ᐈ Diseases of the elbow joint ~【elbow joint treatment in Moscow】

Treatment of elbow joint diseases in our clinic
Conservative treatment
Treatment of diseases of the elbow joint using the UVT method
How is the treatment procedure for elbow joint diseases performed?
Side effects in the treatment of diseases of the elbow joint
Elbow joint diseases: general information
Calcific tendinitis of the elbow joint
Elbow bursitis
Arthrosis of the elbow joint
Arthritis of the elbow joint
Clinic and diagnosis of elbow joint diseases
Conservative treatment of elbow joint diseases
Shock wave therapy for diseases of the elbow joint
SWT for diseases of the elbow joint: review of scientific literature
conclusions

Treatment of elbow joint diseases in our clinic

Our clinic has been successfully treating Achilles tendon diseases for quite a long time, using an integrated approach. Pathologies of the elbow joint are varied.

Arthrosis of the elbow joint occurs as a result of chronic microtraumas in representatives of a number of professions and athletes and is manifested by moderate pain in the elbow joint, aggravated by movement, stiffness, and often a crunching sound.

Epicondylitis of the elbow joint or “tennis elbow” most often occurs in those who are engaged in professional activities - athletes, musicians, loaders and is manifested by pain that increases with load and limited mobility.

Elbow bursitis or inflammation of the olecranon bursa often occurs as a result of injury, less often as spontaneous inflammation due to gout or diabetes mellitus and is characterized by moderate pain, swelling and swelling in the olecranon area as a result of inflammation of the bursa and fluid accumulation.

Arthritis is acute inflammation of a joint. It occurs, like bursitis, against the background of metabolic disorders in the body or after an injury and is manifested by pain, swelling and redness of the tissues around the elbow joint. The skin feels hot to the touch.

Calcific tendonitis occurs as a result of monotonous movements in the joint, accompanied by load, leading to microtrauma in the area of attachment of tendons to the bone, resulting in local inflammation and deposition of calcium salts. Accompanied by pain and swelling around the elbow joint.

1.What is a bone spur?

Bone spur or osteophyte

is a growth that forms on top of normal bone. The specific name of this phenomenon misleads many people who mistakenly believe that a bone spur is something sharp, but it is soft to the touch, a completely normal bone tumor.

Most often, osteophytes are located

on the lower or posterior surface of the heel bone, less often they are found on the shoulders, elbows, hips or knees.
As a rule, their presence is not accompanied by painful phenomena, but when they come into contact with soft tissues, bones and tendons, they can cause excruciating and severe pain.
A huge role is played by
the localization of the bone spur
. If a bone spur is located, for example, on the olecranon, then its owner will not feel discomfort or other painful manifestations, and, therefore, there is no need for its treatment. But if a bone spur has formed on the heel bone, which is used when a person walks, then over time it will cause increasingly stronger and longer-lasting pain.

Another common location for a bone spur, or osteophyte, is the shoulder area.

. The complex structure of the shoulder joint determines its versatility, the ability to move the shoulder and arm in various directions. Over time, the tendons, muscles, ligaments and bones that make up the shoulder joint begin to wear out. This process primarily affects the tendons that attach the muscles to the upper arm.

When moving, the tendons can come into contact with the bones, causing the formation of bone spurs with subsequent inflammation and pain in the affected area. This pathology is typical for older people and athletes, as well as for those who, due to their professional activities, are forced to hold their hands above their heads.

A must read! Help with treatment and hospitalization!

Conservative treatment of elbow joint diseases

We use both classical conservative approaches in the treatment of various diseases of the elbow joint, and we use new treatment methods. Conservative treatment of elbow joint pathologies is complex, depends on the nature of the disease and includes rest, rest or restriction of movements in the joint, the use of NSAIDs, injections of corticosteroid hormones into the pathological focus, physiotherapeutic procedures and exercise therapy.

The operation is used in very rare cases when the joint is completely destroyed or there is no effect from conservative therapy.

The clinic has collected an impressive arsenal of methods for restorative treatment and relief of acute and chronic pain: various methods of physiotherapy, medical massage, manual techniques and exercise therapy, methods of regenerative medicine, various types of blockades are carried out, the “dry needle” method is used, medical botulinum therapy, pharmacotherapy.

Recently, we have successfully used the shock wave therapy method as one of the most effective methods as part of complex therapy.

