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 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, th