Epikondilit – a degenerate and inflammatory disease of fabrics in an elbow joint. Develops in places of an attachment of sinews of an internal and external surface of a forearm to, respectively, internal and external to nadmyshchelka of a humeral bone. Taking into account localization distinguish external and internal epikondilit. External epikondilit it is observed 7-10 times more often than internal. The disease develops gradually and affects mainly patients of middle age. The cause – the repeating microinjuries owing to an overload of muscles of a forearm. Epikondilit it is shown by the elbow joint pain amplifying at extension (at an external epikondilit) and at a hvataniye (at an internal epikondilit). Treatment is usually conservative. The forecast is favorable, in most cases the disease well gives in to therapy.
Epikondilit – degenerate and dystrophic process in the field of an attachment of sinews of muscles of a forearm to nadmyshchelka of a humeral bone and the fabrics surrounding these sinews. Depending on localization it is shown by local pain on the external or internal surface of an elbow joint. Develops as a result of a chronic overload of muscles of a forearm. The diagnosis of an epikondilit is exposed on the basis of characteristic clinical data. Treatment is conservative, the forecast favorable.
Epikondilit an elbow joint is one of the most widespread diseases of the musculoskeletal device. At the same time precisely it is not possible to estimate the incidence frequency as a large number of patients because of poorly expressed symptomatology do not see doctors. The disease usually develops at the age of 40-60 years, at the same time at right-handed persons is surprised right more often, and lefthanders have the left hand.
Reasons of development of an epikondilit
External (lateral) epikondilit call the tennis player's elbow as this disease is often observed at players in tennis. However much more often the disease develops in connection with professional activity. The stereotypic, constantly repeating movements – extension of a forearm and its rotation of a knaruzha become the reason of an epikondilit. From an external epikondilit massage therapists, workers of construction specialties (painters, carpenters, bricklayers), tractor operators, milkmaids, general workers quite often suffer. The disease develops at men more often.
Internal (medial) epikondilit which is also called an elbow of the golfer, arises at the repeating movements of small intensity and develops mainly at the people doing easy manual work – seamstresses, typists etc. The disease is more often observed at women.
In either case the chronic overload is the cause of an epikondilit. As a result of repeated microinjuries the degenerate process which is followed by an inflammation of surrounding fabrics develops in tissues of a sinew. Small hems which weaken resistance of a sinew to loadings even more that, in turn, promotes increase in number of microdamages are formed.
In some cases symptoms of an epikondilit arise after a direct trauma. Congenital weakness of the copular device increases risk of development of this disease and causes its heavier current.
Symptoms of an epikondilit
At a lateral epikondilit accurately localized pain on the external surface of an elbow joint arising at extension and rotation of a brush of a knaruzha is observed. At a research of muscular force weakening of muscles from the sick party at rotation of a brush of a knaruzha and resistance to capture is defined. The text of a coffee cup (pain in attempt to lift the cup filled with liquid from a table) usually positive. When pressing obvious, but not sharp morbidity is defined on a lateral condyle.
At a medial epikondilit pain is localized on the internal surface of an elbow joint. At a research of muscular force weakening of muscles from the sick party at a hvataniye is noted. Strengthening of pain at the pro-nation comes to light at right angle and bending of a forearm with a resistance. At a palpation morbidity and consolidation in the lower part of a medial nadmyshchelk is defined. The test of milking (strengthening of pain at milking imitation) positive.
Diagnostics and differential diagnostics of an epikondilit
The diagnosis of an epikondilit is exposed on the basis of complaints of the patient and data of external survey. Additional researches usually are not required. Differential diagnostics of an epikondilit is carried out with diseases of actually elbow joint (an aseptic necrosis of articulate surfaces, arthritis) and tunnel syndromes: (a syndrome of the kubitalny channel – infringement of an elbow nerve and a syndrome of a round pronator – infringement of a median nerve). Usually diagnosis does not cause difficulties.
At arthritis pain arises in the most elbow joint, but not in the area a nadmyshchelka, at the same time it more "indistinct", but not localized in accurately certain area. The sgibatelny contracture of an elbow joint can develop. At infringement of nerves neuritis and neurologic symptomatology, characteristic of it, is observed – violations of sensitivity in a zone of an innervation and decrease in force of the innervated muscles are noted.
If epikondilit develops at people of young age, it is necessary to exclude the syndrome of hyper mobility of joints (GMS) caused by congenital weakness of connecting fabric. For this purpose the doctor studies the anamnesis of life, paying attention to the frequency of developing of sprain, tendinit, sharp and chronic artralgiya and pains in a back. Besides, can confirm existence of GMS longitudinal and cross flat-footedness, and also increase in mobility of joints.
