 of the forearm muscles, preventing their atrophy.
If the pain syndrome in epicondylitis is not clearly expressed, and the patient goes to the doctor mainly in order to find out the cause of unpleasant sensations in the elbow joint, it will be enough to recommend the patient to observe a protective regime – that is, to closely monitor his own feelings and exclude movements in which pain appears.
If a patient with epicondylitis is engaged in sports or his work is associated with heavy physical exertion on the muscles of the forearm, it is necessary to ensure rest of the affected area for a while. The patient is given a sick leave or recommended to temporarily stop training. After the pain disappears, the load can be resumed, starting with a minimum and gradually increasing. In addition, the patient is recommended to find out and eliminate the cause of overload: revise the sports regime, use more convenient tools, change the technique of performing certain movements, etc. With a chronic course of epicondylitis with frequent exacerbations, patients are advised to stop playing sports or switch to another job, limiting the load on the forearm muscles.
With severe pain syndrome in the acute stage of epicondylitis, short-term immobilization is necessary. A light plaster or plastic splint is applied to the elbow joint for a period of 7-10 days, fixing the bent elbow joint at an angle of 80 degrees and hanging the arm on a kerchief bandage. In the chronic course of epicondylitis, the patient is recommended to fix the elbow joint and the forearm area with an elastic bandage during the day. At night, the bandage must be removed.
If the symptoms of epicondylitis appeared after the injury, cold should be applied to the affected area during the first days (an ice bubble wrapped in a towel). Patients suffering from epicondylitis in the acute period are prescribed physiotherapy: ultrasound, phonophoresis (ultrasound with hydrocortisone), paraffin, ozokerite and Bernard currents.
At the end of the acute phase of epicondylitis, the patient is prescribed electrophoresis with potassium iodide, novocaine or acetylcholine, UHF and warming compresses on the affected area. In addition, starting from this moment, the patient with epicondylitis is shown therapeutic gymnastics – repeated short-term overextension of the hand. Such movements help to increase the elasticity of connective tissue structures and reduce the likelihood of subsequent microtrauma. In the recovery period, massage and mud therapy are prescribed to restore the volume of movements and prevent muscle atrophy.
Pain syndrome in epicondylitis is caused by an inflammatory process in soft tissues, therefore, nonsteroidal anti-inflammatory drugs have a certain effect in this disease. NSAIDs are used topically, in the form of ointments and gels, since inflammation in epicondylitis is local. Administration of nonsteroidal anti-inflammatory drugs orally or intramuscularly in modern traumatology and orthopedics in epicondylitis is not practiced due to their insufficient effectiveness and unjustified risk of side effects.
With persistent pain that does not weaken for 1-2 weeks, therapeutic blockades with glucocorticosteroids are performed: betamethasone, methylprednisolone or hydrocortisone. It should be borne in mind that when using methylprendisolone and hydrocortisone during the first day, there will be an increase in pain due to the reaction of tissues to these drugs.
A glucocorticosteroid drug is mixed with an anesthetic (usually lidocaine) and injected into the area of maximum soreness. With external epicondylitis, the choice of the injection site is not difficult, the blockade can be carried out in the patient’s position both sitting and lying down. In case of internal epicondylitis, the patient is placed on a couch face down with his arms stretched out along the body to carry out the blockade. This position ensures the accessibility of the area of the internal condyle and, unlike the sitting position, eliminates accidental damage to the ulnar nerve during the procedure.
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