Treatment methods

Treatment of these formations is in most cases conservative. It includes symptomatic therapy aimed at relieving pain and inflammation, and destruction of the spur using physiotherapeutic methods. In some cases, surgery is performed.

General recommendations

The first condition when treating spurs is rest. The affected limb can be secured with an elastic bandage or bandage so as not to accidentally make a sudden movement. It is necessary to immobilize the elbow so that the spur does not injure the soft tissues. As a result, after 1-2 weeks, pain, inflammation and swelling will subside, and the doctor will be able to carefully examine the elbow joint and carry out the necessary tests.

Spurs often occur against the background of metabolic disorders, so with any destructive changes in the joints, you need to pay attention to diet. Proper nutrition will not help completely restore the cartilage or get rid of the spur, but it will prevent the cartilage from deteriorating in the future.

You can familiarize yourself with the main principles of nutrition for elbow spurs at your first appointment with a doctor:

exclude fatty, salty, smoked foods;
reduce consumption of alcohol and carbonated drinks;
pay attention to vitamins and minerals;
to restore cartilage - products containing gelatin (jellied meat, jellied dishes, jelly).

At home you can make compresses and applications that will relieve pain

If the spur does not grow and does not bother you, you don’t have to treat it. However, if you do not reconsider your lifestyle and do not pay attention to the health of your joints, it can resume growth and begin to cause pain.

Conservative methods

Spurs are mainly treated with physiotherapy. They affect tissue regeneration, improve blood supply and innervation in the damaged joint, relieve pain and swelling:

various baths (mud, mineral, paraffin);
electrophoresis;
shock wave therapy;
exposure to ultrasound or laser.

Massage helps with pain caused by a spur. The only condition is that it must be carried out by a specialist, otherwise the situation can be aggravated by incorrect actions. Massage will not remove the spur, but will restore sensitivity to the surrounding tissues. Drug treatment includes anti-inflammatory and pain-relieving tablets or injections.

ethnoscience

At home, you can relieve pain and inflammation with folk remedies. They will complement the main set of procedures:

baths with the addition of calendula, chamomile, essential pain-relieving oils;
compresses and applications with anti-inflammatory herbs or clay;
baths with soda and salt, which soften the spur.

It is worth remembering that self-medication can be dangerous. Any methods have their contraindications, including folk remedies. You need to be treated under the supervision of a doctor.

Surgical treatment of spurs

Surgery is prescribed only in extreme cases, if the spur grows and causes pain, and conservative methods do not bring results. To do this, the surgeon opens the joint and removes the bone growth using excision. This method is necessary if the bone presses on the nerves - the disease can cause loss of sensitivity in the limb.

Elbow spur is a severe condition. This location is uncharacteristic; in most cases it forms on the heel bone. Many patients live with this formation for a long time and do not feel pain. Treatment is necessary if the spur disrupts the normal functioning of the elbow joint or compresses nerves or blood vessels. Therapy in most cases is conservative, but it is necessary to consult a doctor.

Treatment of diseases of the elbow joint using the UVT method

In our clinic, focused and radial shock wave therapy is successfully used as part of the complex treatment of diseases of the elbow joint. According to numerous recent scientific publications and our practice, the UVT method has established itself as part of a complex treatment, giving good results in combination with conservative methods.

A patient visiting our clinic for the first time undergoes an initial appointment with an orthopedist-traumatologist. The doctor may need MRI and radiography of the joint, ultrasound, arthroscopy, and examination of the joint fluid obtained during joint puncture.

A course of UVT procedures is prescribed, usually from 5 to 10 procedures with an interval of 3 to 7 days.

The interval between procedures is individual and can be reduced if there are no side effects and the procedures are well tolerated. The duration of the procedure is from 20 to 40 minutes. (in some cases more).

How is the procedure for treating elbow joint diseases using the UVT method?

The procedure itself is performed in combination using focused and radial applicators. Radial shock wave is most often used at the beginning of the procedure. The radial wave is used not only when working in the joint area, but also with adjacent regions, since the pathological process often affects adjacent tissues. The radial applicator targets tissue at shallow depths and results in many beneficial long-term “tissue” effects (reduced inflammation, capillary sprouting, stem cell influx, etc.). These effects do not appear immediately, but after a fairly long period of time - from 3 weeks, and develop over several months, leading to deep tissue regeneration. The main effect of the shock wave is aimed at relieving pain and swelling, suppressing inflammation, accelerating tissue metabolism, and loosening the tissues of the affected areas.

