Epicondylitis of the elbow - Causes, Symptoms and Treatment .MF .
Musculoskeletal system - this is an important system of the body, allowing the person to move freely and to defend and carry out other important functions for productive interaction with the environment.Always frustrating when some part of the skeleton, whether the joints, muscles or bones, suffering from disease.It is broken motor function, as is well known, the movement - that's life.Especially it violates the quality of life such diseases as epicondylitis of the elbow joint.
elbow joint - this anatomical structures between the bones of the arm and forearm.It consists of three joint between the humerus, ulna and radius, surrounded by a single joint capsule, which is formed by dense connective tissue.Inside is the joint fluid.
Functionally, the joint motion of the forearm provides such as flexion, extension, rotation upward (supination) and rotating downward (pronation).Movement due to the work of the muscles, which with the help of the tendons attached to the shoulder epicondyle - a bony projections
epicondylitis of the elbow joint - a disease that occurs usually as a result of physical overloads and distension of the tendon, characterized by disturbance of normal structure in the epicondyle, periosteum and tendons, and clinically manifested by pain syndrome.
The figure depicts a semi-schematic elbow, seen tears in the tendon attachment to the epicondyle.
epicondylitis may be external and internal, respectively, with the defeat of the tendons on the outside, responsible for the extension of the elbow joint, and on the inside, are responsible for flexing.More common external epicondylitis, with equal frequency in men and women, mostly in people older than 30 - 35 years.
reasons epicondylitis of the elbow sutava
epicondylitis can trigger the development of the following factors:
1. Sports.Frequent load, prolonged exercise, repetitive motion invariably lead to the fact that the shoulder tendons and epicondyle formed cracks that cause degenerative changes in the tendon.Most commonly affects the elbow with professional occupations such sports:
- Tennis - typical external epicondylitis, called "tennis elbow»,
- Golf - typical internal epicondylitis, called "elbow golfer»,
- weight lifting, weightlifting, playing withpole.
2. Injuries.Around 25% of all cases of significant trauma in the elbow area lead eventually to the development of epicondylitis.
3. Continuous overvoltage and shoulder muscles of the forearm in patients with certain professions.For example, often suffer from epicondylitis pianists, drivers, machine operators, milkmaids, painters, plasterers, carpenters, massage therapists, porters, and the seamstresses.
4. To promote the emergence of the disease may be continuous carrying heavy bags, household chores activity such as sawing wood, painting surfaces, and others. The presence in the patient of congenital dysplasia of the connective tissue may also contribute to degenerative changes in the tendons of the elbow due to the predisposition to change the original structureconnective tissue fibers.
Symptoms of epicondylitis of the elbow
main manifestation epicondylitis is pain in the muscles of the arm and forearm.Pain is a different character - a burning, aching, pulling, dull or sharp, and gives to the brush.The external epicondylitis pain occurs when you try to straighten the forearm, and at home in flexion of the elbow.
Symptoms usually appear gradually - first, there are unpleasant sensations and discomfort in the affected limb loads, and then alone.Sometimes intense shooting pains occur suddenly, without prior discomfort.Often the pain is so pronounced that the patient is difficult to shake the hand of a friend, take a glass, hold the spoon when eating or performing other household functions.
Adrift distinguish between acute, subacute and chronic types of disease.For the acute phase epicondylitis is characterized by attacks of pain with exercise, and at rest.In the process of calming the pain disturb only when the hand and disappear during the rest - it's subacute stage.If the treatment was not initiated in a timely manner, and the symptoms persist for three months or longer, talk about the formation of chronic epicondylitis of the elbow joint.
In addition to pain, characterized by numbness of the affected limb, tingling or pins and needles.Active movements hampered by the elbow, while the passive flexion and extension of the forearm by another person or a healthy arm pain do not cause.
If you have symptoms similar to symptoms of epicondylitis, should consult a doctor or an orthopedic traumatologist.
For diagnosis crucial inspection and survey the patient's physician, since deviations in blood tests is not observed, and the elbow joint radiographs are no changes.Sometimes symptoms detected radiographically calcium deposits in the tendon, but usually at an advanced stage of epicondylitis, and only in 10% of cases.
In a survey clarifies the nature of the complaints, issues related to the profession and sport, as well as the remoteness of the onset of symptoms and their relation to the load on the limb.
On examination, the following functional tests are carried out:
- Test Velta .For his conduct is necessary to pull the hands forward in front of you and turn up and down the open palms of both hands simultaneously.On the affected side are lagging behind from when the healthy limb movements.
- Test for mobility .The doctor records the patient's elbow, turning the wrist to the side.Further, it offers the patient to turn the brush in the opposite direction, overcoming the resistance of the doctor's hands.When epicondylitis occurs intense pain.
If you suspect epicondylitis should be eliminated diseases such as osteoarthritis and arthritis of the elbow, a broken forearm and shoulder epicondyle.They are characterized by symptoms that are not observed in epicondylitis, for example:
- inflammatory elements are determined in blood tests, increased C reactive - passive motion in the joint arthrosis and arthritis sharply painful,
- there are swelling and redness in the joints,
protein positive rheumatologic tests for rheumatism, rheumatoid arthritis, and others,
- ultrasound of the joints is determined by effusion in the joint cavity, that is, inflammatory fluid,
- at joint radiographic osteoarthritis is manifested narrowing interarticular cracks and changes in the articular surfaces of bones and fracture - violationintegrity of bone and possible displacement of bone fragments.
