Medial epicondylitis is an inflammatory process in the area of attachment of muscles to the inner condyle of the humerus. Develops due to overloading of the pronator muscles and flexors of the hand. The beginning is gradual. It is accompanied by unpleasant sensations or pain on the inner surface of the elbow joint with irradiation in the forearm. The pain increases with exertion. Muscle strength is preserved or slightly reduced. In 50%, the ulnar nerve is involved in the process. The diagnosis is made on the basis of anamnesis and characteristic symptoms. To exclude other pathological processes, radiography, ultrasound, and MRI are prescribed. Treatment is usually conservative: load limitation, cold, exercise therapy and physiotherapy. In case of inefficiency, the operation is shown.
M77.0 Medial epicondylitis
Medial epicondylitis is an inflammation in the area of the inner condyle of the shoulder, at the place of attachment of the flexor muscles and pronators of the hand. In practical traumatology and orthopedics, it has been noted that medial epicondylitis occurs less frequently than lateral epicondylitis. The development of the disease is caused by sports loads or professional duties involving the performance of multiple flexion or rotational movements with the brush. Men aged 30-50 are more likely to get sick. Usually the dominant limb suffers (in right–handed people – the right hand, in left-handed people – the left). Medial epicondylitis is treated by orthopedic traumatologists.
The occurrence of medial epicondylitis, as a rule, is caused by characteristic sports loads. The disease can be detected in golfers, baseball players, swimmers, fencers, people engaged in arm wrestling, and athletes who often perform throwing movements. Sometimes the cause of medial epicondylitis is the performance of professional duties. Usually the disease develops in people who are engaged in heavy physical labor: movers, loggers, builders, carpenters, etc.
The medial condyle is a small bump in the lower part of the humerus. Located on the inner surface of the elbow joint, it is the place of attachment of the tendons of the muscles involved in flexion and pronation of the hand. With repeated movements due to overload, micro-tears form in the tendon tissue, inflammation occurs. Over time, dystrophic changes develop in the area of tendon attachment. A full-fledged tendon tissue capable of withstanding high loads is replaced by a less durable scar tissue.
Patients complain of discomfort or pain on the inner surface of the elbow. The pain increases during movements, radiates to the distal parts of the limb. The anamnesis reveals regular increased loads on the forearm and hand. During palpation, soreness is determined along the anterior surface of the inner condyle, as well as in the projection of the pronator muscles and flexors of the hand. Movements in full. Sometimes there is an indistinct atrophy and a decrease in muscle strength.
The diagnosis of medial epicondylitis is established on the basis of clinical signs and a characteristic anamnesis. To exclude osteoarticular pathology, radiography of the elbow joint is performed in two projections. Differential diagnosis is carried out with ligament damage (rupture or stretching of the ulnar collateral ligament), medial instability of the elbow joint, cervical radiculopathy and cubital canal syndrome. To assess the condition of the tendon-ligamentous apparatus, an elbow MRI is prescribed, electromyography is used to clarify the condition of the muscles, and neurologist’s consultation and detailed neurological examination are used to exclude disorders from the nervous system.
Treatment is usually conservative. In the early stages, it is recommended to exclude the load on the joint and apply cold to the affected area. To reduce inflammation and eliminate pain, NSAIDs are prescribed. Subsequently, orthoses are used, the patient is referred for physiotherapy. In some cases, electrical stimulation is used. With persistent pain syndrome, therapeutic blockades are resorted to – pricking the inflamed area with glucocorticoid drugs (hydrocortisone, diprospan, etc.). After pain is eliminated, exercises for stretching the pronators and flexors begin. Then isometric exercises are added to the program, and a little later – exercises with increasing load.
The indication for surgical treatment in medial epicondylitis is the ineffectiveness of conservative therapy with a disease duration of 6-12 months. Surgical intervention involves the removal of pathologically altered areas, followed by suturing of tendons to the place of attachment. In some cases, the medial condyle is tunneled to improve blood supply. If necessary, an audit of the ulnar nerve is performed. In the postoperative period, short-term immobilization is carried out, after which rehabilitation measures are started. Pronation of the forearm and flexion of the wrist with overcoming resistance is allowed after 6 weeks.
Prognosis and prevention
The prognosis is favorable. About 90% of patients return to sports and professional duties. In other cases, there may be some weakening of muscle strength, which does not affect the ability to carry out ordinary everyday actions. With conservative therapy, the resumption of habitual loads is allowed after the complete elimination of the pain syndrome, with surgical treatment – four months after the operation. Prevention consists in the exclusion of excessive loads on the elbow joint.