After the radial wave, a focused wave is used, which penetrates deep into the tissue, reaching the area of pain, and causing loosening, analgesic and anti-inflammatory effects. At the same time, the doctor carefully directs the focal spot area of the device to the affected areas; when working with pain syndrome, it is important to get to the places of greatest pain, from which the procedure may cause some discomfort, which does not harm health in any way and should be perceived as a benefit. Thus, the effect of a focused wave is usually immediate and increases with each procedure, while the effect of a radial wave is delayed, noticeable from the 3rd week onwards.

Side effects in the treatment of diseases of the elbow joint

The procedure is well tolerated; mild side effects sometimes manifest themselves in the form of pain and slight swelling at the procedure site and disappear by the 2nd day after the procedure. Based on the experience of our clinic, we can say that pain and stiffness in the joint are relieved in most cases by the 4th - 7th procedure. Tissue regeneration, as a consequence of the effects of radial wave application, provides a longer delayed positive effect after completion of the course of treatment.

Elbow epicondylitis (Golfer's Elbow, Tennis Elbow)

Security mode

Therapeutic tactics depend on the duration of the disease, the severity of clinical symptoms and the causes of tendon overload.
For fresh epicondylitis with mild pain, it is sometimes sufficient to prescribe a protective regimen that excludes certain movements of the limb. If epicondylitis occurs due to professional overload, the patient is issued a sick leave. If the cause of the disease is sports activities, it is recommended to temporarily stop training. After the pain disappears, the load is gradually increased. To prevent relapse, it is necessary to establish what caused the muscle overload. Patients are advised to pay attention to the technique of performing stereotypical movements, use other tools, take regular breaks during work, review their training regimen, etc. Sometimes the listed measures are sufficient to eliminate the symptoms of the disease and prevent relapses. If this method is ineffective, as well as with intense pain and prolonged epicondylitis, more active treatment is necessary.

Drug therapy

The arm is provided with complete rest by applying a splint and hanging the limb on a scarf. After the pain has reduced, the plaster is removed, and patients are advised to use topical NSAIDs. NSAIDs in tablets are usually not prescribed, since the risk of side effects (irritation of the stomach wall) outweighs the potential of anti-inflammatory therapy.

In case of persistent sharp pain, blockade of the affected area is carried out with solutions of glucocorticosteroids. The best option for epicondylitis is blockade with betamethasone, since this drug does not cause increased pain immediately after the blockade and does not provoke degenerative changes in tissue at the injection site. Betamethasone can be replaced with methylprednisolone or hydrocortisone, but in this case the patient must be warned that the pain will intensify on the first day after the blockade, and only then will relief come.

The use of triamcinolone for epicondylitis is contraindicated, since this drug, when administered subcutaneously, can cause disruption of skin pigmentation and the formation of adhesions between the skin and the underlying tissues (in this case, the surface of the condyle of the humerus).

Elbow joint diseases: general information

Diseases of the elbow joint are a group of pathological conditions that develop as a result of injuries, inflammatory or degenerative (gradual destruction of joint tissue) processes. This includes a number of diseases with different etiologies.

Epicondylitis of the elbow joint

The cause of the development of epicondylitis of the elbow joint or “tennis elbow” most often becomes professional activity. The disease often occurs in athletes, musicians, loaders and miners.

Calcific tendinitis of the elbow joint

Monotonous movements in the joint, accompanied by load, lead to microtrauma in the area where the tendons attach to the bone, resulting in local inflammation. If the tissues do not have time to recover, inflammation intensifies, areas of compaction appear, calcium salts are deposited - calcific tendinitis or inflammation of the tendons develops.

Elbow bursitis

Bursitis of the elbow joint or inflammation of the bursa in the area of the olecranon often occurs as a result of injury, less often as spontaneous inflammation due to gout or diabetes, treatment with corticosteroid hormones - aseptic bursitis, or infection from chronic foci in the body (tonsillitis, dental caries) - septic bursitis.

Rice. 1. In the diagram: bursitis of the elbow joint

Arthrosis of the elbow joint

Arthrosis of the elbow joint occurs as a result of chronic microtraumas in representatives of a number of professions and athletes. The mechanism of its development is exactly the same - microdamages in the cartilage do not have time to heal, they are replaced by scar tissue, then the surrounding ligaments and capsule are involved in the process, and the joint is gradually destroyed.

Arthritis of the elbow joint

Arthritis is acute inflammation of a joint. It occurs, like bursitis, against the background of metabolic disorders in the body or after injury, as well as as a result of the introduction of microorganisms from foci of infection in the body.

