Epicondylitis: What to Watch Out For

Surely, each of us at least once in our lives has encountered “strange” pain in the forearms after long and monotonous work with our hands in the country or at home, or after carrying a heavy schoolbag on one hand every day to school and back. Moreover, these painful sensations were often combined with another nuisance - an incomprehensible weakness in the hand, which sometimes made it impossible to even bring a cup of coffee or tea to the mouth. If all this is familiar to you, most likely you are faced with the manifestation of epicondylitis. Which means – you have serious prerequisites for visiting a doctor, which should not be postponed!

What is epicondylitis

Epicondylitis is an inflammatory (with subsequent tendency to tissue degeneration) lesion of the periarticular tissues (consisting of bones, periosteum and tendons), starting from the place where the muscular tendons of the forearm attach to the humerus. This happens after prolonged muscle strain of the forearm (often in combination with a strong load on them), as a result of which the periarticular tissues are constantly injured (microtears form), become inflamed and eventually scar.

Additionally, damage to the styloid process of the radius may occur, causing damage to the flexor and extensor tendons of the thumb. Epicondylitis occurs, as a rule, on the hand that is the working hand for a person (on the right - for right-handers and on the left - for left-handers).

Factors that provoke epicondylitis can be:

long-term movements of the elbow in the “mode” of flexion-extension
elbow injuries
point muscle strain
disruption of local blood supply
the presence of some bone pathologies

Representatives of professions that involve frequent and prolonged monotonous (usually up and down “mode”) movements of the elbow (builders, painters, massage therapists, violinists, pianists, professional tennis players and golfers) are most susceptible to the disease. Those who too fanatically force the work on their summer cottage also run the risk of getting epicondylitis. According to statistics, the disease is more often observed in men in the age group of 40-60 (sometimes over 30) years.

Who is more likely to experience epicondylitis of the elbow joint?

The cause of the disease is physical stress on the elbow joint and surrounding tissues. The disease can be provoked by sudden intense movements, strength exercises, and monotonous long-term work.

In this regard, patients who perform certain actions as part of their work activities are at risk.

Lateral E. mainly occurs in workers and athletes who regularly supinate and extend the forearm:

massage therapists;
tennis players;
carpenters;
painters;
golfers.

Medial epicondylitis of the joint develops in people with light physical labor and athletes:

typists;
keyboard typists;
builders involved in laying bricks;
installers;
seamstresses;
tennis or golf players with improper playing technique;
spear throwers.

It is also worth noting that there is no such thing as epicondylitis of the knee joint. This pathology applies only to the upper limb.

What are the types of epicondylitis

Based on the location of the source of inflammation, epicondylitis is usually divided into:

external (or lateral) - when overstrain occurs in a muscle located on the outside of the forearm, and the lateral epicondyle of the humerus is also involved in the inflammatory process;
internal (or medial) - when overstrain occurs in the carpal flexor muscles, and the medial epicondyle of the humerus is involved in the inflammatory process.

Based on the presence of factors provoking the disease, epicondylitis is usually classified into:

traumatic - when frequent trauma to the periarticular tissues occurs as a result of the patient’s “background” diseases (such as, for example, elbow arthrosis or cervical osteochondrosis) or after damage to the ulnar nerve (with subsequent scarring of the injured tissues)
post-traumatic – when the inflammatory process begins against the background of an incorrect rehabilitation period after injuries (dislocations or sprains) of the elbow joint
chronic – when a long alternation of exacerbations and relapses causes significant weakening of the muscles, which is accompanied by minor pain (pulling and aching pain is often observed)

Outer

The appearance of pain in the area of the lateral condyle of the humerus, as well as the extensor tendons of the forearm, is typical. Unpleasant sensations occur when performing physical activity with resistance. For example, when hitting a tennis ball, when screwing in a screw with a hand screwdriver, when rowing, pulling up, and when performing other movements. The area of distribution of the unpleasant symptom is from the elbow joint to the middle of the forearm. The patient also feels pain when:

twisting the forearm inward with the elbow bent;
palpation of the affected area;
flexion at the wrist joint and intense clenching of the palm into a fist.

