Lateral epicondylitis is an inflammation in the area of attachment of muscles to the external condyle of the shoulder. The disease occurs due to muscle overstrain. It develops gradually. Accompanied by a decrease in the strength of the extensors of the hand and fingers, burning or pain on the outer surface of the elbow. The diagnosis is made on the basis of clinical data, during differential diagnosis, radiography and other instrumental studies can be prescribed. Treatment is usually conservative: rest, analgesics, anti–inflammatory drugs, followed by special exercises. With a long course and ineffectiveness of conservative therapy, surgical operations are performed.
M77.1 Lateral epicondylitis
Lateral epicondylitis is an inflammatory process of the elbow area, in the place where the muscles attach to the outer condyle of the shoulder. In traumatology and orthopedics, a fairly widespread pathology is more often detected at the age of 30-50 years. Mostly athletes and people who, due to household or professional duties, often have to perform intensive repetitive movements with their hands are ill. As a rule, the “leading” limb suffers – the left one for left-handers and the right one for right-handers. In some cases, both upper limbs are affected.
Lateral epicondylitis is often a consequence of incorrect hitting technique when playing tennis, so the disease is called “tennis player’s elbow”. However, this disease affects not only athletes, but also people who have to hold an unbent arm in the air for a long time or repeatedly lift something with a straightened brush. Lateral epicondylitis can occur in painters, artists, carpenters, gardeners, butchers, cooks, car mechanics and people who perform similar work in everyday life (for example, in the country).
The lateral condyle is a small tubercle located slightly above the elbow joint on the outer surface of the humerus. This anatomical formation is the place of attachment of several muscles: the short radial extensor of the hand, the elbow extensor of the hand, the extensor of the little finger and the extensor of the fingers, which in the upper part are connected into one common tendon. With repetitive movements (usually lifting something with an extended hand), the tendon begins to suffer from constant overload. Microfractures are formed in its tissue. Due to microtrauma, the tendon becomes inflamed, damaged cells are replaced by connective tissue. There is a gradual degeneration of the tendon – it increases in volume and, at the same time, becomes more vulnerable under stress.
The disease develops gradually, there is usually no history of trauma. Initially, patients report unpleasant sensations or minor unstable pain in the elbow area. Subsequently, the pain syndrome progresses, the pain becomes constant, gives in the forearm, prevents the performance of household or professional duties. The strength of the extensor muscles of the fingers and hand decreases. On examination, the elbow area is not changed, there is no swelling and hyperemia. Movements in full. Palpation is determined by soreness on the outer surface of the elbow with a maximum at a point located slightly outwards and anteriorly from the outer condyle.
The diagnosis is established on the basis of a characteristic anamnesis and the clinical picture of the disease. During the examination, osteochondropathy, elbow arthritis, compression neuropathy of the posterior interosseous or radial nerve and cervical radiculopathy are excluded. To assess the condition of bone structures, an elbow joint is radiographed – there are usually no changes in epicondylitis. To identify pathology from the peripheral nerves, a neurologist’s consultation, cervical spine x-ray and electrophysiological examination (EMG, ENG) are prescribed.
Treatment is usually conservative, carried out by an orthopedic traumatologist. The goal of therapy is to eliminate inflammation, relieve pain and strengthen muscles. At the initial stage, NSAIDs and cryotherapy are used, it is recommended to limit the load on the joint. In some cases, orthoses are used. Subsequently, physical therapy classes are prescribed, which include isometric exercises at first, and then eccentric and concentric exercises. With persistent pain syndrome, blockades are performed by injecting glucocorticosteroid drugs into the inflamed area.
In lateral epicondylitis, four techniques are used: Goymann’s laxative operation (tendon incision), excision of altered tissues with subsequent fixation of the tendon to the bone, removal of the synovial sac together with the annular ligament and tendon elongation. The operation is performed as planned in an orthopedic or traumatology department under conducting anesthesia or general anesthesia. After surgery, a plaster is applied to the arm, and physical therapy is prescribed in the postoperative period. Resistance exercises are allowed to be performed a month after surgery.
The outcome of conservative therapy and surgical treatment of lateral epicondylitis is usually favorable. More than 90% of patients are completely cured and return to their previous loads. With conservative therapy, symptoms usually disappear after 3-4 weeks, the resumption of significant loads is possible after a few months. The recovery period after surgery also lasts several months. In some cases, muscle weakness occurs after surgical treatment, motor activity is slightly or moderately limited (for example, when lifting weights).
Prognosis and prevention
Prevention of lateral epicondylitis in tennis players includes practicing the correct technique of hitting, using suitable equipment and fixing the elbow with an elastic bandage. People who perform repetitive movements with their hands are recommended to improve the ergonomics of the workplace, take breaks during work and, if possible, limit the load on the extensor muscles.