Lateral and medial epicondylitis are similar diseases, localized in the upper extremities. Epicondylitis causes pain and functional impairment and usually occurs as a result of certain physical activities associated with occupational and sports activities. Lateral , originally described by Morris as "tennis elbow" in 1882. Currently, people can develop tennis elbow when performing any activity that involves repeated flexion and extension of the forearm at the elbow under load. Medial elbow , commonly referred to as “golfer’s elbow,” can occur in discus throwers, tennis players, and in workers whose occupations involve repetitive stress (for example, carpenters). Lateral epicondylitis occurs 7-10 times more often than medial epicondylitis. Both types (lateral and medial) most often occur at the age of 40 - 50 years of age, in both women and men.
Lateral epicondylitis most often results from repetitive microtrauma, but can occur as a result of direct trauma. Quite common among tennis players, especially non-professionals, for whom the lack of normal movement technique is a provoking factor. Lateral epicondylitis is caused by repetitive contraction of the forearm extensor muscles, especially at the insertion site, resulting in microtears with subsequent degeneration, insufficient regeneration, and resulting tendinosis. Lack of vascularization on the undersurface of the tendon further contributes to degeneration and tendinosis.
The disease was initially thought to arise from an inflammatory process involving the radial bursa, synovium, periosteum and annular ligament. In 1979, Nirschl and Pettrone described their observations as disruption of the normal collagen architecture by fibroblasts, which, when there is insufficient vasculature in the area, cause a process they called angiofibroplastic hyperplasia, later described as "angiofibroplastic tendinosis." Over time, the scar tissue resulting from these processes replaces normal tissue, further weakening the tissue and putting it at greater risk of damage. Continuation of this cycle of injury and deficient regeneration impairs biomechanics, impairs muscle function, and leads to symptoms.
Epicondylitis is a degenerative-dystrophic process involving the extensor tendons in the lateral and the tendons of the flexor-pronator muscle group in the medial. It is believed that systematic loads lead to tendinosis. Microtraumas and partial tears can lead to significant thickening of the tendon. The diagnosis is made based on a thorough history of physical and instrumental examination. In most patients, it is possible to relieve the inflammatory process by prescribing a short course of NSAIDs and using orthoses. Treatment methods also include injections of autologous blood or platelet-rich plasma, extracorporeal shock wave therapy, iontophoresis and phonophoresis with drugs that penetrate deep into the tissue.
In addition, the rehabilitation program includes
measures to gradually increase muscle strength, elasticity and functionality in order to return to work or the ability to continue playing sports. In rehabilitation, it is important to eliminate any biomechanical disorders that could lead to the initial injury.
While conservative treatment is often successful, sometimes there is a need for instrumental examination methods, such as MRI or ultrasound. These studies are necessary to verify the presence of calcifications, the degree of tendon damage, the presence of bone growths and when planning surgical treatment methods. A differential diagnosis may need to be made for lateral epicondylitis with a fracture, osteoarthritis, or carpal tunnel syndrome. If medial epicondylitis is suspected, medial osteoarthritis, medial ligament injury, and ulnar neuropathy must be excluded, although these conditions may co-occur with epicondylitis.
What are the most common elbow diseases?
The elbow is a complex mechanism, which is represented by the connection of three bones (humerus, radius, ulna). Important blood vessels and nerve endings pass through it. Without realizing it, subjecting it to colossal stress in everyday life, people may increasingly encounter diseases of the elbow joint. Although the damage does not put the patient in mortal danger, it worsens the quality of life to a greater extent. Despite the periodic pain that bothers the elbow area, people attribute them to overwork, accidental bruises, the weather, and treat themselves by taking pills, applying compresses and using folk remedies. Unfortunately, in most cases, this leads to complications, loss of sensation and freedom of movement. Important! To determine the diagnosis, you need to consult a specialist.
Diseases of the elbow joints can be varied and the list of them is quite large:
- Various occupational injuries.
- Diseases caused by inflammation: tendonitis, epicondylitis, fasciitis, arthritis.
- Neurological diseases: nerve root lesions, carpal tunnel syndrome, neuritis, etc.
- Due to changes in tissues, both cartilage and bone: osteoarthritis, gout, chondrocalcinosis, osteochondrosis.
diagnostics
diagnosis
Clinical manifestations of medial epicondylitis may have certain similarities with other pathologies of the musculoskeletal system affecting the structures of the upper limb, therefore, an objective examination is required to make a final diagnosis. It includes instrumental diagnostic techniques with visualization of the internal structures of the elbow joint:
- ultrasound;
- X-ray;
- CT;
- MRI;
- arthroscopy.
Laboratory research techniques are used to determine the cause and severity of inflammation. After the research, the orthopedic traumatologist has the opportunity to select the most adequate treatment for this disease.
Main diseases of the elbow joint and their treatment
What is Arthritis?
