend the hand and fingers.

These symptoms are aggravated by stress on the muscles that attach to the epicondyles of the humerus (holding a grip, push-ups, striking techniques)

Most often, pain occurs on the leading side (right in right-handed people and left in left-handed people), but the disease can occur on both sides.

Treatment of epicondylitis

In the vast majority of cases, conservative (non-surgical) treatment is possible. It is effective in 80-95% of cases.

Conservative treatment

If pain appears, for several days completely eliminate movements/exercises that provoked pain (wrestling, push-ups). To relieve pain, it is recommended to take anti-inflammatory drugs (for example, diclofenac, Nise, Nimesil, Arcoxia, ibuprofen) until the pain completely subsides. Read the medication instructions carefully!!! Do not take on an empty stomach!! Do not take with ulcers, gastritis, or colitis. More than 2-3 days only after consultation with a doctor!!!
If pain reappears, apply cold (cryotherapy) to the outside of the elbow joint for 15-20 minutes several times a day. Cryotherapy is continued for 3-4 days.
After a significant reduction in pain, local cold is changed to local heat (several times a day), which finally removes the pain.
After pain disappears permanently, stretching exercises begin. Using the other hand, slowly bend the wrist of the affected arm until a feeling of tension and slight pain appears in the elbow area, stay in this position for 10-15 seconds, slowly shaking the hand. Repeat three sets 10 times a day.
Once the stretching exercises are completely pain-free, begin strengthening and stretching exercises. Take a dumbbell (no more than 1.0 kg) or another heavy object in the hand (the back of the hand is facing upward, the elbow is bent about 100-120 degrees). The hand and forearm are supinated and returned to their original position. 10 approaches, rest 2-3 minutes, 2 more times 10 approaches (2-3 times a week).
Repeat a similar exercise, but the hand is turned with the back surface down, 10 approaches, rest for 2-3 minutes, 2 more times for 10 approaches (2-3 times a week).

Orthotics

For treatment, orthoses are used, also known as braces, of the “wristband” type; its center should be located in the upper third of the forearm, posteriorly. This orthosis is effective for lateral epicondylitis. The “wristband” can be used not only for treatment, but also for prevention.

Elastic bandages around the elbow joint are practically useless.

Physiotherapeutic procedures

These treatment methods are highly effective. Physical methods have a beneficial effect on inflamed and injured tissues, which leads to improved blood supply and metabolism in cells, and healing processes proceed much faster. A course of treatment is prescribed for 7-10 days. Applicable:

pulsed magnetic therapy - the effect of low-frequency magnetic pulses on the elbow joint
paraffin and ozokerite applications on the elbow area
diadynamic therapy - exposure to electric current of different polarity
electrophoresis using hydrocortisone or novocaine - deep, uniform penetration of active substance molecules into the affected tissues
exposure to infrared laser radiation
cryotherapy - exposure to a stream of dry cold air.

Injection of corticosteroid drugs

Local single (less often double) administration of drugs such as diprospan, kenalog or hydrocortisone can very effectively relieve pain, but you need to understand that treatment with corticosteroids without changing the load and identifying the causes of pain is not the most optimal way. Moreover, treatment of lateral epicondylitis should begin with changing loads, exercises, orthoses, taping, and only if the effect is insufficient, proceed to the injection of corticosteroid drugs. No amateur performances!!! Injections should only be given by a doctor!!! I will not describe possible complications if administered incorrectly!

Extracorporeal shock wave therapy

The essence of this method is that sound vibrations cause microtrauma, which, in turn, stimulates the healing process. In some ways, the principle of action is similar to the homeopathic approach - like is treated with like. Unfortunately, at present this technique still has an experimental status and most of the studies are of an advertising nature or are generally carried out with serious flaws. On the other hand, there are a number of serious scientific studies in which shock wave therapy has shown to be effective. In any case, it cannot currently be considered as a first-line treatment option.

PRP plasma injection

The essence of the method is the introduction of specially treated activated patient’s own blood plasma into the site of inflammation. The method is widely used in sports medicine all over the world, and has now become available in Russia.

Surgery

In cases where conservative treatment does not have an acceptable effect within 6-12 months, surgical treatment is used.

Almost all surgical methods boil down to separating the muscles from the area of attachment to the condyle of the humerus, removing chronically inflamed and altered tissue, and reattaching the muscles to the bone.

The operation can be performed either in the traditional open way (through an incision 4-6 cm long) or arthroscopically (through two punctures 1 cm long). In any case, the operation is inevitably accompanied by risks of complications, which, although rare, can arise despite all the skill of the surgeon:

Infectious complications (need for repeated operations)
Damage to blood vessels and nerves
Slow growth of muscles to bone, resulting in a long rehabilitation period
Decreased forearm strength
Decreased flexibility of movements

After surgery, the arm is immobilized (immobilized) with an orthosis for 1-2 weeks, which reduces muscle tension. After this, they begin physical exercises, which are selected individually by the doctor. Stretching exercises begin no earlier than 2 months after surgery. Return to sports activities usually occurs 4-6 months after surgery. Fortunately, in most cases, the strength of the forearm muscles is completely restored after such operations.

In fact, there are many causes of pain in the elbow joint, and a specialist doctor can figure out the cause. Therefore, if the pain is severe, increases, and is accompanied by numbness of the hand - no self-medication!!! Let's go to the clinic!!!

Dima Doc (student of Applied Karate group of Yu.M. Fedorishen)

Traumatologist-orthopedist. Practicing since 2002. Specializes in joint injuries.

Epicondylitis of the elbow is a degenerative process also known as tennis elbow. Don't let the name fool you. Research has found that carpenters, for example, are more susceptible to this disease than tennis players. The reason for the unusual name is the following - the first major description of the disease was compiled using the example of tennis players.

There are a lot of civilian professions that have nothing to do with professional sports, but have one thing in common - stereotypical monotonous movements - the aforementioned carpenter, a gardener who works with a hoe, a computer operator who spends the whole day typing. Although this pathology is considered safe, take care of your joints in advance; it is better to prevent the disease than to treat it later.

What is epicondylitis?

Epicondylitis (tennis elbow, tennis elbow) is a disease based on degenerative damage to the muscles where they attach to the bone. Epicondylitis is a chronic disease that, if not treated correctly, can progress and increasingly cause painful symptoms of exacerbation.

In the area of the elbow joint, there are bumps on the humerus called epicondyles or epicondyles. They do not participate in the work of the joint, but serve to attach muscles and tendons. Under certain circumstances, inflammation of the tendons in the area of the epicondyles develops. This disease is called “epicondylitis of the elbow joint,” although the joint itself is usually not affected by inflammation.

The pathological process involves muscles and tendons in the place where they are attached to the bone. This disease is quite common, especially affecting people over 35 years of age. But many patients do not go to the doctor, since the inflammation is mild and usually goes away quickly. According to statistics, both men and women are equally susceptible to such inflammation. Moreover, epicondylitis of the right elbow most often occurs, since there are more right-handers than left-handers, and the disease develops from increased stress.

Essentially, ulnar epicondylitis is a microtrauma. A small rupture of the tendon in the elbow area occurs, which subsequently becomes inflamed. Most often this happens due to an unsuccessful or sudden movement of the hand, as well as due to the constant load on this muscle group. The patient may not even notice the injury itself, sometimes at this moment there is not even pain. But over time, swelling increases and the area becomes inflamed. This is how epicondylitis develops.

But not all doctors admit that the disease appears due to injury to muscles and tendons. Many believe that such inflammation may be due to osteochondrosis. But in any case, this disease never develops on its own, inflammation is always secondary, so for effective treatment it is important to understand what caused it. After eliminating the provoking factors, the disease goes away faster.

Causes of epicondylitis of the elbow joint

Most often, inflammation develops due to increased stress, for example, with constant flexion and extension of the elbow or hand. Therefore, there is a certain risk group, people from which most often suffer from this disease. These are athletes who lift weights or barbells, engage in tennis, rowing, and wrestling.

Painters, masons, milkmaids, massage therapists, violinists, hairdressers, and typists are also susceptible to this disease. Often inflammation develops due to constant carrying of heavy objects, such as bags. Therefore, pathology can occur among housewives. There are also other causes of elbow epicondylitis:

Soft tissue bruises or injuries to the elbow joint;
Congenital weakness of the ligamentous apparatus;
Poor blood circulation or metabolic processes;
Osteochondrosis of the spine, osteoporosis or glenohumeral periarthritis.

Sport. As we have already noted, the most common cause of lateral epicondylitis is overstrain of the muscles attached to the lateral epicondyle (the short extensor carpi radialis, the extensor digitorum, the extensor of the little finger and the extensor carpi ulnaris are attached by a common tendon to the lower part of the epicondyle; just above and separately from them to the humerus the extensor carpi radialis longus is attached).

