ps more often in men.
Internal (medial) epicondylitis, which is also called golfer’s elbow, occurs with repetitive movements of low intensity and develops mainly in people engaged in light physical labor – seamstresses, typists, etc. The disease is more often observed in women.
As a result of chronic overload and repeated microtrauma, a degenerative process develops in the tendon tissue, accompanied by inflammation of the surrounding tissues. Small scars are formed, which further weaken the resistance of the tendon to loads, which, in turn, contributes to an increase in the number of micro-injuries. In some cases, the symptoms of epicondylitis occur after a direct injury. Congenital weakness of the ligamentous apparatus increases the risk of developing this disease and causes its more severe course.
With lateral epicondylitis, there is clearly localized pain on the outer surface of the elbow joint, which occurs when the hand is extended and rotated outward. In the study of muscle strength, the weakening of the muscles on the diseased side is determined when the hand rotates outward and resists capture. The text of the coffee cup (pain when trying to lift a cup filled with liquid from the table) is usually positive. When pressing on the lateral condyle, obvious, but not acute soreness is determined.
With medial epicondylitis, the pain is localized along the inner surface of the elbow joint. In the study of muscle strength, there is a weakening of the muscles on the sick side when grasping. There is an increase in pain when pronating at right angles and bending the forearm with resistance. Palpation determines soreness and tightness in the lower part of the medial condyle. The milking test (increased pain during simulated milking) is positive.
The diagnosis of epicondylitis is made on the basis of patient complaints and external examination data. Additional research is usually not required. Differential diagnosis of epicondylitis is carried out with diseases of the elbow joint itself (aseptic necrosis of articular surfaces, arthritis) and tunnel syndromes: (cubital canal syndrome – infringement of the ulnar nerve and circular pronator syndrome – infringement of the median nerve). Usually, the diagnosis does not cause difficulties.
With arthritis, pain occurs in the area of the elbow joint itself, and not in the area of the condyle, while it is more “blurred”, and not localized in a well-defined area. Flexion contracture of the elbow joint may develop. When the nerves are pinched, neuritis and neurological symptoms characteristic of it are observed – there are sensitivity disorders in the innervation zone and a decrease in the strength of the innervated muscles.
If epicondylitis develops in young people, joint hypermobility syndrome (HMS), caused by congenital weakness of connective tissue, should be excluded. To do this, the doctor studies the history of life, paying attention to the frequency of sprains, tendinitis, acute and chronic arthralgia and back pain. In addition, the presence of HMS can be indicated by longitudinal and transverse flat feet, as well as an increase in joint mobility.
Additional research methods for the diagnosis of epicondylitis are usually not used. In some cases, radiography is performed to exclude traumatic damage (fracture of the condyle). If differential diagnosis between epicondylitis and tunnel syndrome is difficult, an MRI may be prescribed. If inflammatory diseases of the joints are suspected, a blood test is performed to exclude signs of acute inflammation.
Treatment is carried out on an outpatient basis by an orthopedic traumatologist. The scheme and methods of treatment of epicondylitis are determined taking into account the severity of functional disorders, the duration of the disease, as well as changes in the muscles and tendons. The main goals of treatment:
- Elimination of pain syndrome.
- Restoration of blood circulation in the affected area (to ensure favorable conditions for the restoration of damaged areas).
- Restoration of the full range of movements.
- Restoring the strength