There is no pain when performing passive movements or at rest.

What symptoms accompany epicondylitis?

The acute stage of the disease is often characterized by the following symptoms:

severe pain syndrome spreading along the outer or inner (depending on the type of epicondylitis) side of the elbow, especially acute with strong muscle tension and calmer, aching in nature, in the future, even in the absence of any stress;
rather limited range of elbow movements;
gradual development of muscle weakness in the arm (due to inflammation, depending on the type of epicondylitis).

The chronic course of the disease is usually characterized by alternating fairly long (from 3 to 6 months) remissions and relapses of the disease.

Epicondylitis of the elbow joint: symptoms and treatment

Epicondylitis of the elbow is a condition caused by swelling of the tendons. It is accompanied by acute pain and makes it impossible to move the arm freely.

These tendons are bands of tough tissue that connect the muscles in the lower arm to the bone. This is the most common reason why people go to the doctor with painful forearm symptoms. The disease can appear in people of any age, but most often occurs around the age of 40.

We will talk about what causes inflammation, how this disease is diagnosed and treated, in this article.

Medial epicondylitis: signs

Medial epicondylitis (golfer's elbow) is a type of tendinitis that affects the inside of the elbow. The disease develops where the tendons in the forearm muscle connect to the bony part on the inside of the elbow.

Tendons attach muscles to bones. Due to injury or irritation, they may become swollen and painful.

Although medial epicondylitis is called golfer's elbow, it does not only affect golfers. This can occur from any activity that involves using the hands or wrists, including tennis and baseball. It got its name because it is in this sport that the greatest stress is placed on the inside of the elbow.

Medial epicondylitis is much less common than lateral epicondylitis (tennis elbow), with the former accounting for only 9 to 20% of all epicondylitis diagnoses. Golfer's elbow occurs as a result of the high-energy tension created by an overhead shot. In sports, this phenomenon occurs frequently in tennis, bowling, archery, weightlifting, javelin throwing, racquetball and American football.

However, from 90 to 95% of all cases, the disease is not associated with sports training.

Because chronic repetitive contractile loading of the carpi flexor and pronator muscles is the most common etiology, occupations such as carpentry, plumbing, and butchering may also cause inflammation. The pathology can also be caused by sudden tension in these tendons.

In many cases, an injury at work is the cause of symptoms.

More specific occupational factors associated with medial epicondylitis are forceful activities in men and repetitive hand movements in women. Smokers and people with type 2 diabetes are at risk.

Medial epicondylitis may occur suddenly or develop slowly over a period of time. Symptoms can range from mild to severe.

The person experiences the following symptoms:

pain inside the elbow;
elbow stiffness;
weakness of the hands and wrists;
tingling sensation or numbness in the fingers, especially the ring and little fingers;
difficulty moving the elbow.

It is not uncommon for pain in the elbow to radiate down the arm to the wrist. This makes it difficult to perform everyday activities such as picking up objects, opening a door, or shaking hands. Typically, medial epicondylitis affects the dominant hand.

Symptoms in both tennis and golfer's elbow usually begin gradually and get worse over time.

The condition can be caused by excessive force used to bend the wrist toward the palm.

During professional activities (playing tennis, baseball), this can happen when swinging a stick or bat.

Other possible causes include:

undeveloped playing technique;
weak shoulder and wrist muscles;
sudden lifting of a suitcase (any load);
Using a tennis racket that is too heavy or too short.

Despite the “sports” name, tendon inflammation can occur in any person when performing everyday tasks: carrying heavy or bulky objects, throwing a projectile, chopping wood, operating a chain saw.

What are the causes of medial epicondylitis?

Medial epicondylitis is caused by repetitive movements, which is why the condition is most common in athletes.

Golfers can develop this type of tendonitis from repeatedly swinging a golf club, while tennis players can develop it from repeatedly using their arms to swing a tennis racket. In both cases, overuse of the hands and wrists damages the tendons and causes pain, stiffness and weakness.