Scientific studies have proven that among all these muscles, a particularly important role is played by the short extensor carpi radialis, which stabilizes the entire hand in an extended position with the elbow joint straightened. This stabilization is especially important when playing sports. When this muscle is overloaded, microtears occur in it in the area of attachment to the epicondyle of the humerus, microtears appear in it, which, in turn, leads to inflammation and pain.

In any case, a coach should play an important role in the prevention of lateral epicondylitis in athletes, since incorrect striking technique significantly increases the risk of this disease. In addition, the short extensor carpi radialis is located in such a way that when flexing and extending the elbow joint, the upper part of the muscle can be injured , which will also lead to inflammation and pain.

Professional activity. It is a mistake to think that lateral epicondylitis can only affect tennis players or athletes in general. Monotonous movements, especially when you have to hold the lesson on weight for a long time, can also lead to damage to the muscles attached to the lateral epicondyle. Painters, painters, gardeners, carpenters... the list goes on.

Scientists even studied the frequency of this disease, and it turned out that it was statistically significantly more common among car mechanics, cooks and butchers compared to people in other professions. In all these cases, the professions have one thing in common - the need to repeatedly lift something with a straightened hand.

Age. Another cause of inflammation in the area of muscle attachment is age-related changes in muscles and tendons. Sometimes the disease can develop without any apparent reason, in which case they speak of “sudden” lateral epicondylitis.

Symptoms of epicondylitis

As a rule, the disease develops gradually. At first the pain is slight and intermittent, but over several weeks or months it gradually progresses and may become constant. Often the onset of pain is not preceded by any injury. The most common symptoms of lateral epicondylitis are:

Pain or burning sensation on the outside of the elbow;
Decreased strength of the forearm muscles that extend the hand and fingers.

These symptoms are aggravated by stress on the muscles that attach to the lateral epicondyle of the humerus (holding a racket, tightening screws with a screwdriver, etc.). Most often, pain occurs on the leading side (right in right-handed people and left in left-handed people), but the disease can occur on both sides.

Overstrain of the muscles and tendons in the elbow area is the main cause of the development of epicondylitis. Repetitive forceful movements of the elbow joint can cause hyperextension of the elbow tendons. It doesn't have to be extreme loads in professional tennis. Hammering nails, carrying buckets of water in the garden, trimming bushes - all this can lead to the development of tennis elbow.

When tissue is damaged, inflammation develops, which is a protective reaction of the body. Leukocytes migrate to the site of inflammation, clearing it of damaged tissue and promoting healing. In medical terminology, diseases accompanied by inflammation have the ending -itis. For example, inflammation of the tendons is called tendonitis. Accordingly, inflammation of the tissue near the lateral epicondyle is called lateral epicondylitis.

It should be noted that tennis elbow is not always accompanied by tissue inflammation. In the absence of inflammatory changes in the tendons, the disease is called tendinosis. With tendinosis, stretching and microtears lead to degenerative changes in the tendon.

In such a tendon, the arrangement of collagen fibers is disrupted. The tendon cells begin to be replaced by fibroblasts - cells that produce a slightly different type of collagen, not as strong and without an orderly arrangement of fibers. The tendon gradually degenerates: it becomes thicker due to the growth of defective connective tissue. Naturally, such a tendon can be damaged even with minor injuries.

The exact mechanism of development of epicondylitis is still unknown. One common hypothesis is that the tendon that attaches to the lateral epicondyle develops microtears due to overload. Restoring the integrity of the tendon is hampered by continued stress, which can also lead to the formation of new damage. The growth of connective tissue at the site of injury leads to weakening of the tendon and pain.

Few people know what epicondylitis is, although many people experience this pathology. But some people relieve elbow pain on their own without seeing a doctor. This attitude can lead to complications and loss of arm mobility. Therefore, it is important to know the main symptoms so that treatment for epicondylitis of the elbow joint is started on time.

The main symptom of the disease is pain. It is usually aching and localized in the elbow area, but can radiate to the shoulder or forearm. The pain becomes sharp, even burning, when performing active movements of the arm. A particularly strong reaction occurs when bending and straightening the elbow, wrist, or clenching the hand into a fist. At first, pain occurs only when moving, but as inflammation develops, it becomes constant.

Swelling and redness in the elbow area usually appears if epicondylitis is complicated by arthritis. When inflammation develops, joint mobility is severely limited. Over time, muscle weakness and rapid arm fatigue develop. With external epicondylitis, the patient cannot even lift a cup of tea from the table. This form of the disease can also be identified by pain during a handshake. And medial epicondylitis is characterized by weakness and pain when flexing the forearm or moving the hand.

Types of epicondylitis

This disease comes in two types: medial and lateral epicondylitis. This classification takes into account the place of attachment of the affected muscles and tendons. Lateral epicondylitis of the elbow joint occurs most often in athletes. Therefore, this pathology is also called “tennis elbow.” After all, inflammation develops from the outside, at the site of muscle attachment to the epicondyle of the humerus.

The disease can appear from any monotonous hand work, for example, sawing wood, painting a wall, or from sudden heavy lifting. External epicondylitis occurs approximately 10-15 times more often than its second type. Medial, or internal, epicondylitis develops less frequently and is easier. In this case, the tendons on the inside of the elbow joint become inflamed at the point of attachment to the bone of the forearm. Most often it is caused by monotonous movements of the brush. Therefore, recently people who work at the computer for a long time have begun to suffer from such a pathology.

Medial epicondylitis very often becomes chronic, since the pain is not so intense, and not every patient decides to see a doctor about this. Sometimes there is also post-traumatic epicondylitis, which develops due to non-compliance with doctor’s recommendations during the rehabilitation period after injury. And the chronic form of the disease is very common, since it can be completely cured only if you consult a doctor on time and follow all his recommendations.

Diagnostics

To recover faster, you need to know which doctor treats epicondylitis. Patients usually turn to a traumatologist or surgeon for elbow pain. A specialist can make a diagnosis only based on a conversation and external examination.

Diagnosis of the disease is simplified due to its specificity. After all, pain occurs only with active movements of the hand. And with passive movements, when the doctor bends the patient’s arm, there is no pain. In this respect, epicondylitis differs from arthritis, arthrosis and various injuries. A characteristic sign of the disease is also that the soft tissues in the elbow area are very painful on palpation.

When making a diagnosis, the doctor may ask the patient to perform several tests. The Thompson test goes like this: you need to put your hand on the table, palm up, and try to make a fist. In a patient with epicondylitis, the palm quickly turns around. For the Welt test, you need to raise your arms to chin level and bend and unbend them at the elbow. In this case, the affected arm will noticeably lag behind the healthy one. The disease can also be determined by the following sign: if the patient tries to hold his hand from behind, placing it on the lower back, the pain will intensify.

Additional diagnostic methods are usually not used. Only if the doctor suspects another disease can he refer the patient for examination. An X-ray is done if there is a suspicion of a fracture or osteoporosis, an MRI is done in order to exclude carpal tunnel syndrome. If acute arthritis or bursitis is suspected, a biochemical blood test may be performed.

Tell your doctor about how the disease developed, how you think it started, and how quickly the pain or other symptoms progressed. Pay special attention to the specifics of your physical activity - what kind of work you do, what sport you do and how often you do it.

To diagnose lateral epicondylitis, your doctor will ask you to perform special hand movements (diagnostic tests). Typically, these special tests allow you to establish the diagnosis without any doubt, but in some cases, ultrasound, x-ray or even magnetic resonance imaging may be necessary.

Treatment of epicondylitis

Treatment of epicondylitis is complex, based on the duration of the disease, the level of dysfunction of the joint, as well as changes in the tendons and muscles in the area of the hand and forearm. The main objectives of treatment of epicondylitis of the elbow joint can be formulated in a certain way:

Eliminate pain at the site of the lesion;
Restore or improve regional blood circulation;
Restore full range of motion in the elbow joint;
Prevent forearm muscle atrophy.

The solution to the first problem in the treatment of epicondylitis is carried out through the use of traditional and surgical methods. Treatment of lateral epicondylitis in the acute stage involves immobilization of the upper limb for a period of 7-8 days with the forearm bent at the joint (80 degrees), and the wrist joint with slight dorsal extension. In case of a chronic course, doctors recommend bandaging the forearms and elbow joint with an elastic bandage, but removing it at night.

Injection of corticosteroid drugs. Local single (less often double) administration of drugs such as diprospan, kenalog or hydrocortisone can very effectively relieve pain, but you need to understand that treatment with corticosteroids without modifying the load and identifying the causes of pain is not the most optimal way.

Moreover, in our opinion, treatment of lateral epicondylitis should begin with modifications of loads, exercises, orthoses, taping, and only if the effect is insufficient, proceed to the injection of corticosteroid drugs.

