Epicondylitis of the elbow joint - Causes, symptoms and treatment. MF.

Musculoskeletal system is an important body system that allows a person to move around freely, defend himself and perform other important functions for productive interaction with the environment. It is always unpleasant when some part of the skeleton, whether it be joints, muscles or bones, suffers from disease. After all, the motor function is disrupted, and, as you know, movement is life. Especially violates the quality of life such a disease as epicondylitis of the elbow joint.

The elbow joint is an anatomical formation between the bones of the shoulder and forearm. It consists of three joints between the shoulder, elbow and radial bones, surrounded by a single joint bag, which is formed by a dense connective tissue. Inside is the joint fluid.

Functionally, the joint provides forearm movements such as flexion, extension, upward rotation( supination) and downward rotation( pronation).The movements are caused by the work of the muscles, which, with the help of tendons, attach to the epicondyle of the shoulder - these are bony projections designed specifically to fix the tendons. Tendons are elastic - they are able to take the same shape after stretching. But this ability is a little delayed in time, that is, after a mechanical load on the tendon it remains in a stretched form for some small time interval. If the mechanical force acts again during this interval, then the stretched tendon is stretched, and it simply does not have time to recover. Given that the blood supply of the tendon is relatively small compared to, for example, the muscle, the restoration of fibers with constant same-type loads slows down. This can lead to the formation of microcracks, as well as changes in the structure of the epicondylitis. Epicondylitis develops, literally - inflammation of the epicondyle.

Epicondylitis of the elbow joint is a disease that occurs, as a rule, as a result of physical overloads and overstretch of the tendons, characterized by a violation of the normal structure in the region of the epicondyle, periosteum and tendon, and clinically manifested by pain syndrome.

The figure shows the semicircular elbow joint, there are tears in the area of ​​attachment of the tendon to the epicondyle.

Epicondylitis can be external and internal, respectively, with the defeat of tendons on the outside, responsible for extension in the elbow joint, and on the inside, responsible for flexion. Often found external epicondylitis, with the same frequency in men and women, mostly in individuals older than 30 - 35 years.

Causes of Epicondylitis of Elbow Sutava

The following factors may provoke the development of epicondylitis: 1. Sports. Frequent loads, prolonged training, monotonous movements invariably lead to the formation of cracks in the tendons and epicondies of the shoulder, causing degenerative changes in the tendon. The elbow joint is most often affected with professional activities such sports:
- tennis is characterized by an external epicondylitis, called "tennis elbow",
- golf - is characterized by an internal epicondylitis, called "elbow of a golfer",
- weightlifting, weightlifting,the barbell.

2. Injuries. Approximately in 25% of all cases, significant injuries in the elbow area lead to the development of epicondylitis.

3. Constant overstrain of the muscles of the shoulder and forearm in patients with certain professions. For example, pianists, drivers, machinists, milkmaids, painters, plasterers, carpenters, masseurs, porters and seamstresses often suffer from epicondylitis.

4. The presence of a patient with congenital dysplasia of the connective tissue can also contribute to the appearance of degenerative changes in the tendons of the elbow joint due to a predisposition to the initial change in the structure of connective tissue tissuesfibers.

Symptoms of epicondylitis of the elbow joint

The main manifestation of epicondylitis is pain syndrome in the muscles of the shoulder and forearm. Pain has a different character - burning, aching, pulling, blunt or sharp, and gives in a brush. With external epicondylitis, pain occurs when trying to unbend the forearm, and when the inner is flexed at the elbow joint.

Symptoms, as a rule, appear gradually - at first there are unpleasant sensations and a dyscomfort at loads on the amazed extremity, and then and in rest. Sometimes intense shooting pains occur suddenly, without previous discomfort. Often the pain syndrome is so severe that the patient finds it difficult to shake hands with a friend, take a glass, hold a spoon while eating or perform other household functions.