Other risk factors for this type of inflammation include playing baseball or softball, rowing, and weightlifting. Activities such as playing an instrument and typing on a computer can also lead to pathology.

Symptoms of this disease are similar but occur on the inside of the arm and include:

pain inside the elbow;
discomfort spreads down the arm from inside the elbow;
weakness in the hand or wrist;
numbness or tingling in the little fingers
pain when gripping and bending the wrist.

Most cases of golfer's elbow are not caused by inflammation. Rather, it is a problem in the tendon cells. With increased cell release and calcification, the tendons begin to lose their elasticity (collagen loses its strength). This leads to tendon fragility and ruptures.

Improper technique while playing can cause damage

Every time collagen breaks down, the body reacts by forming scar tissue into the tendon. Over time, the tendon thickens with excess scar tissue. The tendon varies from a white, shiny and hard surface to a dull, slightly brown and soft surface.

Since the medial epicondylitis is a flexor group tendon attached to the humerus, the most sensitive area will be located near the origin of the carpi flexor group.

Lateral epicondylitis: what is the cause?

Tennis elbow (lateral epicondylitis) is a painful condition that occurs when the tendons in the elbow are overused. This usually occurs due to overload and frequent repetition of the same movement.

Despite the name, athletes are not the only ones who can experience this pathology. People whose profession involves working with their hands (carpenters, plumbers, builders) often turn to doctors with a similar problem. The pain occurs primarily where the forearm muscle tendons attach to the bony lump on the outside of the elbow. The pain may also spread to the forearm and wrist.

The following symptoms are typical for this condition:

sharp or aching pain in the elbow;
discomfort during a handshake;
problems with grasping an object.

With severe inflammation of the elbow joint, the patient may experience pain from holding a coffee cup in his hand or when turning a doorknob.

This condition indicates that you should consult a doctor immediately.

Rest and over-the-counter pain relievers help relieve the condition, but do not cure it. If the conservative method does not help, the doctor may suggest surgery.

Risk factors

Age. People aged 30 to 50 years most often turn to a specialist with a similar problem.
Professional activity. People who have jobs that involve repetitive movements of the wrist and hand are more likely to develop this condition. Examples include plumbers, painters, carpenters, butchers and chefs.
Certain sports. Participation in racquet sports increases the risk of tennis elbow, especially if the person has poor hitting technique.

Diagnosis and treatment

Fortunately, in most cases, both types of elbow inflammation respond well to conservative treatment.

Surgery is usually not required, although full recovery may take weeks or even months, depending on the severity of the condition. As with other forms of tendinitis, the most important aspect of treatment is to reduce the stress on the affected tendons. This may include resting the arm, using a brace or a tourniquet.

After recovery, it is mandatory for athletes to correct incorrect technique to prevent recurrence of the injury.

If elbow pain does not go away within 2-3 days, you should immediately consult a doctor.

The specialist will ask questions about your symptoms, pain level, medical history, and any recent injuries. During the consultation, you should provide information about daily activities, including work responsibilities, hobbies, and recreational activities.

The doctor performs a standard external examination, which may include applying pressure to the elbow, wrist, and fingers to check for stiffness or discomfort.

Before diagnosing medial epicondylitis, your doctor may order x-rays of the inside of your elbow, arm, or wrist to rule out other possible causes of pain, such as a fracture or arthritis.

When making a diagnosis, a specialist takes into account many factors: professional, household, degree of pain and development of the disease. If there was a history of injury to the shoulder or elbow, it is necessary to mention this. There are cases when inflammation appears several months after the tendon is damaged.

You should also tell your doctor if you have a history of rheumatoid arthritis or nerve disease. These factors will help to correctly diagnose the disease and prescribe a competent course of therapy.

During the examination, the doctor uses various tests to accurately determine the diagnosis. For example, the specialist may ask to straighten the wrist and fingers against resistance while keeping the arm fully extended to see if this causes pain.

If the reaction is positive, the specialist can determine muscle damage.