Extracorporeal shock wave therapy. The essence of this method is that sound vibrations cause microtrauma, which, in turn, stimulates the healing process. In some ways, the principle of action is similar to the homeopathic approach - like is treated with like.

Unfortunately, at present this technique still has an experimental status and most of the studies are of an advertising nature or are generally carried out with serious flaws. On the other hand, there are a number of serious scientific studies in which shock wave therapy has shown to be effective. In any case, it cannot currently be considered as a first-line treatment option.

Ultrasound has a good analgesic effect in the treatment of epicondylitis of the elbow joint, but it is even better to use phonophoresis (so-called ultrasound with hydrocortisone). Bernard currents, ozokerite and paraffin applications are also widely used. In order to anesthetize the area and improve local trophism, blockades are carried out at the attachment point of the extensors of the fingers and hand with novocaine or lidocaine, which are often combined with hydrocortisone.

During the entire period of treatment for epicondylitis of the elbow joint, 4-6 blockades are performed (an interval of a couple of days). When the plaster splint is removed, warm compresses with Vaseline, camphor alcohol, or regular vodka compresses are used. To improve regional blood circulation in the affected area, UHF therapy, electrophoresis with acetylcholine, novocaine or potassium iodide are used. In addition, medications such as nicoshpan and aspirin are prescribed to treat medial epicondylitis of the elbow joint.

To change the trophism of tissue at the site of tendon attachment, blockades are used with double-distilled water. Although such blockades have a good effect, it should be said that the process of administering the drug itself is quite painful. In case of chronic disease, injections of vitamins such as B1, B2, B12 are prescribed.

To prevent and treat muscle atrophy and restore joint function, massage of the muscles of the forearm and shoulder, mud therapy, exercise therapy and dry air baths are used. In addition, special exercises help with epicondylitis of the elbow joint.

In the case of a chronic course of this disease with frequent exacerbations and unsuccessful treatment, patients must change the nature of their work. In the vast majority of cases, conservative (non-surgical) treatment is possible. It is effective in 80-95% of cases.

Surgical intervention

In cases where there is no acceptable effect from conservative treatment within 6-12 months, the solution is seen in surgical treatment. Almost all surgical methods for treating tennis elbow involve separating the muscles from the area of attachment to the condyle of the humerus, removing chronically inflamed and altered tissue, and reattaching the muscles to the bone.

Surgical methods for the treatment of medial epicondylitis of the elbow joint are used when conservative treatment has been unsuccessful for 3-4 months. The so-called Hohmann operation is widely used. In 1926, he proposed excising some of the tendon from the extensor muscles of the fingers and hand.

Today, such excision is performed not at the point of transition into the muscle, as was proposed in the original version, but near the zone of attachment of the tendon to the bone itself. After such an operation, some time is required for recovery, appropriate procedures and special exercises for epicondylitis of the elbow joint.

The operation can be performed either in the traditional open way (through an incision 4-6 cm long) or arthroscopically (through two punctures 1 cm long). It is difficult to compare these techniques with each other, but it is worth noting that open surgery probably allows you to more closely see all the changes in the area of muscle attachment to the bone. In any case, the operation is inevitably accompanied by risks of complications, which, although rare, can arise despite all the skill of the surgeon:

Infectious complications (need for repeated operations)
Damage to blood vessels and nerves
Slow growth of muscles to bone, resulting in a long rehabilitation period
Decreased forearm strength
Decreased flexibility of movements

Despite the fact that the disease is not considered severe and does not lead to loss of performance, people at risk need to know how to treat epicondylitis of the elbow joint. Otherwise, inattention to such a pathology can lead to the development of a chronic form of the disease, which will then be much more difficult to get rid of.

The goal of treatment should be more than just pain relief. It is necessary to use methods that would improve metabolic processes and blood circulation in tissues and help relieve inflammation. But the main thing is to restore joint mobility. To do this, you need to prevent muscle atrophy and restore their function.

Treatment of lateral epicondylitis of the elbow joint, like medial epicondylitis, should be comprehensive. An individual hike is also very important. Therefore, the doctor usually conducts a full examination to determine the presence of concomitant pathologies or chronic diseases. Most often, conservative therapy is sufficient. But in advanced cases, excision of the affected tissue may be recommended. Recently, the operation has been performed in a low-traumatic way - using laser ablation. To treat epicondylitis of the elbow joint, it is necessary to use several methods at once:

NSAIDs internally and externally;
For severe pain - novocaine blockade;
Special exercises;
Immobilization;
Physiotherapy;
Massage;
Traditional methods.

Immobilization of the elbow joint

Treatment usually begins with limiting the load on the joint. The patient is advised to rest; sometimes it is necessary to change his occupation. In the acute period of the disease, it is recommended to use a special orthosis on the elbow joint, which will help immobilize it.

Lack of stress promotes faster healing and prevents pain. In particularly severe cases, a plaster cast or splint may be required. The elbow is fixed in a bent position; sometimes it is also necessary to fix the wrist joint. Such immobilization is carried out for up to 7 days.

Sometimes it is recommended to constantly wear a bandage for epicondylitis of the elbow joint if its course has become chronic. Instead of a special device, you can use an elastic bandage before expected physical activity. This will help avoid overstrain and muscle strain.

Drug therapy

Most often, the patient is bothered by pain. You can cope with them with the help of painkillers. Your doctor should recommend how to treat epicondylitis. NSAIDs are mainly prescribed, as they help relieve not only pain, but also inflammation. This could be Ibuprofen, Ketorolac, Naproxen, Nimesil, Nise and others.

If such treatment is ineffective or if the pain is severe, the doctor may prescribe injections. These can be the same non-steroidal anti-inflammatory drugs intramuscularly, as they act more effectively. Or a novocaine blockade of the elbow joint is performed, usually 4 times with an interval of a couple of days. To enhance the effect, Novocaine is mixed with Hydrocortisone or Methylprednisolone.

External agents are often used in the form of ointments or solutions for compresses. The best drugs are based on non-steroidal anti-inflammatory drugs - Voltaren, Ketoprofen, Indomethacin, Diklak and others. They need to be rubbed into the affected area with gentle movements so as not to increase pain. Compresses with Dimexide are also effective.

Additionally, other medications may be used. To improve blood circulation, Aspirin or Nikoshpan are prescribed. In the chronic form of the disease, B vitamins or the drug “Milgamma” are indicated.

Physiotherapy

After the pain subsides, physical therapy is required. Exercises should be aimed first at stretching and relaxing the muscles of the forearm and shoulder, and then at strengthening them. You can exercise on your own, but it is better to use a complex selected by a doctor. It is very important to follow some rules: gradually increase the load, avoid pain, but the main thing is to do the exercises daily. At the initial stage of training, the basis of the complex should be passive movements:

With your healthy hand, hold the affected arm by the wrist and bend it slowly to an angle of 90 degrees;
Stand in front of the table and place your palms on it, lean forward so that your hands make a right angle with your forearm;
Sit down, place your hands with your fingers on the back of you, leaning back a little so that your hands make an angle of 90 degrees with your forearm.

When such passive movements are easy, it means the muscles have stretched. After this, you can perform exercises to strengthen them. This can be bending and straightening your arms at the elbows, clenching a fist, rotating your shoulders, circular movements with your arms, or scissors. It is useful to use various Bubnovsky simulators or simpler ones - a rubber cord, a gymnastic stick, an expander.

Massage and physiotherapy

Massage for the treatment of epicondylitis is also used after the completion of the acute stage. This method improves blood circulation and metabolic processes well. It helps relieve pain and get rid of inflammation faster. Massage also helps restore hand mobility, as it strengthens damaged muscles and prevents their atrophy.

Treatment of epicondylitis of the elbow joint using manual therapy is also effective. A correctly performed procedure will help restore joint mobility and muscle function. A type of manual therapy is post-isometric relaxation - a more modern and effective method of treatment.

This treatment for epicondylitis of the elbow joint is used at any stage. In the acute period, pulsed magnetic therapy, laser radiation, ultrasound, and diadynamic therapy help well. After the pain subsides, ultraphonophoresis, paraffin or ozokerite applications, cryotherapy, Bernard currents or shock wave therapy are used to restore tissue.

This treatment improves metabolic processes and blood circulation in tissues, relieves pain and reduces inflammation. To improve blood circulation and trophism of soft tissues, UHF therapy is useful, as well as electrophoresis with potassium iodide or Acetylcholine.

Acupuncture, mud therapy, hirudotherapy, and regular and dry air baths are also effective. Typically, a full range of such procedures can be obtained during sanatorium-resort treatment.