Acute, subacute and chronic types of the disease are distinguished along the course. The acute stage of epicondylitis is characterized by attacks of pain during exercise and at rest. When the process stops, the pain is disturbed only during the work by hand and disappears during rest - this is a subacute stage. In case the treatment was not started in time, and the symptoms persist for three months and longer, they speak of the formation of a chronic epicondylitis of the elbow joint.

In addition to pain, there is a feeling of numbness in the affected limb, a sensation of tingling or crawling. Active movements in the elbow joint are difficult, while passive flexion and extension of the forearm by another person or healthy arm does not cause painful sensations.

Diagnosis of epicondylitis

If symptoms similar to manifestations of epicondylitis occur, you should consult a traumatologist or orthopedist.

To determine the diagnosis, the questioning and examination of the patient by the doctor is crucial, as there are no deviations in the blood tests, and there are no changes on the x-ray of the elbow joint. Occasionally, signs of deposition of calcium salts in the tendon area are detected radiographically, but, as a rule, in the far-reaching stage of epicondylitis, and only in 10% of cases.

The questionnaire specifies the nature of complaints, questions related to the profession and sports, as well as the prescription of symptoms and their connection with the load on the limb.

Upon inspection, the following functional tests are performed:

- Velta test .To hold it, you need to stretch your arms forward in front of you and turn up and down the open palms of both hands simultaneously. On the affected side, there is a lag behind the healthy limb when performing movements.
- Mobility test .The doctor fixes the elbow of the patient, turning the brush to the side. Next, he suggests that the patient turn the wrist in the opposite direction, overcoming the resistance of the doctor's hand. With epicondylitis, there is an intense pain sensation.

If suspicion of epicondylitis should be excluded diseases such as osteoarthritis and arthritis of the elbow joint, fracture of the bones of the forearm and epicondyle of the shoulder. They are characterized by signs that are not observed in the epicondylitis, for example:

- passive joint movements in arthritis and arthritis are sharply painful,
- swelling and redness of the skin in the joint area are observed,
- inflammatory elements, elevated C reactive protein, positive rheumatological tests for rheumatism, rheumatoid arthritis, etc.,
- with ultrasound of the joints, the effusion in the joint cavity is determined, that is, the inflammatory fluid,
- with the radiography of the joint arthrosisIt appears interarticular gap narrowing and changes of the articular surfaces of bones and fracture - bone integrity violation and possible displacement of bone fragments.

If the doctor has prescribed additional methods of examination, and with their help, no such signs were found, then, most likely, the patient has epicondylitis. But in most cases, the patient does not need such a check to make a diagnosis.

Treatment of epicondylitis

For the greatest effectiveness, complex treatment of epicondylitis is used, which includes the following directions. First, it is the complete rest of the joint for at least 7 days, then medicamental and physiotherapy.

Medication therapy.

In addition to creating rest for the affected limb and temporary failure for 7 to 10 days from the kind of activity that caused the disease, medicines are prescribed:

- non-steroidal anti-inflammatory drugs( NSAIDs) - diclofenac( orthophene), nimesulide( nise), ibuprofen(ibuprom), meloxicam( movalis, mataren), etc., are applied twice a day for tablets and three four times a day for ointments, gels and patches on the elbow joint area, with a course of at least 10-14 days. Tableted forms are rarely used, since ointments have a fairly good effect with regular application.

- glucocorticosteroids , also possessing a strong anti-inflammatory effect( GCS) - diprospan( betamethasone), hydrocortisone and prednisolone. They are used as a single intramuscular injection in the elbow joint area, in the absence of effect, it is possible to reintroduce after a few days, but not more than two injections per course of treatment,

- local anesthetics -lidocaine, ultracaine and others. Also used in the form of injections to eliminate pain syndrome.

Physiotherapeutic procedures

These treatment methods have good efficacy. Inflamed and injured tissues are beneficially influenced by physical methods, which leads to improved blood supply and metabolism in cells, and healing processes occur much faster. Course treatment is prescribed for 7-10 days.