Arthritis is an inflammatory process that occurs in the joint and involves a disruption of immune processes in the body.
Symptoms of the disease are: pain, malaise, swelling due to excess synovial fluid, increased temperature in the affected area, vomiting, muscle aches, etc. There are two forms of arthritis: acute and chronic. The presence of this diagnosis can be confirmed by an orthopedic doctor
after examination with palpation, and then referred for hardware examination - radiography, magnetic resonance, or computed tomography to determine the presence and localization of the inflammatory process.
“Ten percent of elbow pain is due to arthritis.”
Basically, the patient is prescribed conservative therapy, which consists of taking medications, physical therapy, and physiotherapeutic procedures.
Surgery is used in severe cases when the disease is already too advanced. Ulnar epicondylitis
Epicondylitis is a disease that is quite common in the musculoskeletal system.
It often occurs due to the patient’s professional activity associated with overload. This problem affects musicians, surgeons and massage therapists, athletes, builders, as well as those professions where the emphasis is on the hands. Damage to muscle tissue and ligaments is a characteristic of epicondylitis, the appearance of which is provoked by constant overload of the elbow, trauma and microtrauma, and impaired local circulation. Treatment consists of eliminating pain, restoring full movement, and preventing muscle atrophy. Physiotherapy is an integral part of recovery. Magnetic therapy, dynamotherapy, and infrared radiation are beneficial with conservative treatment along with medication. Therapeutic exercises are also indicated to improve blood circulation and metabolic processes, which contributes to better absorption of medications and vitamins taken. Exercises should be performed daily, increasing the duration of exercise and load according to the schedule prescribed by the doctor. If conservative methods do not help within 3 months, then surgical intervention will be required. Advice.
To prevent the appearance and further development of epicondylitis, you need to have the right approach to physical activity, follow the rules of doing exercises, warm up before activity, avoid monotonous movements that load the joint, and also take complex vitamins regularly. Tunnel syndrome
Another problem of the elbow joint, which manifests itself as a pinched nerve, is tunnel syndrome. Compression of the nerve occurs due to inflammation of the ligamentous apparatus, incorrect positioning of the hand during physical activity, when working at a personal computer, playing sports, etc. The main signs of carpal tunnel syndrome are:
- numbness;
- tingling in fingers;
- shooting pain;
- muscle weakness and atrophy, cut.
Carpal tunnel syndrome can lead to loss of motor characteristics in the arm. Correct and timely consultation with a doctor is important here. The disease often requires surgical intervention, since conservative methods are possible only in the initial stages. During therapy, agents are used that increase blood circulation, reduce swelling and improve metabolic processes. An important part of non-surgical recovery is physical therapy aimed at strengthening muscles. Elbow arthrosis
Arthrosis is a disease that occurs in people over 45 years of age. Tennis players, writers, violinists, pianists, drivers and women with hormonal changes are the main risk group. The causes of arthrosis are metabolic disorders, poor diet, chronic diseases (gastritis, tonsillitis, cholecystitis), inflammation due to infections entering the joint capsule, diseases of the endocrine system, etc.
Symptoms are divided into 4 groups: 1. pain when bending and straightening the arm; 2. crunching, which occurs as a result of bone friction; 3. restriction of movement in the joint; 4. modification of the shape of the elbow. To treat arthrosis, you must follow the following instructions:
- performing development exercises;
- refusal of loads on the sore arm;
- To reduce pain and inflammation, you need to take medications;
- in cases where the disease is advanced, surgery is required, but only in cases where conservative methods cannot help.
For arthrosis, it is advisable to adhere to a diet. It should be regular and varied.
The following should be removed from the patient’s diet:
- hot, spicy dishes;
- sparkling water, yeast dough, peas;
- rich broths;
- smoked fish and meat;
- strong teas and coffee.
Limit consumption:
- table salt (use sea salt);
- conservation;
- animal by-products (lungs, kidneys, tongue).
Be sure to include in your diet:
- jelly (no dyes);
- lean meats in gelatin, jellied fish;
- sufficient amount of water;
- vitamin and microelement complex;
- products containing calcium, phosphorus, manganese, magnesium, zinc, sulfur, vitamins B and C.
Disease prevention
To prevent the onset of symptoms and treat epindocolitis of the elbow joint, it is necessary to lead a correct lifestyle. If a change in activity leading to illness is impossible, then you need to follow a set of simple rules so that the illness does not return again.
For example, if the main activity is related to sports, then training must be carried out in special devices - orthoses. Before starting classes, you need to warm up your muscles and warm up.
You need to protect the limb from injury, eat right, including healthy minerals and vitamins in your food, follow a regimen, and undergo regular examinations with a doctor.
If you are at risk and perform work that provokes the development of epicondylitis of the joint, then it’s time to worry about preventive measures. By following the following recommendations from doctors, the course of the disease can be stopped or its occurrence can be completely prevented:
- When playing sports, always follow the correct technique and strictly adhere to the trainer’s recommendations.