Traditional methods and self-treatment of epicondylitis

Very often, epicondylitis at the very beginning of its development is not very painful. That is why the attitude towards it is appropriate; patients do not rush to the doctor, trying to cure the diseased joint on their own. Of course, self-medication can have dangerous consequences, but if you decide to do it, you should keep in mind a few basic principles:

If pain appears, completely eliminate the movements/exercises that provoked the pain for several days. If you play tennis, pay attention to the size of the racket itself and the tension of the strings - when you resume training, you may need to change the racket. To relieve pain, it is recommended to take anti-inflammatory drugs (for example, ibuprofen every 4-6 hours) until the pain stops completely.
If pain reappears, apply cold (cryotherapy) to the outside of the elbow joint for 15-20 minutes several times a day. Cryotherapy is continued for 3-4 days.
After a significant reduction in pain, local cold is changed to local heat (several times a day), which finally removes the pain.
After pain disappears permanently, stretching exercises begin. Using the other hand, slowly bend the wrist of the affected arm until a feeling of tension and slight pain appears in the elbow area, stay in this position for 10-15 seconds, slowly shaking the hand. Repeat three sets 10 times a day.
Once the stretching exercises are completely pain-free, begin strengthening and stretching exercises. Take a hammer or other heavy object in the hand (the back of the hand is facing upward, the elbow is bent about 100-120 degrees). The hand and forearm are supinated and returned to their original position. 10 approaches, rest 2-3 minutes, 2 more times 10 approaches (2-3 times a week).
Repeat a similar exercise, but the hand is turned with the back surface down (picture). 10 approaches, rest 2-3 minutes, 2 more times 10 approaches (2-3 times a week).

Treatment of epicondylitis of the elbow joint at home is possible using traditional methods. You should not limit yourself to them; complex treatment is more effective. In addition, only a specialist can make a diagnosis; perhaps the pain in the elbow has completely different causes. Therefore, before using any traditional methods, you should consult a doctor. The following recipes are considered the most effective and common:

Use an ointment prepared from comfrey root and nutria fat;
Blue clay compresses;
Rubbing or applying a tincture of horse sorrel roots in vodka;
Bay oil in the form of compresses is also good for relieving pain;
Warming compresses with vodka or camphor alcohol are effective;
Iodine mesh on the joint area.

Prevention

Since this disease is quite common, it is very important to know how to prevent it. Athletes especially need this. When playing sports, you must follow the rules of performing exercises and safety precautions when working with equipment. Be sure to warm up before classes. If you are predisposed to the disease, you need to use taping, which will help reduce the load.

People who perform monotonous work with their hands need to take periodic breaks and try to avoid overload. Change monotonous work for a few minutes and you will immediately feel relief

With chronic epicondylitis, do not forget about daily exercises and the importance of self-massage. This pathology seems not serious, but still you should not self-medicate. To prevent the disease from becoming chronic and leading to complications, you must consult a doctor in time and follow all his recommendations.

Source: “travmaorto.ru,moyaspina.ru,orthoped.i.ua”

megan92 2 weeks ago

Tell me, how does anyone deal with joint pain? My knees hurt terribly ((I take painkillers, but I understand that I’m fighting the effect, not the cause... They don’t help at all!

Daria 2 weeks ago

I struggled with my painful joints for several years until I read this article by some Chinese doctor. And I forgot about “incurable” joints a long time ago. That's how things are

megan92 13 days ago

Daria 12 days ago

megan92, that’s what I wrote in my first comment) Well, I’ll duplicate it, it’s not difficult for me, catch it - link to professor's article.

Sonya 10 days ago

Isn't this a scam? Why do they sell on the Internet?

Yulek26 10 days ago

Sonya, what country do you live in?.. They sell it on the Internet because stores and pharmacies charge a brutal markup. In addition, payment is only after receipt, that is, they first looked, checked and only then paid. And now everything is sold on the Internet - from clothes to TVs, furniture and cars

Editor's response 10 days ago

Sonya, hello. This drug for the treatment of joints is indeed not sold through the pharmacy chain in order to avoid inflated prices. Currently you can only order from Official website. Be healthy!

Sonya 10 days ago

I apologize, I didn’t notice the information about cash on delivery at first. Then, it's OK! Everything is fine - for sure, if payment is made upon receipt. Thanks a lot!!))

Margo 8 days ago

Has anyone tried traditional methods of treating joints? Grandma doesn’t trust pills, the poor thing has been suffering from pain for many years...

Andrey A week ago

No matter what folk remedies I tried, nothing helped, it only got worse...

Ekaterina A week ago

I tried drinking a decoction of bay leaves, it didn’t do any good, I just ruined my stomach!! I no longer believe in these folk methods - complete nonsense!!

Lateral and medial epicondylitis of the elbow joint or brachial epiindicolitis is a pathology that is inflammatory in nature.

The disease affects the elbow joint where the muscles attach to the forearm bone. The humerus in the elbow area has special bone formations (epicondyles or epicondyles). They are the place where the tendons of the flexor and extensor muscles, as well as the articular ligaments of the wrist and fingers, are attached.

Reasons for the development of pathology

Epicondylitis of the shoulder is a secondary disease and therefore does not develop suddenly, but gradually. The exact causes of the pathology are not known; experts only identify the main risk groups.

These are construction workers whose activities involve monotonous manual work (painters, plasterers), and athletes (weight lifters, boxers, weightlifters).

However, these types of activities by themselves do not lead to the development of epicondylitis. The disease occurs as a result of constant monotonous flexion and extension of the elbow joint when placing a load on the arm.

There are two epicondyli on the humerus, medial (internal) and lateral (external). Therefore, there is lateral and medial epicondylitis.

The tendons of the muscles that are responsible for inward rotation (pronation) of the hand and forearm, flexion of the fingers and hand at the wrist joint are attached to the medial epicondyle. Extensor muscles are attached to the lateral one, which allow you to rotate the hand and forearm outward.

The development process and causes of brachial epicondylitis are not fully understood. Some experts believe that its causes are damage to the tendons as a result of their friction against the bone. Others believe that the disease is preceded by an inflammatory process in the periosteum of the epicondylus.

There is also a theory that epicondylitis of the shoulder and elbow joint develops due to osteochondrosis. This theory is confirmed by the fact that when treating osteochondrosis, pain in the elbow decreases.

Most often, lateral epicondylitis of the dominant hand develops. In this case, aching pain occurs when attempting active physical movements, flexing or straightening the elbow and hand. Passive movements do not cause discomfort. Pain occurs when palpating the extensor muscles and radiates to the outer part of the shoulder.

Medial epicondylitis is not diagnosed so often and is a consequence of repeated monotonous flexion movements. The pain is sharp and radiates to the inner surface of the forearm. Occurs when the forearm rotates and during flexion movements.

Symptoms

Epicondylitis of the shoulder can be acute, subacute and chronic. Initially, the pain is accompanied by a sharp overstrain of the muscles, then it becomes constant and at the same time the arm muscles quickly get tired.

In the subacute stage of epicondylitis of the shoulder joint, the intensity of pain decreases, and it goes away with rest. The chronic course is characterized by alternating relapses and remissions, which last from 3 months to six months.

The most obvious sign is an aching pain in the wrist and elbow joint, difficulty in active movements. Symptoms of pain become stronger with the most common movements, for example, when shaking hands, trying to clench the hand into a fist, or straightening the arm.

In the initial stages, pain disappears at rest. And then they become permanent.

Types of epicondylitis

Lateral

Inflammation develops at the site of bone attachment to the lateral epicondyle. Lateral epicondylitis of the elbow joint is called “external” or “tennis elbow”, as it is typical for players involved in this sport.

But this does not mean that the disease only affects tennis players. A factor in the development of the disease is excessive tension in the muscles of the elbow joint at the point of their attachment to the epicondyle of the shoulder bone.

This disease often occurs in tennis players, but in ordinary people it can also occur when performing monotonous strenuous work, for example, when chopping wood.

Interior

Internal epicondylitis is called golfer's elbow or medial. The disease occurs as a result of injuries, unsuccessful movements with sharp straightening of the arm and the use of a number of hand tools.

Diagnostics

Before treating epicondylitis of the elbow joint, the doctor asks the patient about complaints, studies the symptoms, and examines the diseased joint. Sometimes x-rays are ordered to rule out old injury. A number of tests are being carried out.

Coffee cup test

The patient is asked to lift a cup of liquid from the table. When he tries to do this, the painful symptoms intensify several times. This indicates lateral epicondylitis.

Thomson test

The sick person is asked to clench his hand into a fist, palm down. Then quickly turn it around with your palm facing up.

Welt test

It is necessary to raise your forearms to the level of your chin and begin to bend and straighten both arms at once.
When carrying out the Welt and Thomson tests, the actions performed by the healthy and diseased hand differ significantly in speed. In addition, severe pain symptoms are observed in the affected limb.

Therapy

It is necessary to treat lateral and medial epicondylitis together.