If your doctor has prescribed additional examination methods, and with their help, there was no evidence of such symptoms, then most likely, the patient epicondylitis.But in most cases, the diagnosis of the patient in such a survey is not needed.
Treatment of epicondylitis
apply comprehensive treatment of epicondylitis, which includes the following areas to achieve maximum efficiency.Firstly, it is a complete joint rest at least 7 days, followed by medication and physiotherapy.
In addition to creating the rest of the affected limb and the temporary denial of 7 - 10 days of occupation, cause of the disease, medicinal products are prescribed:
- non-steroidal anti-inflammatory drugs (NSAIDs) - diclofenac (Ortophenum) Nimesulide (Nise), ibuprofen (Ibuprom), meloxicam (movalis, Mataro), etc., are used twice a day for the tablets, and three to four times a day for ointments, gels and patches on the elbow, a course of at least 10 - 14 days.Tablet forms are rarely used as an ointment have quite a good effect when used regularly.
- glucocorticosteroids , also have strong anti-inflammatory effect (GCS) - diprospan (betamethasone), hydrocortisone and prednisone.Used as a single intramuscular injection in the elbow, in the absence of the effect of possible re-introduction of a few days, but no more than two injections per course of treatment,
- local anesthetics - lidocaine, articaine and others.Also used as an injection for treating pain syndrome.
These treatments have good efficiency.Traumatized and inflamed tissue is beneficial effects of physical methods, which leads to improved blood circulation and metabolism in the cells and healing processes proceed much faster.Appointed exchange treatment is 7 - 10 days.Apply:
- pulsed magnetic therapy - exposure to low frequency magnetic pulses on the elbow,
- paraffin and ozokerite applications on the area of the elbow,
- diadynamic - impact electric current of different polarity,
- electrophoresis using hydrocortisone or novocaine - deep uniform penetration of molecules actingsubstance into the affected tissue,
- infrared laser radiation exposure,
- cryotherapy - exposure to dry cold air stream.
As has been said, for complete cure and reduce unpleasant symptoms should create a protective regime for the limbs on the affected side.To do this, apply an elastic bandage, bandage on headscarves type brace ( "wristband"), the locking arm in the upper third of the shoulder.At strongly expressed painful syndrome can be shown on the imposition of a plaster splint the joint area.All these measures help to make the most physiological limb position at rest and reduce the strain on tendons and muscles.
brace for fixing the muscles - the extensor forearm.
Physiotherapy at epicondylitis
is used to restore the function of the tendons and muscles.Appointed physiotherapy physician in the absence of pain in the elbow as subacute stage.Can perform the following exercise lasting two - three minutes each twice a day:
- patient alternately compresses and decompresses the hand holding the bent forearm at chest level,
- flexion and extension of the forearms of both hands separately,
- alternating rotation of the forearms at varioushand,
- patient joins hands in the castle and produces flexion and extension of the forearms of both hands together,
- patient grabs the brush with his good hand and slowly begins to bend it at the wrist joint, holding the position of maximum flexion for a few seconds,
- exercise "scissors"- horizontal waving outstretched arms alternately right over left, and vice versa.
Any exercise should only be prescribed by a doctor providing treatment as premature start of classes can hurt yet to recover tendons, leading to further their hyperinflation.
Traditional methods of treatment of epicondylitis
are auxiliary in the treatment of the patient and should be applied only after consultation with your doctor.Well established methods such traditional medicine:
- ointment of the herb comfrey, honey and vegetable oil in the ratio of one to one.The oil can be replaced with fat or beeswax.Currently this ointment can be purchased at the pharmacy.It is used at night for seven days or more.
- Warming poultice of clay.200 grams of cosmetic clay, purchased at the pharmacy, mix with hot water, apply to the elbow, wrap in several layers of cheesecloth and woolen cloth.The wrap has an effect similar to the effects of physiotherapy.Do not use in the acute stage.It is used three times a day, each time a compress should be kept on hand for at least an hour, as the cooling of replacing a new portion of the mixture.
- compress alcohol tincture sorrel, which is a disadvantage in the long insisting (minimum 10 days).It is prepared by mixing shredded leaves, ethyl alcohol and water.
- Frequent rubbing the joints of nettle leaves, which had previously been necessary to pour over boiling water.
Surgery treatment of epicondylitis
Operative treatment method is used very rarely, in the case of running epicondylitis where conservative complex therapy does not help the patient get rid of the excruciating pain in his hand for six months or more.Then, this operation is performed - a small incision is made on the back surface of the forearm and the doctor incised tendon, then sutured the skin over the wound.
recovery functions limb can begin in one - two weeks after the operation.
This operation can be performed using the puncture instead of cut - arthroscopic procedure under the control of special instruments, arthroscopy.
If the patient is not acceptable to change the type of activity, it is necessary to observe a few simple rules to prevent subsequent episodes epicondylitis of the elbow joint.So, in sports need to train in special splints, and before the start of training should be "warmed up" and have a little workout, helps to improve blood flow to the muscles and tendons.When repetitive movements in the joint should frequently take breaks and massage the area of the elbow before starting work.
In addition, to avoid injury, pay sufficient attention to the right and nutritious food and a healthy lifestyle.
Complications and prognosis of epicondylitis
Due to the fact that the disease is easily treatable complications occur rarely, and the prognosis is favorable.In case of prolonged absence of therapy can develop elbow bursitis - inflammation of the synovial membrane, which can cause a lot of discomfort and require surgical intervention.
therapists Sazykina OJ