Why do spurs appear on the elbow?

Bone growth is a slow process. This pathology is never primary, that is, the spur will not appear on an initially healthy elbow joint. Factors that trigger bone growth include various diseases or injuries to the elbow.

Most patients have a history of at least one of the following:

arthrosis or arthritis:
joint bone fractures;
elbow dislocations:
sprains or tears of ligaments and tendons.

The incidence of elbow spurs in older people can be explained by metabolic disorders in the body. The cavity of the elbow joint is lined with cartilage, which acts as a shock absorber and prevents friction of the elbow bones when moving the arm. Normally, articular cartilage should be strong and elastic, but with age it begins to break down. In this case, the main load falls not on the cartilage, but on the surface of the bones of the joint. The body turns on compensatory mechanisms and replaces the lost cartilage tissue with bone tissue.

People whose profession involves manual work are at risk. These could be mechanics, builders, musicians or conductors. Sports also affect the functionality of the joint, especially those types that involve the hands (tennis, volleyball, basketball). In some patients, spurs may appear due to a bruise or fall on the elbow, which they no longer remember at the time of their appointment with the doctor.

Clinic and diagnosis of elbow joint diseases

Epicondylitis of the elbow joint is manifested by pain that increases with exercise and limited mobility. With external (lateral) epicondylitis, the pain syndrome is localized along the outer surface of the joint and radiates to the outer surface of the forearm. If there is pathology of the internal (medial) epicondyle, then the pain, accordingly, is localized along the inner surface.

Rice. 2. Classification of epicondylitis

Symptoms of bursitis are moderate pain, swelling and swelling in the olecranon area as a result of inflammation of the bursa and fluid accumulation.
With arthrosis, patients are bothered by moderate pain in the elbow joint, which intensifies with movement, stiffness, and a crunching sound often appears.
Arthritis is characterized by pain, swelling, and redness of the tissue around the elbow joint. The skin feels hot to the touch.

Diagnosis is based on complaints and external examination. An X-ray of the joint is performed, which can reveal changes on the articular surfaces due to arthrosis, and deposits of calcium salts due to calcific tendinitis. With bursitis, ultrasound helps in diagnosis - it detects fluid in the synovial bursa (bursa), tissue compaction and an increase in the amount of fluid in the joint cavity during arthritis.

Symptoms

A spur is a convexity of various shapes. The symptoms it will cause depend on its size, location and structure. While it is small, it does not injure soft tissues and does not bother the patient.

Further development of the disease can occur in one of the following ways:

The spur does not increase in size and does not cause pain. It can exist in this form throughout life. Such formations do not require treatment.
The spur is large, flat in shape. In most cases, it does not interfere with normal joint movement and does not cause pain. If it grows quickly, treatment is necessary.
A large spur in the form of a thorn is the most serious option. Such a formation will interfere with normal flexion and extension of the limb at the elbow and cause pain when moving. In this case, urgent treatment is required.

If the spur causes pain, it is better to fix the elbow with a bandage or bandage.
The spur itself cannot cause pain, since it consists of insensitive bone tissue. If it puts pressure on the surrounding soft tissue, compresses blood vessels and nerves, injures synovial bursae, the disease is accompanied by intense pain. Inflammation and swelling develop around the spur, and the elbow becomes inactive.

Conservative treatment of elbow joint diseases

Treatment of elbow joint pathologies includes:

rest or limitation of movements in the joint;
anti-inflammatory therapy - NSAIDs (non-steroidal anti-inflammatory drugs) in the form of ointments or tablets;
injections of corticosteroid hormones into the pathological focus;
physiotherapeutic procedures;
exercise therapy;
Spa treatment.

The operation is used in rare cases when the joint is completely destroyed or there is no effect from conservative therapy.

Recently, we have successfully used the shock wave therapy method as one of the most effective methods as part of complex therapy.

Shock wave therapy for diseases of the elbow joint

The procedure itself is performed in combination using focused and radial applicators. A radial shock wave is most often used at the beginning of the procedure, a focused one at the end.

Shock waves cause the following therapeutic effects in tissues:

blood circulation improves due to the dilation of blood vessels and the formation of new capillaries;
anti-inflammatory substances are produced;
pain receptors are affected, endorphins are released into the tissues;
tissue swelling decreases due to improved fluid outflow through blood and lymphatic vessels;
softening of fibrous and scar tissue occurs, loosening of calcium deposits.