It all depends on the stage of development of the disease, the cause of its occurrence, changes in the tendons and muscles in the area of the hand and elbow, and the level of dysfunction of the joint.

The treatment helps relieve pain symptoms, relieve muscle strain, and eliminate inflammation. Drug therapy and folk remedies are used. In order to unload the muscles, use:

Gentle treatment and bandage

Treatment involves temporary cessation of professional activities that led to the development of epicondylitis. A special bandage is also used to immobilize the joint.

It allows you to immobilize the sore limb and relieve severe pain. Professional athletes regularly wear a brace to prevent overload of the joint.

A bandage is a special device that is attached to the upper part of the forearm. It prevents inflamed muscles from contracting and thereby relieves stress on them. The orthopedic bandage is worn only while awake; it is removed while sleeping.

The principle of its use is simple. The bandage firmly fixes the elbow joint, preventing excessive range of motion. Its choice must be approached thoroughly; it is better that the bandage is selected by an orthopedist, taking into account the anatomical features of the joint.

Gymnastics

It helps restore motor functions of the elbow joint. Gymnastics involves performing simple movements that stimulate muscle function. Exercises are performed aimed at stretching the tendons with maximum abduction of the hand.

Wrist trainers are used to help perform three-dimensional exercises. Exercises begin with exercise machines of maximum rigidity. Exercises are selected in such a way that the muscles are not overstrained.

Eliminating pain

To relieve pain, tablets are prescribed: analgin, ketanov, renalgin. Local treatment is also carried out, using injections of glucocorticoids, such as Diprospan, Betamethasone.

Anti-inflammatory drugs are prescribed in the form of tablets or ointments, which contain Indomethacin, Diclofenac, Ibuprofen. Apply compresses with Dimexide.

For pain relief and improvement of local tissue trophism, blockades are made at the attachment point of the hand and fingers with lidocaine or novocaine in combination with hydrocortisone.

4 blockades with an interval of two days will be enough. Injections of B vitamins are prescribed.

Physiotherapy

Physiotherapeutic treatment is carried out:

magnetic therapy;
phonophoresis;
cryotherapy;
mud therapy;
paraffin therapy;
Bernard currents;
electrophoresis with anti-inflammatory drugs (with acetylcholine, potassium iodide, novocaine);
shock wave therapy.

These procedures improve metabolic processes in tendon and muscle tissue, restore blood microcirculation in muscle tissue, and eliminate pain and inflammation.

The painful area is cooled. Use cold accumulators or irrigation with chlorethyl. You can use ice cubes wrapped in a towel. The procedure is carried out once a day.

Perform a massage every day for 15 minutes. Knead the points where muscle tightness is located. The course is 12 days. Massage should not cause discomfort to the patient.

If all of the above procedures do not bring positive dynamics and the expected result, the disease progresses, then surgical treatment is used.

Operational Impact

It includes the following techniques:

tendoperiostomy;
dissection of the extensor carpi brevis tendon;
arthroscopy;
lengthening of the extensor carpi brevis tendon.

Prevention

To prevent epicondylitis of the shoulder and elbow joint from becoming chronic, a number of rules should be followed:

Before physical activity, you should warm up your muscles;
correctly distribute physical activity without overstraining the muscles;
before heavy physical activity, fix the elbow joints by putting on a bandage;
When carrying out monotonous monotonous movements, it is necessary to constantly take breaks.

Treatment with folk remedies

Comfrey ointment

To prepare, you will need to take the leaves and roots of the plant (1:1). Heat vegetable oil and honey, combine them in a deep container. The volume of this mixture should be equal to the volume of plant material taken.

The comfrey is gradually added to the bowl with the honey and oil, stirring constantly. The result should be a homogeneous mixture in the form of an ointment. The fabric is impregnated with it and the affected joint is wrapped. Secure with an elastic bandage and insulate with a woolen scarf. The compress is kept on the joint for a day, then replaced with a new one.

Treatment with folk remedies such as a mixture of comfrey and lard will help restore damaged ligaments. A glass of lard is mixed with half a glass of comfrey root. Apply a compress to the affected joint for 2 hours until pain completely disappears.

Blue clay

It is used after acute inflammation has been relieved. Take clay and hot water in equal proportions, mix and place on gauze folded in half.

Apply to the sore joint and secure. Insulate and leave for half an hour. You can do three such compresses a day. Clay warms up the sore joint and relaxes tense muscles.

Treatment with sleeping green tea

After drinking the tea, it is necessary to collect what is left in the teapot and freeze it. Then wipe the sore joint with the resulting ice in a circular motion.

This method is good for treating external epicondylitis. You need to wipe the affected joint with herbal ice for about a minute, but you can repeat the procedure several times a day.

The above ointments and compresses are easy to make at home, but it is worth remembering that treatment with folk remedies may be unsafe, so you should consult a doctor.

There are certain similarities between shoulder (elbow) and knee epicondylitis. Epicondylitis of the knee joint is called “jumper’s or runner’s knee” and develops according to a similar principle.

That is, it is caused by damage to the joint capsules, ligaments, as well as lumbar osteochondrosis. Treatment for both diseases is also largely similar.

Epicondylitis is a chronic degenerative disease, so it is not completely curable.

However, if you use all of the above treatment methods, take care of the elbow joint, wear a bandage, do gymnastics, and use folk remedies, then you can achieve stable remission and forget about the feeling of discomfort without changing your usual life and professional activities.

The diagnosis of “epicondylitis of the elbow joint” is often made in adults whose professional activities involve physical activity on the upper extremities. The disease is accompanied by severe symptoms; in advanced cases, a person may completely lose the functionality of the hand. In the initial stages, epicondylitis can be treated conservatively, otherwise surgery cannot be avoided.

Causes

Epicondylitis of the elbow is a degenerative-inflammatory disease in which inflammation of the muscles of the right or left elbow joint occurs. The pathology affects the soft tissues attached to the tendons of the forearm and in the place where the epicondyle of the humerus protrudes. As the inflammatory complication progresses, it spreads to the bone tissue, periosteum, tendon apparatus, which is attached to the epicondyle, as well as the vagina. Inflammation affects not only the external or internal condyle; tissue degeneration of the styloid process of the radius occurs, as a result of which styloiditis begins to develop.

The disease affects the connective tissue of the joint.

The cause of ulnar epicondylitis may be:

physical activity that involves more use of the elbow;
chronic injury to the joint;
impaired blood supply to the limb;
osteochondrosis, osteoporosis, spondylosis and;
arthrosis and arthritis;
congenital weakness of the tendon-ligamentous apparatus.

Bilateral epicondylitis of the elbow joint is often diagnosed. As the disease progresses, a person begins to experience pain, the intensity of which increases.

Types of pathology

Considering the location of the degenerative-inflammatory disorder, they distinguish:

Lateral or external epicondylitis. In such a situation, inflammation develops at the external site of attachment of tendon fibers, in the area of the lateral epicondyle of the bone. The pathology is called differently because often people involved in this type of sport are diagnosed with this subtype of epicondylitis.
Medial or internal epicondylitis. In this case, inflammation affects the tendons that attach to the internal epicondyle of the bone. This diagnosis is most often found in people involved in golf and shot throwing.

Depending on the nature of the symptoms, lateral or medial epicondylitis can be:

spicy:
subacute;
chronic.

Characteristic symptoms of epicondylitis of the elbow joint

Pain syndromes intensify with prolonged loads on the joint.

Right-sided or left-sided epicondylitis is characterized by the following symptoms:

sudden, intense and acute pain localized in the elbow joint;
exacerbation of pain after physical activity or muscle tension in the forearm;
dystrophy of the muscle tissue of the limb, as a result of which the functionality of the elbow, wrist and hand is impaired.

If it develops, the outer surface of the elbow joint hurts, and the symptoms worsen after attempts to straighten the joint or rotate the hand. When the medial ligaments are affected, the pain is localized on the inner surface of the joint. Symptoms intensify if you try to bend the limb in the forearm area.

During the period of exacerbation of the pathology, a person is bothered by acute, constant pain, accompanied by prolonged tension in the muscle fibers. At the time of the subacute course, the symptoms become dull, and the pain disappears when the patient rests his hand. When the disease becomes chronic over the course of a year, periods of remission alternate with exacerbations.

Consequences

The disease develops against the background of inflammation of the joint.

If the treatment of epicondylitis of the elbow joint was timely and adequate, complications do not develop. Otherwise, there is a high risk of developing inflammatory bursitis, which will require surgery to eliminate. Therefore, in case of characteristic symptoms, the use of drugs at your own discretion is contraindicated. It is necessary to consult a doctor in a timely manner and treat the problem under his supervision.

Diagnostics

Before prescribing effective treatment, the doctor must establish an accurate diagnosis and conduct a differential diagnosis. For this purpose, instrumental research methods are used:

radiography;
MRI or CT;

In advanced stages of the disease, muscle tissue atrophy develops.