To rule out the possibility of another diagnosis, your doctor may recommend additional tests:

X-rays. These tests provide clear images of dense structures such as bones. This test can help rule out elbow arthritis.
Magnetic resonance imaging (MRI). If your specialist suspects your symptoms are related to a neck problem, an MRI may be ordered. Tomography shows details of soft tissues and helps determine the presence of a herniated disc or arthritis in the neck. Both of these factors can cause pain.
Electromyography (EMG). The analysis helps to exclude compression of the nerve. Many nerves are concentrated around the elbow, and the symptoms of nerve compression are similar.

Given the painful symptoms, this disease requires immediate diagnosis and treatment.

Delayed therapy can cause a chronic condition. In this case, the slightest injury or careless movement of the shoulder joint may return the painful condition in the future.

Treatment of the elbow joint

Doctors classify two types of therapy for epicondylitis: surgical and conservative.

Approximately 80% to 95% of patients are treated successfully with non-surgical methods.

The first priority is to rest your hand. This means that it is necessary to completely stop participating in training, competitions, and put off hard work for several weeks.
Anti-inflammatory drugs. These medications reduce pain and swelling.
Physiotherapy. Specific exercises are useful for strengthening the forearm muscles. The therapist may also perform ultrasound, ice massage, or muscle stimulating techniques to promote muscle healing. The technique is prescribed after a complete examination and diagnosis of the degree of inflammation of the joints.
Using a bandage. The bandage is applied to the center of the back of the forearm. This method helps to immobilize the hand, giving the necessary rest, and significantly relieves pain.
Steroid injections. Steroids such as cortisone are very effective anti-inflammatory agents. A specialist may prescribe a course of such injections to relieve pain.
Extracorporeal shock wave therapy. Shockwave therapy sends sound waves into the elbow, where they create a “microtrauma.” This promotes the body's natural healing processes. Shock wave therapy is still considered experimental, but today studies show its effectiveness.

Also, if you are injured during sports games or training, prevention is important. A specialist may advise checking the equipment to ensure it fits correctly in your hand.

Stiffer racquets and more flexible racquets can often reduce the stress on the forearm. If you are using the wrong size racquet, switching to a smaller head size may help prevent symptoms from recurring.

Treatment methods for epicondylitis:

Surgical intervention

1. Open surgery (excision of the area)

2. Arthroscopic surgery (through a puncture)

Non-surgical therapy

Drug treatment

2. Physiotherapy

3. Massage

4. Physical therapy

Surgery

If painful symptoms do not go away after 6-12 months of general therapy, the doctor may give a referral for surgery.

Most surgical procedures for epicondylitis involve removing the affected muscle and rebuilding the healthy muscle back to the bone.

The correct surgical approach depends on a number of factors:

extent of injury;
previous therapy;
state;
activity.

Before surgery, you should consider all possible risks associated with surgery and evaluate the need for such treatment.

Surgical intervention can take two forms: open and superficial.

The most common approach to tendon repair is open surgery. The operation involves an incision above the elbow.

The open method is usually performed quickly and does not require long-term rehabilitation. The patient does not even need an overnight hospital stay.

Arthroscopic surgery.

Inflammation can also be treated using miniature instruments and small incisions. Like open surgery, it is a one-day or outpatient procedure.

This therapy has recently gained great popularity as it minimizes the risk of surgery and does not require long recovery.

The surgeon will mark the elbow joint before the procedure. To do this, the patient's elbow is bent at an angle of 90 degrees.

The procedure is performed using two methods: in supination or pronation position.

In the first case, the patient lies on his back, and the arm is moved to the side. In the pronation position, the patient lies on his stomach, the hand is fixed in a special way through a suspension device. The operation is performed on the elbow joint, bent at a 90-degree angle.

A tourniquet is pulled onto the upper forearm with a maximum pressure of 250 mmHg. The first stage involves filling the joint with a special saline solution through a lateral approach. This allows the nerve fibers to be displaced to prevent damage. Next, the surgeon carefully inserts the needle into the muscle of the joint capsule.

Possible risks:

infection;
loss of strength;
loss of flexibility;
long recovery;
damage to nerves and blood vessels;
need for further surgery

Postoperative rehabilitation

After the intervention, it is very important to immobilize the arm so that there is no load on it at all. The specialist applies a splint, which is removed after 6-7 days.

