e 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.
With conservative therapy without the use of glucocorticosteroids, the pain syndrome in epicondylitis is usually completely eliminated within 2-3 weeks, during blockades – within 1-3 days. In rare cases, persistent pain is observed, which does not disappear even after injections of glucocorticosteroid drugs. The probability of such a course increases with chronic epicondylitis with frequent relapses, joint hypermobility syndrome and bilateral epicondylitis.
If the pain syndrome persists for 3-4 months, surgical treatment is indicated – excision of the affected areas of the tendon in the area of its attachment to the bone. The operation is performed as planned under general anesthesia or conduction anesthesia. In the postoperative period, a splint is applied, the stitches are removed after 10 days. Subsequently, rehabilitation therapy is prescribed, including physical therapy, massage and physiotherapy procedures.