If epicondylitis of the elbow joint develops over a long period, muscle tissue atrophy occurs, and the patient develops the following symptoms:

Thompson's sign. If you ask the patient to hold the hand clenched in a fist in the position of dorsiflexion, it will be possible to hold the limb in this state for a short time, it will quickly lower and go into a state of palmar flexion.
Welt's sign. To perform this test, the patient will be asked to simultaneously extend and supinate the healthy and diseased forearm. On the affected side, these actions are performed with a lag, which confirms the diagnosis.

Differential diagnosis will help to exclude the development of osteochondrosis, spondylosis, and epicondyle fracture.

What treatment is prescribed?

Effective medicines

Topical applications will help eliminate the symptoms of the disease.

Conservative treatment is primarily aimed at relieving inflammation and eliminating pain. For these purposes, it is recommended to use ointments and gels belonging to the group of non-steroidal anti-inflammatory drugs. Well proven:

"Fastum gel";
"Ketonal";
"Nimesil".

Taking NSAID tablets is ineffective; injections are also prescribed during an exacerbation. If ointments do not help relieve inflammation and pain, a glucocorticosteroid blockade is prescribed. The injection is given directly into the elbow joint, where the inflammatory complication is localized. The drugs Diprospan and Hydrocortisone are used, mixed with anesthetics, for example, Lidocaine, Novocaine. This injection completely relieves pain within 2-3 days. If you use only ointments and gels of the NSAID group, the pain disappears within 2.5-3 weeks.

Additionally, you can supplement the therapy with painkillers such as Aspirin, Butadione. Dimexide, or more precisely, compresses based on it, is prescribed as a local anesthetic. It is recommended to apply a bandage to the affected area, covering the surrounding healthy tissue. In addition to the analgesic effect, the medicine helps remove inflammation.

Physiotherapy and massage

Under the influence of direct current, the healing agent acts at the cellular level.

With this disease, physiotherapy procedures are necessarily prescribed as auxiliary therapy, for example, the following:

electrophoresis;
magnetic therapy;
laser therapy;
phonophoresis;
shock wave therapy;
paraffin or ozokerite applications;
hirudotherapy, in which leeches are applied to the inflamed area.

At home, you can use the Retona-Forte physiotherapeutic device to treat epicondylitis. Using the device, you can undergo courses of ultrasound therapy, magnetic therapy, and heating with infrared rays. Along with physiotherapy, manual massage is prescribed, which is no less effective in treating epicondylitis of the elbow joint. With the help of massage manipulations, it will be possible to restore blood supply and nutrition to atrophied muscle tissue, due to which the functioning of the limb will be normalized and restored.

This disease is considered an occupational disease and is otherwise called “tennis elbow,” or it affects people who have a heavy load on their elbow. It is characterized by gradually increasing pain and burning in the elbow joint.

Lateral epicondylitis occurs equally often in both men and women, mainly after 30 years. It is possible that over the years, pain and discomfort may increase and it will be difficult to perform even ordinary household work.

In this article we will analyze in detail all the intricacies of the disease, causes, diagnosis, different methods of treatment, prevention, which doctor to see, in general, everything that will help you prevent or treat this disease.

Lateral epicondylitis is degenerative-inflammatory changes at the site of attachment of the tendons of the muscles of the inner and outer forearm to the humerus. Most often, the external epicondyle is affected (external epicondylitis), less often the flexor tendons of the hand are damaged (internal epicondylitis). The disease develops as a result of systematic overload of the indicated places of attachment of ligaments to bones (entheses) with the subsequent development of the inflammatory process.

In lateral epicondylitis, inflammation is always secondary and occurs as a protective reaction to tissue damage, in which leukocytes concentrate in a specific area and promote healing. However, the tissues may not become inflamed, in which case microtears will lead to degeneration of the ligaments, in which the arrangement of collagen fibers is disrupted.

The tendon cells are replaced by fibroblasts - structures that no longer produce such a strong type of collagen, without an orderly arrangement of fibers. There is a growth of defective connective tissue and thickening of the tendon.

The disease is called “epicondylitis”, since the Latin word epicondylus is translated as epicondyle, and the ending -itis indicates an inflammatory process. The term “lateral” refers to the area on the outer “bone” of the elbow called the “lateral epicondyle.”

Reasons for development

The lateral epicondyle is a small tubercle located slightly above the elbow joint on the outer surface of the humerus. This anatomical formation is the site of attachment of several muscles: the short extensor carpi radialis, the extensor carpi ulnaris, the extensor of the little finger and the extensor digitorum, which in the upper part are connected into one common tendon.

With repeated movements (usually lifting something with an outstretched hand), the tendon begins to suffer from constant overload. Micro-tears form in its tissue. Due to microtraumas, the tendon becomes inflamed and damaged cells are replaced by connective tissue. There is a gradual degeneration of the tendon - it increases in volume and, at the same time, becomes more vulnerable under load.

Lateral epicondylitis is often a consequence of improper hitting technique when playing tennis, which is why the disease is called “tennis elbow.” However, this disease affects not only athletes, but also people who have to hold an extended arm suspended for a long time or repeatedly lift something with a straightened hand.

Lateral epicondylitis can occur in painters, artists, carpenters, gardeners, butchers, cooks, car mechanics and in people who perform similar work at home (for example, in the country).
At the same time, at the moment of injury, a person feels instant pain, which quickly passes.

But the first signs of the disease appear after a few hours, or even days, as the swelling and inflammatory process grow. Single-use stress on the arms can also cause epicondylitis of the elbow joint. Very often, patients involved in arm wrestling or working with a wrench or screwdriver suffer from such injuries.

Chronic stress on the tendons is another factor that increases the risk of developing elbow joint inflammation. Epicondylitis appears due to inflammation of the tendons and in this case is a secondary disease.

The deterioration of blood circulation caused by pinching leads to dystrophic changes in the tendon and the development of an inflammatory reaction. As the disease progresses, the arm becomes weaker.

It is difficult for the patient to hold even a light object in his hand. Over time, the muscles can completely atrophy.
Among all the joint muscles attached to the lateral epicondyle, the extensor carpi radialis brevis is the most vulnerable.

It keeps the hand extended with the elbow straight. Fixing this position is of great importance for athletes who play tennis. The risk of developing the disease increases many times if the athlete does not master the technique of hitting the ball.

Since monotonous movements provoke the development of the pathological process, the lesion is found on the person’s hand that he uses more often. However, there are cases where patients were diagnosed with ulnar epicondylitis on both arms.

Experts name a number of other reasons that lead to this disease:

practicing active sports (especially if the wrong exercise technique is used);
work activity (for example, in agriculture, construction, tailoring, etc.);
physiological changes associated with aging of the body after thirty years of age.

Inflammatory processes in lateral epicondylitis are secondary, because they are a protective reaction to one of the above-mentioned causes.

The main signs characterizing epicondylitis are painful sensations in the forearm and upper arm. To verify this, you can take a cup or shake someone’s hand. That is, every minor movement is accompanied by severe pain.

At the first stage of the disease, unpleasant sensations occur: weak, unstable pain and a burning sensation in the elbow and the outer surface of the forearm and shoulder. Pain may appear when shaking hands or picking up a glass.

With progressive lateral epicondylitis, the pain becomes constant and radiates to the forearm, which is accompanied by difficulties in performing work or household duties. Any slight movement causes unbearable suffering.

But when extending the elbow, there is almost no pain, in contrast to cases associated with arm injuries, when the limb hurts continuously. The strength of the extensor muscles of the hand and fingers decreases. The range of motion is preserved, and upon examination, neither redness nor swelling in the elbow area is usually observed.

When palpating the outer surface of the elbow, especially at a point located slightly outward and anterior to the external epicondyle, pain is detected. No pathological changes on the x-ray.

However, in comparison with the injured limb, in this case there is no discomfort during extension of the elbow joint. Signs may persist for several months until the person begins treatment.

The greatest risk of developing lateral epicondylitis is observed in people over 40 years of age and in those who have a congenital pathology - weakened ligamentous apparatus.

A factor in the development of the disease can be not only the profession, but also the constant carrying of heavy objects and bags. Monotonous movements, for example, monotonous housework, also contribute to the appearance of the disease.

To prevent the occurrence of pathology, you do not need to overstrain the muscular system. Therefore, when returning home from the store, the burden must be divided into both hands. And you shouldn’t try to carry a large number of bags at one time, because it’s better to do it in two stages than to experience discomfort in your elbow afterwards.

Overstrain of the muscles and tendons in the elbow area is the main cause of the development of epicondylitis. Repetitive forceful movements of the elbow joint can cause hyperextension of the elbow tendons.