- Try to avoid the same type of repetitive movements at work, take breaks.
- Before any physical activity, be sure to warm up the ligaments and get a massage.
Injuries
Injuries are quite dangerous violations of the integrity of the elbow. They can be considered bruises, fractures and dislocations, and quite often they are accompanied by damage to blood vessels and nerves. After injury, before the regeneration period begins, the patient experiences severe pain, hematomas, ruptured tendons and deformities. As a result of the bruise, arthrosis or other problems may develop. The main injury to the elbow is a dislocation. It is necessarily accompanied by a bone fracture. A dislocation is accompanied by severe elbow pain, stiffness, and a person loses sensation in the wrist. Damage of this kind requires immediate consultation with a doctor and an x-ray of the elbow joint, which will show the extent of the damage, whether the muscles and nerve endings are affected. The doctor will restore the correct position by reduction, if possible, and apply a plaster splint. If the nerve has been damaged or the coronoid process is fractured, then treatment can only be surgical. Tissue bruising can occur due to a push, compression or blow to the elbow area. Symptoms of a bruise are pain when moving, bruises, increased skin temperature at the site of impact, and swelling. A bruise also requires consultation with a doctor.
Effective recipes
If a person feels the slightest symptoms of epicondylitis of the elbow joint, he needs to urgently consult a doctor. Treatment with folk remedies for many joint diseases often has a positive effect, so you should consider the most useful recipes that can really help:
- ointment from the roots and leaves of comfrey. These parts of the plant are taken in equal proportions. You will also need vegetable oil (sunflower oil) and liquid honey. In a small mortar you need to grind the roots and leaves of the herb, and gradually pour honey and oil into this mixture. This must be done until the mixture turns into a homogeneous mass. The prepared product is applied to clean gauze and applied to the affected area. For greater effect, it is advisable to tie a warm scarf around the elbow joint. The compress will have to be kept for a day. Treatment with folk remedies will not harm only if all the rules for preparing the composition are followed;
- blue clay. The powder must be mixed in equal proportions with boiling water. After the temperature of the mixture becomes tolerable for the skin, it must be placed on a piece of cloth and applied to the elbow. You should not think that a compress that is too hot will be useful and effective. In some cases it can be harmful. For a good effect, the affected elbow joint should be tied with a scarf. Keep the compress on your hand until it cools completely. The procedure must be carried out twice a day for a week;
- pain can be treated with bay oil. To prepare it you need 4 tbsp. l. Break dry raw materials well and pour a glass of sunflower oil. The mixture must be infused for at least a week, after which it is simply rubbed into the sore elbow joint;
- green tea. Treatment of epicondylitis with this folk remedy is carried out in the acute stage, when the pain syndrome is as severe as possible. Green tea should be loose leaf. It is necessary to brew a strong drink in the amount of 1 glass. The liquid is filtered, poured into special molds for ice cubes and placed in the freezer. The treatment is very simple: this ice should be applied to the affected area until it completely melts;
- epicondylitis can be treated with compresses from horse sorrel tincture. To prepare it, you need to fill a liter jar with raw materials, which is filled with vodka. The mixture needs to steep for at least a week. Using this remedy is quite simple: you need to soak a piece of cloth in the tincture and apply it to the sore joint. If the vodka is too high in strength or the patient’s skin is very sensitive, then the composition should be diluted a little with water;
- epicondylitis inside the elbow joint can also be treated with salt baths. To do this, add a tablespoon of sea salt to a liter of water. When the water has warmed up a little, dip your elbow into the liquid. The procedure takes 30 minutes. After the bath, it is advisable to wrap the joint in a warm scarf.
These are all the features of the folk treatment of epicondylitis of the elbow joint. Be healthy!
Traditional methods of treating diseases of the elbow joint
We must not forget about the methods that our ancestors used to eliminate pain in bone joints. Attention! The use of these methods should be carried out as an aid to the main treatment, and not as a replacement for it. Let's look at the most effective treatment methods. 1. Rubbing the damaged area with tinctures of Kalanchoe and propolis; 2. Drink decoctions of chamomile, dandelion or St. John's wort; 3. Apply various compresses; blue clay is considered effective; 4. Baths with pine needles or sea salt; 5. Grind honey with apple cider vinegar. By following simple rules, eating right, without injuring or loading the limb, you can not only cure diseases that may appear in the elbow joint, but also completely prevent their reappearance.
Pathogenesis
The part of the humerus that participates in the formation of the elbow joint contains small tubercles called the outer (lateral) and inner (medial) epicondyles. The tendons of the forearm muscles are attached to them. With a significant increase in the functional load on the hand flexor muscles, which are attached to the medial epicondyle, microdamage to the fibers of their tendons, as well as the bone base of the attachment area, is formed with the development of an inflammatory reaction.