Additional methods of researches for diagnostics of an epikondilit usually are not used. In some cases for an exception of traumatic damage (a change a nadmyshchelka) the X-ray analysis is carried out. At difficulty of differential diagnostics between epikondility and a tunnel syndrome MRT can be appointed. At suspicion of inflammatory diseases of joints blood test for an exception of signs of an acute inflammation is made.
Treatment of an epikondilit
Treatment of an epikondilit is performed on an outpatient basis by the traumatologist or the orthopedist. The scheme and methods of therapy of an epikondilit are defined with expressiveness of functional violations, disease duration, and also changes from muscles and sinews. Main objectives of treatment:
- Elimination of a pain syndrome.
- Restoration of blood circulation in a defeat zone (for providing favorable conditions for restoration of the damaged sites).
- Restoration of full volume of movements.
- Restoration of force of muscles of a forearm, prevention of their atrophy.
If the pain syndrome at an epikondilita is expressed unsharply, and the patient sees a doctor generally to find out the reason of emergence of unpleasant feelings in an elbow joint, will to recommend to the patient observe the guarding mode enough – that is, to watch closely own feelings and to exclude the movements at which pain develops.
If the patient epikondility plays sports or its work is connected with big physical activities on forearm muscles, it is necessary to provide rest of the struck area for a while. Issue to the patient the sick-list or recommend to stop trainings temporarily. After disappearance of pains loading can be renewed, starting with minimum and gradually increasing. Besides, to the patient recommend to find out and remove the overload cause: to reconsider the sports mode, to use more convenient tools, to change technology of performance of certain movements etc.
At the expressed pain syndrome in a sharp stage of an epikondilit the short-term immobilization is necessary. On an elbow joint impose easy plaster or plastic to steak for a period of 7-10 days, fixing the bent elbow joint at an angle of 80 degrees and suspending a hand on a kosynochny bandage. At a chronic current of an epikondilit to the patient recommend to fix an elbow joint and area of a forearm elastic bandage in the afternoon. For the night bandage should be removed.
If symptoms of an epikondilit appeared after a trauma, it is necessary to put during the first days to the struck area cold (the bubble with ice wrapped in a towel). To the patients suffering epikondility in the sharp period appoint physiotreatment: ultrasound, (ultrasound with a hydrocortisone), paraffin, ozokerite and Bernard's currents.
The pain syndrome at an epikondilita is caused by inflammatory process in soft fabrics therefore at this disease a certain effect is rendered by nonsteroid resolvents. NPVP apply locally, in the form of ointments and gels as the inflammation at an epikondilita has local character. Purpose of nonsteroid anti-inflammatory medicines orally or intramuscularly at an epikondilita does not practice in modern traumatology because of their insufficient effectiveness and unjustified risk of development of side effects.
At the persistent pains which are not weakening within 1-2 weeks carry out medical blockade with glucocorticosteroids: betametazony, methylprednisolonum or hydrocortisone. It is necessary to consider that when using a metilprendizolon and hydrocortisone within the first days strengthening of pains caused by reaction of fabrics to these medicines will be observed.
Glyukokortikosteroidny medicine is mixed with anesthetic (usually lidocaine) and entered into the area of the maximum morbidity. At an external epikondilit the choice of the place of an injection does not represent difficulties, blockade can be carried out in position of the patient both sitting, and lying. At an internal epikondilit for carrying out blockade of the patient stack on a couch facedown with the hands extended along a body. Such situation provides availability of a zone of an internal nadmyshchelk and, unlike a sitting position, excludes casual injury of an elbow nerve during the procedure.
Upon termination of a sharp phase of an epikondilit to the patient appoint an electrophoresis with iodide potassium, novocaine or acetylcholine, UVCh and the warming compresses to area of defeat. Besides, from this time the remedial gymnastics – repeated short-term reextension of a brush is shown to the patient with epikondility. Such movements promote increase in elasticity of soyedinitelnotkanny structures and reduce probability of the subsequent microinjuries. In the recovery period for restoration of volume of movements and the prevention of a muscular atrophy massage and mud cure is appointed.
At conservative therapy without application of glucocorticosteroids the pain syndrome at an epikondilita usually completely is eliminated within 2-3 weeks, when carrying out blockade – within 1-3 days. The persistent pains which are not disappearing even after injections of glyukokortikosteroidny medicines are in rare instances observed. The probability of such current increases at a chronic epikondilit with a frequent recurrence, a syndrome of hyper mobility of joints and a bilateral epikondilit.
At a chronic current of an epikondilit with frequent aggravations to patients recommend to stop sports activities or to pass to other work, having limited load of forearm muscles. If the pain syndrome remains within 3-4 months, surgical treatment – excision of affected areas of a sinew in the field of its attachment to a bone is shown.
Operation is performed in a planned order under the general anesthesia or conduction anesthesia. In the postoperative period it is imposed steak, seams are removed in 10 days. In the subsequent the recovery therapy including physiotherapy exercises, massage and physiotherapeutic procedures is appointed.