It doesn't have to be extreme loads in professional tennis. Hammering nails, carrying buckets of water in the garden, trimming bushes - all this can lead to the development of tennis elbow.

For example, inflammation of the tendons is called tendonitis. Accordingly, inflammation of the tissue near the lateral epicondyle is called lateral epicondylitis.

It should be noted that tennis elbow is not always accompanied by tissue inflammation. In the absence of inflammatory changes in the tendons, the disease is called tendinosis. With tendinosis, stretching and microtears lead to degenerative changes in the tendon.

The exact mechanism of development of epicondylitis is still unknown. One common hypothesis is that the tendon that attaches to the lateral epicondyle develops microtears due to overload.

Restoring the integrity of the tendon is hampered by continued stress, which can also lead to the formation of new damage. The growth of connective tissue at the site of injury leads to weakening of the tendon and pain.

When doing repairs or household chores, you should take breaks as often as possible. After all, muscles that are not accustomed to heavy loads need to be given rest. Therefore, you should not lift heavy objects or move large objects yourself.

Pain in the elbow joint due to epicondylitis

Pain in the elbow joint with epicondylitis is the only pronounced symptom of the disease. The pain syndrome has a number of features that help to separate it from similar joint diseases.

Pain sensations can be acute and subacute:

In acute epicondylitis, pain is localized in the area of the supracondylar bone of the shoulder and is constant and intense. In some cases, the pain radiates to the forearm and impairs the mobility of the elbow. It is very difficult to keep the limb in an extended position; discomfort occurs when trying to squeeze the hand.
The subacute form of inflammation is accompanied by a dull pain, which manifests itself with slight pressure on the external or internal epicondyle. Unpleasant sensations occur with light loads on the elbow.

At rest or during flexion-extension movements, pain in the elbow joint does not occur.

Inflammation of the elbow joint due to epicondylitis

Inflammation of the elbow joint with epicondylitis occurs at the site of attachment of the elbow muscles to the bone of the forearm. The severity of the inflammatory process depends entirely on the form of the disease, the cause and location of the pathology.

Despite the fact that epicondylitis is considered an occupational disease, patients with diseases of the musculoskeletal system are increasingly suffering from this disease.

Due to the scanty symptoms, the inflammatory process cannot always be detected on time. At first, inflammation of the tendons causes discomfort, but as the disease progresses, the pain becomes aching and sharp, and is localized. The inflammatory process intensifies with loads on the affected limb, with flexion and extension of the elbow.

The danger of the latent form is that epicondylitis can last for months, acquiring a chronic stage. In this case, the patient will undergo surgical treatment and a long period of rehabilitation.

When symptoms of this disease appear (most often these are severe pain in the elbow area), a person seeks help from qualified specialists - orthopedists.

On palpation in the area of the flexor-pronator tendons (5-10 mm and distal to the middle part of the medial epicondyle), induration and tenderness are noted. In addition, pain increases when the wrist resists forearm flexion and pronation at an angle of 90°. Flexion contractures can develop in professional athletes due to muscle hypertrophy.

It is necessary to differentiate the medial one with tunnel syndrome and ulnar nerve neuritis. There is a simple "milking" test (simulated milking) that causes increased pain in medial epicondylitis.

However, sometimes there is a need for instrumental diagnostics (visualization) for differential. diagnostics with other diseases. It has been noted that 5% of people with a primary diagnosis of lateral epicondylitis have radial tunnel syndrome.

The diagnostic process takes place in several stages:

Visual inspection of the hand and area of inflammation:

localization of pain syndrome;
range of motion such as “flexion-extension” of the elbow, hand, fingers.

Feeling the outer surface of the elbow for specific injuries.

X-ray of the elbow area (the procedure is necessary so that when diagnosing, the doctor can exclude diseases with similar symptoms - arthritis, neuropathy, osteochondropathy).

Ultrasound (determines the location of the inflamed area).

MRI (shows specific damaged areas of ligaments and muscle tissue).

Additionally, you may need to consult a neurologist. This specialist usually prescribes an EMG or ENG and x-ray of the cervical spine to identify possible pathological changes in the peripheral nervous system.

Conservative treatment

Treatment is usually conservative, carried out by an orthopedist or traumatologist. The goal of therapy is to eliminate inflammation, relieve pain and strengthen muscles. At the initial stage, NSAIDs and cryotherapy are used, and it is recommended to limit the load on the joint.

In some cases, orthoses are used. Subsequently, exercise therapy classes are prescribed, including first isometric, and then eccentric and concentric exercises. For persistent pain, blockades are performed by injecting glucocorticosteroid drugs into the inflamed area.

For lateral epicondylitis, four techniques are used: Heumann's laxative operation (incision of the tendons), excision of the changed tissues with subsequent fixation of the tendon to the bone, removal of the synovial bursa along with the annular ligament and lengthening of the tendon.

The operation is performed as planned in an orthopedic or traumatology department under conduction anesthesia or general anesthesia. After surgery, a cast is placed on the arm, and exercise therapy is prescribed in the postoperative period. Resistance exercises are allowed one month after surgery.

The outcome of conservative therapy and surgical treatment of lateral epicondylitis is usually favorable. More than 90% of patients are completely cured and return to their previous activities. With conservative therapy, symptoms usually disappear after 3-4 weeks, and the resumption of significant exercise is possible after a few months.

The recovery period after surgery also lasts several months. In some cases, after surgical treatment, muscle weakness occurs, and motor activity is slightly or moderately limited (for example, when lifting weights).

If the pain does not go away within 1-2 weeks, blockades using glucocorticosteroids may be prescribed. During the first day after their use, an increase in the intensity of painful sensations is often noted - this is a typical reaction of the affected tissues to the medicine.

The procedure for using glucocorticosteroid drugs is as follows: the drug is mixed with lidocaine or another painkiller and injected into the affected area - the one where the most severe pain is noted.

If epicondylitis is external, choosing a suitable site for administering the drug is easy. At the same time, the blockade can be done both in a sitting and in a lying position of the patient. If the disease has an internal form, to carry out the procedure the patient must lie on the couch on his stomach and stretch his arms along the body. In this position, the doctor gains access to the internal epicondyle.

Additionally, this position minimizes the risk of nerve damage, unlike when the injection is administered while the patient is sitting.

After overcoming the exacerbation, the patient is referred for electrophoresis. As a rule, it is carried out using iodine or novocaine preparations. Additionally, it is recommended to make warm compresses and undergo UHF.

In addition, upon completion of the acute phase of lateral epicondylitis, the specialist develops a set of rehabilitation exercises for the patient. The main one is hyperextension of the hand. According to the results of such study, tissue elasticity is normalized and the risk of microtrauma in the future is minimized.

Special massage procedures and mud therapy also help to speed up and facilitate recovery processes.

The duration of conservative treatment without the use of glucocorticosteroid drugs is about 2-3 weeks - it is after this time that most patients experience pain relief. If glucocorticosteroid blockade is included in the therapy, pain can be eliminated in 1-3 days.

In exceptional cases, pain persists even after the administration of glucocorticosteroids. This usually occurs in the case of chronic lateral epicondylitis, which is prone to relapse. This risk group also includes patients with bilateral epicondylitis and joint hypermobility syndrome.

In the case of a chronic form, accompanied by frequent exacerbations, the patient will be given recommendations on stopping sports training and changing the place of work in order to relieve the muscles from stress.

If pain persists for 3-4 months, the question of surgical intervention is raised, during which the parts of the tendon affected by the pathology are excised where it connects to the bone.

After a successful operation, a splint is applied to the elbow. For further recovery, the patient is prescribed appropriate physiotherapeutic procedures, special massage and gymnastics are recommended.

If within 6-12 months of conservative treatment it was not possible to obtain the desired result and relieve pain, surgery is prescribed. Surgery takes place under general anesthesia or using conduction anesthesia.

Tendon lengthening. Operation by Homan, who proposed excision of part of the tendons of the extensors of the hand and fingers back in 1926. Currently, such a procedure is not done at the junction of the tendons into the muscle, as the doctor assumed, but near the area where the ligaments attach to the bone.

Removal of the bursa and annular ligament. All these methods boil down to the fact that the muscles are separated from the area of their attachment to the condyle of the humerus bone, the altered tissue is removed and the previously detached muscles are reattached to the bone.

Surgical treatment

Surgical intervention can be performed through a 4-6 cm incision (open), which allows you to see all changes in the damaged area, or through two 1 cm long punctures (arthroscopically). In any case, there is a risk of complications, regardless of the experience and competence of the surgeon.

These include:

damage to nerves and blood vessels;
decreased forearm strength;
infection leading to the need for further surgery;
long recovery period due to slow growth of muscles to bone;
decreased limb flexibility.

The planned operation takes place in the traumatology or orthopedic department of the hospital. After this, a cast is applied for 1-2 weeks to reduce muscle tension. When the plaster cast is removed, warming compresses with camphor alcohol, petroleum jelly or regular vodka begin to be used.