Together, shock waves lead to a reduction in inflammation, relief of pain and restoration of tissue of the elbow joint.

SWT for diseases of the elbow joint: review of scientific literature

A group of Polish researchers compared the effects of radial and focused shock waves on tennis elbow.

50 patients were divided into two groups:

Group 1 received 3 focused shock wave therapy treatments. Group 2 received 3 sessions of radial shock wave therapy.

As a result of treatment, patients from both groups noted a pronounced effect of pain relief. Objectively, there was an increase in the strength of the flexor and extensor muscles.

Based on their study, the authors concluded that the technique is highly effective in the treatment of tennis elbow. However, they did not find any differences in the choice of physical parameters of the wave generator.

Scientists from Germany tested the effectiveness of shockwave therapy in relieving pain in chronic epicondylitis. 100 patients took part in the study. They underwent 3 sessions of shockwave therapy with an interval of 1 week.

After the course of therapy, all patients noted a significant improvement in their well-being - pain was relieved, mobility in the joint improved, and an increase in the strength of the flexor and extensor muscles was noted.

A group of Chinese scientists compared the results of shock wave therapy for tennis elbow with the use of ultrasound. All patients were divided into two groups:

Group 1, consisting of 115 patients, received SWT treatment. Group 2 (118 patients) received ultrasound treatment.

At the end of the course of therapy, scientists noted statistically more significant changes in group 1 - a pronounced decrease in the intensity of pain and a significant increase in the range of motion in the joint. After 6 months, the differences became even more pronounced - patients in group 1 had much less pain relapses.

Fracture of the olecranon

Surgery for olecranon fractures is indicated in the following cases:

Displacement of bone fragments (displaced fractures)
Perforations with bone fragments of skin (open fractures)

The operation usually consists of eliminating the displacement of the fragments and creating conditions so that they do not move until fusion occurs.

Due to the high risk of infectious complications with open fractures, surgery should be performed as soon as possible, usually in the first hours after the injury. In the emergency department, such patients are prescribed antibiotic prophylaxis (intravenously) and tetanus prophylaxis. During the operation, the wound and bone fragments are carefully treated. Reduction and fixation of bone fragments are usually performed simultaneously with treatment of the fracture.

Surgical Treatment Options

Open reduction and internal fixation. This is the most common treatment for olecranon fractures. During such an operation, bone fragments are compared with each other and fixed in their normal position with screws, wires, knitting needles or metal plates.

Below are some of the most commonly used methods of olecranon fixation.

Fixation of an olecranon fracture with knitting needles and a tightening wire loop

( Left ) A single screw that is inserted into the medullary canal can be used to fix an olecranon fracture. ( Right ) Fracture fixation with plate and screws.

Bone grafting . In cases of open fractures, some bone fragments may be lost or they may be significantly fragmented. In such cases, bone grafting is necessary to fill the bone defects. Donor bone or the patient's own bone (most often from the pelvic bone) can be used as a plastic material. In some cases, artificial bone substitutes may be used.

Removal of a bone fragment . If the bone fragment is too small and cannot be fixed, sometimes it has to be removed. In this case, the triceps tendon attached to the fragment is refixed to the remaining part of the ulna.

Results of the operation

Most patients return to normal life within approximately 2-3 months after injury, but full recovery may take more than half a year. Restoring strength to the hand often takes longer than expected.

Despite the presence of radiological evidence of fracture healing, many patients still report limited elbow function. Over time, elbow function usually improves in these patients.

conclusions

Elbow joint diseases are serious conditions that require special attention from doctors and patients. In athletes and representatives of a number of professions, chronic epicondylitis can lead to loss of ability to work, and in some cases to disability.

Medicine uses different directions in the treatment of diseases of the elbow joint. However, their effectiveness remains insufficient, especially in chronic epicondylitis, arthritis and other degenerative processes.

In our clinic, focused and radial shock wave therapy is successfully used as part of the complex treatment of diseases of the elbow joint. The complex effect on tissue provides anti-inflammatory and analgesic effects, and restores mobility in the joint.

The technique does not require anesthesia, preparation and subsequent rehabilitation; there are no side effects or complications. In this case, the course of treatment usually requires 3 sessions, and patients note rapid relief of pain and restoration of mobility in the joint. These effects persist at long-term follow-up.

Researchers from different countries have noted the high effectiveness of the use of shockwave therapy in the treatment of diseases of the elbow joint.