The specialist shows a special training for stretching the elbow and restoring flexibility. Light exercises with gradual strengthening begin 2 months after surgery.

Returning to professional activities and sports training is an individual matter. And in each individual case, the expert gives his recommendations, depending on the type of operation, the severity of inflammation and the effect of rehabilitation. This is usually 4 to 6 months after surgery. Tennis elbow surgery is considered successful in 80-90% of patients.

Treatment with folk remedies

Alternative treatment allows you to relieve pain symptoms and relieve the main tension from the tendons. However, none of the methods is a panacea and if symptoms recur, you should consult a doctor for professional medical treatment.

Ice – Depending on the severity of the tendinitis, icing the affected area may help reduce pain and inflammation. Ice should be applied immediately when pain flares up. A tourniquet can be used for fixation. Experts recommend doing this for 20-30 minutes every 3-4 hours for 2-3 days or until the pain goes away.
Anti-inflammatory drugs (Ibuprofen, Naproxen) are recommended in the early stages of inflammation. They help reduce discomfort, but do not cure the problem.
Stretching exercises – Exercises that stretch the involved forearm muscles can help relieve stress on sore tendons.
Using an elbow strap to protect the injured tendon from further stress.
Massage. Any manual procedures can be performed only after acute inflammation has been relieved, otherwise any pressure may aggravate the situation. A competent massage helps restore tendons, helps strengthen muscle tissue, and prevents atrophy.

Manual therapy

The use of compresses to relieve swelling and inflammation. This ointment-based compress can be easily prepared at home. An effective method is a blue clay compress (the powder is diluted in a 1:1 ratio with warm water).

An application of ointment based on horse sorrel root and vodka shows good effectiveness.

In case of severe pain, doctors recommend applying a compress with camphor alcohol or vodka. This method helps relieve swelling and inflammation.

For minor tendinitis, you can do an iodine grid and rest your arm.

Conclusion

Symptoms for both tennis and golfer's elbow usually begin gradually and get worse over time.

Both conditions are types of tendonitis, or inflammation of the tendon, and both are usually caused by excessive repetition of the same movement. This may occur due to overuse on a regular basis (such as hitting a golf or tennis ball) or other repetitive activities that use the forearm muscles.

Over time, tendons can go from inflamed to ruptured. Therefore, when primary symptoms appear, it is important to immediately seek medical help.

Diagnosis of epicondylitis

When diagnosing epicondylitis, it is necessary to accurately differentiate this disease from others that have almost similar symptoms. Therefore, to make a final diagnosis, the doctor can be guided by the data obtained from:

initial examination of the patient (including medical history)
passing symptomatic tests (Welt and Thompson)
laboratory blood test
x-ray examination
magnetic resonance imaging

Origin

The fragment of the humerus bone, which appears in the creation of the ulnar joint, has small pimples. They are called the external (lateral) and internal (medial) epicondyles. And if we look at the tendons of the forearm muscles, they are attached precisely in this area. With a high increase in the functioning tension on the muscles of the flexors of the hand (attached to the internal epicondyle), minor damage to the threads of their tendons and bone base is created in the attachment zone with the formation of inflammatory effects.

Treatment of epicondylitis

Effective therapy for epicondylitis, as a rule, includes a whole range of measures, consisting of:

eliminating pain syndrome
restoration of normal blood supply to the elbow
returning the elbow joint to normal range of motion
preventing atrophy of the affected forearm muscles

Treatment of epicondylitis begins with providing the patient's forearm (including the elbow joint) with complete immobilization (using a plaster cast, splint or elastic bandage) for a week. Next, the doctor may prescribe:

drug therapy (including the use of non-steroidal anti-inflammatory drugs in ointments, as well as, for severe pain, corticosteroid blockades)
physiotherapy (including high-intensity magnetic and diadynamic therapy, UHF therapy, naphthalan and paraffin-ozokerite applications, phono- and electrophoresis, cryotherapy)
massotherapy
mud therapy
physical therapy complex

If there is no positive dynamics after 4 months of conservative therapy, the doctor may recommend surgical treatment to the patient. It involves excision of the affected tendons that attach to the humerus.