A month after the surgeon’s intervention, physical therapy is prescribed, which includes resistance exercises. Stretching begins no earlier than 2 months after surgery. The patient can return to sports and normal activities only after 4-6 months.

Improving regional blood circulation. Electrophoresis with acetylcholine, potassium iodide or novocaine, as well as UHF therapy are used. To improve the nutrition of cells in the area of tendon attachment, blockades with double-distilled water are prescribed, which have a good effect, but are quite painful when the drug is administered. For chronic forms of epicondylitis, injections of vitamins B1, B2 and B12 are given.

Preventing muscle atrophy and restoring joint function.

Prescribed massage of the muscles of the forearm and shoulder, dry air baths, mud therapy, exercise therapy with the following types of exercises:

Isometric - static exercises based on the patient’s desire to counteract resistance. They are aimed at increasing strength and strengthening the ligaments of the injured limb.
Eccentric (lowering the projectile, in which the muscles lengthen under load)
Concentric (muscle contraction due to lifting weights). Such exercises are aimed at restoring and strengthening muscles.

After surgical and conservative treatment, more than 90% of patients are completely cured and return to their previous lifestyle. With a conservative approach, the symptoms of epicondylitis disappear after 3-4 weeks, and a return to the patient’s usual activities becomes possible after a few months.

After surgery, the recovery period also lasts several months, with muscle weakness sometimes occurring and motor activity being slightly limited, especially when lifting heavy objects.

Treatment at home

Experts say that at home, during the prescribed treatment of lateral epicondylitis of the elbow joint, the patient must adhere to certain rules:

exclude all movements that provoked the occurrence of this disease.
take an anesthetic drug at the time of exacerbation of painful sensations (for example, Analgin or Ketanov).
if painful sensations reoccur, compresses should be added to painkillers. Compresses are used in two types:

at the moment of exacerbation of pain - cold (on the outside of the elbow);
after the painful sensations subside - hot (on the same area of the arm);

The compress is applied for 15-20 minutes, several times a day.

Do not neglect doing exercises to stretch your elbow muscles. To do this you will need the help of a healthy hand. With its help, the hand of the affected arm is slowly bent and extended until a feeling of tension appears. At the same time, it is absolutely impossible to allow the appearance of severe pain. During bending, the hand is held for several seconds in a critical position, while it should be slightly rocked from side to side. It is recommended to perform this exercise in three approaches.

After completion of treatment, they move on to strengthening muscles and ligaments. To do this correctly, you will need some kind of heavy object (for example, a dumbbell from 200 to 500 grams). The hand should be in the desired position - with the back side facing up. Exercise technique:

the elbow is bent 100-120 degrees;
the hand is deployed together with the forearm;
return the hand to its original position.

The exercise is performed 10 times in three approaches. After this, using the same technology, perform the exercise from a different starting position - the back of the hand is turned down. But before performing the described exercises, the patient should consult with the attending physician.

Treatment with folk remedies

Treatment of epicondylitis of the elbow joint with folk remedies is still popular today. As a rule, folk therapy is used simultaneously with conservative treatment, since some folk recipes are really effective for epicondylitis.

But you should not rely entirely on such treatment, since without medical help the inflammatory process can take on very serious proportions. Let's consider the most popular methods of treating epicondylitis with folk remedies.

To eliminate pain, massage oil made from bay leaves is suitable. Take a couple of bay leaves, grind them into powder and mix with slightly warmed olive or vegetable oil. Before use, the product must infuse for 7-10 days. The medicine can be used as compresses or rubbed into the elbow joint.
Take a liter jar and fill it ½ full with chopped horse sorrel roots. Add 500 ml of vodka to the plant, mix thoroughly and place in a dark and warm place for 10-15 days. Use the product as a compress, carefully wrapping the affected limb for 1.5-2 hours. The course of treatment is 10-14 days.
If epicondylitis has become chronic and often recurs, green tea will help cope with painful sensations. Pour boiling water over a spoonful of tea and let steep for 30-40 minutes. Pour the finished drink into a container with ice cubes and freeze. It is recommended to apply green tea ice to the area of pain for 5-10 minutes.
You can make a good pain-relieving and restorative compress from fragrant violets. Pour 200 g of flowers with 200 ml of vodka and place in a dark place for 10-14 days. The resulting product should be applied to the joint for 2 hours, every day for a month.
Pour boiling water over the leaves and flowers of black elderberry for 5-10 minutes. Carefully squeeze out the plant mixture and apply it to the elbow joint, wrapping it with film on top. After 15-20 minutes, the compress can be removed and the skin washed. Treatments must be carried out every 3-4 days for 1-2 months.
In order to relieve an acute inflammatory process, you can use hot clay. Take blue clay and mix it with hot water 1:1. Carefully distribute the product on two-layer gauze and apply it to the elbow, securing the compress with a bandage and wrapping it in a scarf or handkerchief. The compress is kept for 30 minutes and replaced with a new one. The procedure should be carried out 2-3 times a day for 7-10 days.

Exercises

Exercises for epicondylitis of the elbow joint are included in the rehabilitation program to restore normal functioning of the limb. All exercises are prescribed only by the attending physician.

The main goal of the classes is to normalize regional microcirculation, completely eliminate discomfort in the affected area, restore the possibility of full joint movements and prevent atrophy of the forearm muscles.

But doing the exercises has a number of instructions and restrictions. Physical activity should be gradual, that is, from small to large. At first, the exercises should not last long, but as the elbow joint strengthens, the duration of the exercises can be increased.

If acute pain occurs during exercise, it is better to consult your doctor. In general, physical treatment improves blood flow, normalizes the secretion of synovial fluid, strengthens muscles and increases the elasticity of ligaments. Attention must be paid to both passive and active loads using the healthy arm.

Bend your elbows and gradually clench and unclench your fists.
Slowly bend and straighten your elbows, keeping your hands together.
Keep your shoulders still and flex and extend your forearm area in outward and inward circular motions.
Make “mill” and “scissors” with your hands.

In addition to the exercises described above, there are others with strength loads on the arms. But they are not always used to recover from epicondylitis.

Bandage

A bandage for epicondylitis of the elbow joint is used to immobilize the limb and prevent further injury to the ligaments and tissues of the joint. The advantage of the bandage is that this device is not too expensive and will always come in handy.

Athletes and people who have suffered injuries to the elbow joints and those whose work involves the active functioning of flexor-extensor muscles should have this kind of bandages.

It is better to use a bandage for epicondylitis according to a doctor’s technology, that is, wear it at the allotted time, for example, 1-2 hours a day. The bandage is recommended for use in cases where the greatest impact is placed on the elbow joint.

In this case, it acts as a kind of preventive method to prevent injury and rupture of the ligaments and tendons of the joint.

Prevention

Prevention of lateral epicondylitis in tennis players includes practicing proper hitting technique, using appropriate equipment, and using an elastic bandage to support the elbow. People who perform repetitive movements with their hands are advised to improve the ergonomics of their workstation, take breaks during work and, if possible, limit the load on the extensor muscles.

So, with frequent similar movements when playing sports or specific professions, it is necessary to alternate the mode of work and rest. To relieve tension from the muscular system, you can do a warm-up, light massage or special exercises from a physical therapy course.

If the disease is in a chronic stage, but the following procedures can be used to prevent the inflammatory process:

Local cryotherapy on the affected area. To carry out this method, dry cold air with a temperature below 30 degrees is used.

Ultraphonophoresis using anesthetic and anti-inflammatory mixtures in the area of pain localization.
Extracorporeal shock wave therapy is considered a last resort preventive method. It is used when other measures do not provide pain relief and do not contribute to the natural restoration of the muscle tissue of the elbow joint.

Paraffin-ozokerite and naphthalan applications. Prevention involves reducing the risk of injury to the elbow joints when carrying heavy loads or using hand-held equipment at work or in sports. Do not forget about protecting your elbows with elastic bandages or special elbow pads.

Lateral epiconilitis prognosis

The prognosis for epicondylitis of the elbow joint is usually favorable, since the disease does not lead to death or fatal damage to the body. If you seek medical help in a timely manner, you can avoid surgery by quickly restoring damaged muscle tissue.

But if the disease is advanced, then most likely you will have to undergo surgery and make blockades to eliminate the pain. In this case, the prognosis for recovery depends on the nature of the inflammatory process and the degree of damage to the tissues of the limb.

Epicondylitis of the elbow joint responds well to therapy, so even the chronic form of the pathology can be transferred to the stage of long-term remission. But do not forget about taking preventive measures to protect the joints from damage and prevent inflammation, which will cause not only discomfort, but also significant inconvenience when working or playing sports associated with regular loads on the elbow joint area.

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