- pulse magnetotherapy - low-frequency magnetic impulses on the elbow joint,
- paraffin and ozocerite applications on the elbow area,
- diadynamotherapy - electric shock of different polarities,
- hydrocortisone or novocaine electrophoresis - deep uniform penetration of the molecules of the active substanceinto affected tissues,
- exposure to infrared laser radiation,
- cryotherapy - exposure to a spray of dry, cold air.

Orthopedic aids

As already mentioned, for a complete cure and reduction of unpleasant symptoms, you should create a protective regime for the limb on the side of the lesion. To do this, apply elastic bandage, bandage type kerchief, orthosis( "wristband"), fixing the arm in the upper third of the shoulder. In severe pain syndrome, the imposition of gypsum longi on the joint region can be shown. All these measures help to give the limb the most physiological position in the state of rest and reduce the burden on the tendons and muscles.

Orthosis for fixation of the extensor muscles of the forearm.

Therapeutic exercises with epicondylitis

Used to restore the function of tendons and muscles. It is appointed by the physician of medical physical culture in the absence of pain in the elbow area as the acute stage of the process subsides. The following exercises can be performed for two to three minutes each twice a day:

- the patient alternately squeezes and unclasps the wrists, holding the bent forearms at the chest level,
- flexion and extension of the forearms of both hands separately,
- alternating rotation of forearms in different directions,
- the patient connects the hands to the lock and produces flexion and extension of the forearms of both hands together,
- the patient grasps the wrist with a healthy hand and starts slowly bending it in the wrist joint, delayingWhen operating in the maximum flexion position for a few seconds,
- scissors exercises - horizontal swings with arms extended alternately right over the left and vice versa.

Any exercise should only be used as directed by the doctor who is taking the medication, because the early start of the exercise can damage the undeveloped tendons, leading to an even greater overstretch.

Folk methods of treatment of epicondylitis

Have an auxiliary value in therapy and should be applied by the patient only after agreement with the attending physician. Well proven methods of traditional medicine:

- Ointment from grass comfrey, honey and vegetable oil in proportions one to one. The oil can be replaced with lard or beeswax. Currently, this ointment can be purchased at the pharmacy. It is applied at night for seven days or more.

- Warming clay compress.200 grams of cosmetic clay purchased at the pharmacy, mixed with hot water, applied to the elbow, wrapped in several layers of gauze and woolen cloth. Compress has an effect similar to the effects of physiotherapy. Can not be used in acute stages. It is applied three times a day, each time the compress should be kept on the hand for at least an hour, replacing with a new portion of the mixture as it cools.

- Compress from spirit tincture of horse sorrel, inconvenience of which in prolonged infusion( not less than 10 days).It is prepared by mixing crushed leaves, ethyl alcohol and water.

- Frequent rubbing of the joint area with the leaves of the nettle, which must first be doused with boiling water.

Surgical treatment of epicondylitis

The operative method of treatment is used quite rarely, in the case of neglected epicondylitis, when conservative complex therapy does not help a patient to get rid of painful 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 cuts the tendon, then sits the skin over the wound.

Restoration of limb functions can begin one to two weeks after the operation.
A similar operation can be performed using a puncture instead of a cut - an arthroscopic technique controlled by special instruments, arthroscopes.

Lifestyle

In the event that it is unacceptable for a patient to change his occupation, he must follow a number of simple rules to prevent subsequent episodes of epicondylitis of the elbow joint. So, when practicing sports, you need to train in special orthoses, and before the start of training, you should "warm up" and spend a little workout, which allows improving the blood supply of muscles and tendons. When monotonous movements in the joint should be more often take breaks and massage the area of ​​the elbow before starting work.

In addition, avoid injuries, pay enough attention to proper and nutritious nutrition and lead a healthy lifestyle.

Complications and prognosis for epicondylitis

Due to the fact that the disease is easily treatable, complications develop extremely rarely, and the prognosis is favorable. In the case of a prolonged absence of therapy, bursitis of the elbow joint may develop - an inflammation of the synovial membrane, which can cause many unpleasant sensations and require surgical intervention.

Doctor therapist Sazykina O.Yu.