Interior

Pain syndrome develops:

locally in the area of the internal condyle of the humerus and flexor tendons;
when bending the arm at the elbow joint;
when twisting the wrist inside;
may spread from the inside of the elbow to the armpit to the thumb.

If intense loads are necessary for the appearance of symptoms in external epicondylitis, then constant work of the same type is sufficient for internal epicondylitis. More often, this variant of the disease develops in women (seamstresses).

Prevention of epicondylitis

Preventive measures to prevent epicondylitis are also aimed at combating relapses of the disease. Typically they include:

periodic complete rest for the elbow when performing any work with sufficient load on it
minimizing long-term and similar force loads even on a healthy elbow joint
sufficient “warming up” of muscles and tendons before training or work that involves significant stress on the joint
additional protection of the elbow joint (if necessary) through the use of special elastic bandages and special elbow pads

Have you begun to experience discomfort in your forearm, causing you some inconvenience in your daily life? Experienced medical specialists are always happy to help you determine the true cause of your illness and return you the joy of life without pain!

Classification

Based on the localization of the pathological inflammatory process, medial and lateral epicondylitis is distinguished. According to the main causative factor, the disease can be of pathological and traumatic origin; usually the more common form of pathology is provoked by microtrauma of the forearm muscles and their tendons.

Also, for ease of diagnosis and choice of treatment, epicondylitis is classified into types according to the severity of the inflammatory process. All criteria for the classification of the disease are displayed in the final diagnosis after an objective diagnostic study.

Causes

Epicondylitis of the elbow joint develops as a result of prolonged monotonous load on the muscles of the forearm. This disease is typical for people of certain professions - athletes, massage therapists, carpenters, milkmaids, masons, typists, etc.
The occurrence of the disease can also be associated with sudden overload during heavy physical activity - for example, when lifting heavy weights.
Epicondylitis is sometimes a consequence of prolonged carrying of heavy objects in the hand - suitcases, bags, etc. This leads to significant static muscle tension.
The cause of the disease can be injury, as well as congenital weakness of the ligament apparatus.

Therapeutic exercise (physical therapy)

It is recommended to perform special physical exercises only after the inflammatory process has stopped. The complex of therapeutic exercises helps restore muscle tone, tendon elasticity, and improves blood supply to tissues. Even in severe cases, exercise therapy should not be excluded. It is necessary to devote at least 20-30 minutes a day, and for people whose work involves monotonous workload, such exercises should be performed regularly, even in the absence of pain.

Postisometric muscle relaxation (PIR) is carried out by a physical therapy specialist, or a chiropractor, and consists of smooth stretching of the tendons and muscle groups of the forearm, alternating periods of resistance and rest, as well as performing special resistive exercises.

Before performing exercises, you should consult your doctor. Exercising during an exacerbation or premature training leads to muscle overstrain and worsening of the condition.

Hand exercises

Literature sources

Arshin V.V. Orthopedic diseases of the hands from functional overstrain: abstract. dis. Dr. med. Sciences / Arshin V.V. -Samara, 1996.-39 p.
Builova T.V. Rehabilitation for epicondylitis of the shoulder. Clinical recommendations / T.V. Builova, M.B. Tsykunov // Bulletin of Restorative Medicine / - 2021. - No. 1 (71). - With. 80-84
Bukup, K. Clinical study of bones, joints and muscles / K. Bukup. - M., Medical literature, 2008. - 320 p.
Vorotnikov, A.A. Extracorporeal shock wave therapy in the treatment of tendopathies of the upper and lower extremities in patients with aggravated somatic status / A.A. Vorotnikov, A.N. Cymbal.
Zulkarneev, R.R. Shock wave therapy for injuries and diseases of the musculoskeletal system / 6. R.R. Zulkarneev, K.E. Valeev, Yu. R. Stepanov // Kazan Medical Journal/ - 2009. - No. 5 (90). — P.753-754. 6. Karateev, Yu.A. Ermakova // Modern rheumatology. - 2015.-No. 3(9). — P. 33-42.

Pathogenesis

During the development of the disease, periosteal inflammation occurs, subsequently leading to the appearance of microtraumas in the area of muscle attachment. Local inflammation of the nerves innervating the epicondyles may also develop. Factors that provoke the development of these processes are microtrauma or muscle failure. In addition, local disorders in the tendons, collagen degeneration of cartilage tissue, degeneration of fibrils and fibrocytes can be provoking phenomena.

The pathophysiology of the disease is associated with professional activities and activities that require constant forceful supination and pronation of the forearm. During the development of the process, the development of subperiosteal hemorrhages, calcification , and degenerative changes in tendon tissue may be noted.

Physiotherapy

Physiotherapeutic procedures are indicated for all forms of the disease; the orthopedist and physiotherapist select each patient individually. For a speedy recovery, it is recommended to combine several techniques. In this case, the course of the disease, the presence of contraindications, and the characteristics of the body are taken into account. physiotherapy is always carried out in courses of 3 to 15 sessions, with varying intervals between procedures.

Shock wave therapy session

Phonophoresis with hydrocortisone. The medicine is delivered to the inflammatory focus using ultrasound. By stimulating blood flow and metabolism in tissues, hydrocortisone helps relieve swelling and has an anti-inflammatory effect. The result is visible after 3-5 procedures. The course of treatment includes 5,7 or 10 sessions.
Electrophoresis. Electric current is applied to the inflamed area, and novocaine is additionally used to reduce pain. Under the influence of electrophoresis, blood microcirculation improves, inflammation and swelling of the tendons decreases, and drugs penetrate deeper into the tissue. 7-10 procedures are prescribed, with an interval of 1-2 days.
Magnetotherapy. The magnetic field stimulates blood circulation and metabolic processes, reduces swelling. After just a few sessions, movements in the elbow joint become less painful and discomfort decreases. Up to 10-15 sessions are recommended.
Interstitial electrical stimulation (ITES). The technique is based on the ability of electric current to have an analgesic effect. One of the electrodes, in the form of a needle, is placed in the area of the inflamed epicondyle and tendons, the rest are placed cutaneously, in the area of the muscles of the forearm. Duration up to 20-30 minutes, course treatment 5-7 sessions, with an interval of 3-5 or 7 days.
Laser therapy, laser beams are able to penetrate deep into tissue and have a thermal effect. This helps increase blood circulation and relieve the inflammatory reaction.
Myostimulation. The effect of pulsed current on muscle fibers. Improves blood supply and tone of muscles and tendons, helps avoid atrophy.
Darsonval. The elbow is exposed to low-intensity electric currents and high voltage. Capillary blood circulation accelerates, lymph outflow improves, tissues are restored faster. The technique has not found widespread use.
UHF. Method of exposure to high-frequency electromagnetic fields. The thermal effect promotes blood flow and activation of metabolic processes.
Shock wave therapy for epicondylitis acts on the causes of the disease, is based on the effects of acoustic waves, has an effect on pathological tissues - softens areas of fibrosis and salt deposits in the tendons, increases local blood flow, accelerates recovery processes, stimulates the synthesis of collagen and elastin. It has been proven to be up to 96% effective, helps to cure the disease, and combines well with other methods. The course requires 5-7 sessions.
Cryotherapy, treatment using cold, helps reduce local swelling and pain in the acute period, due to short-term spasm and subsequent expansion of microcapillaries, improves blood supply.

The technique of interstitial electrical stimulation according to Gerasimov for epicondylitis helps relieve pain in several sessions.
Orthopedist Timur Vyacheslavovich Kholikov, candidate of medical sciences, recommends:

Good results are obtained by combining shock wave therapy with the use of platelet-rich plasma from the patient's blood (PRP therapy). The technique allows not only to relieve pain and inflammation, but also to strengthen tissue damaged by epicondylitis by stimulating regeneration in tendons and muscles.

Elbow epicondylitis (Golfer's Elbow, Tennis Elbow)