What is epicondylitis?
Epicondylitis (also known as tennis elbow) is an injury that causes pain on the outside of the elbow. Repetitive motions of wrist extension and supination of the forearm cause this injury. These movements cause fibrillar micro-tears and poor repair of the tendons of the muscles located in that region, especially the tendon of the extensor carpi radialis brevis muscle.
Inflammation of the epicondylar tendons is the origin of the extensor musculature that originates in the epicondyle, on the external aspect of the elbow and reaches the hand.
Repetitive use of these muscles causes micro-injuries in the tendon. If this is maintained over time, irritation and pain are produced in the external part of the elbow. Any activity involving repetitive wrist strain can lead to epicondylitis. It is thus caused by constant extension and supination movements of the forearm, leading to tendonitis in muscles and tendons in the area. Final epicondylitis is caused by repeated microtrauma.
Inflammatory changes may occur in acute processes but will only occur if chronic epicondylitis is developed, when tendinosis (degenerative process of the fibers that make up the tendon) will occur.
Although it is commonly called tennis elbow, it can be suffered not only by tennis players but also by anyone who performs work involving repetitive movements of extension and flexion of the forearm and wrist. An example are professional painters, mechanics, laborers or those who work long hours in front of the computer, handling the mouse.
Epicondylitis is caused by repetitive motion of the forearm and wrist
of extension and supination of the forearm and wrist.
Prognosis of the disease
Epicondylitis is not a very serious injury, but it does significantly affect the patient’s life. Most patients improve with non-surgical treatment, and may even be cured. In general, therefore, it is a disease with a good prognosis, although it is common for symptoms to persist for several months before they are completely cured.
Symptoms of epicondylitis
There are some characteristic symptoms, which may lead to suspect epicondylitis:
- Pain and functional impotence when extending the wrist and supinating the forearm.
- Pain in the external part of the elbow.
- Pain when palpating the epicondyle area.
- Pain with some easy movements, such as lifting a cup of coffee. Also, in professionals, when making backhand movements in tennis or paddle.
- Pain that does not subside even with rest, local cold or anti-inflammatory drugs.
Medical tests for epicondylitis
Any specialist in Traumatology must carry out an exhaustive evaluation to diagnose epicondylitis or tennis elbow. This will include, among other procedures deemed appropriate:
- A visual examination to analyze the appearance of the skin, possible inflammation of the area and check that the joint is well aligned.
- Palpation of the epicondyle, to evaluate pain.
- Test of the chair, which consists of raising it with the palm of the hand down and the elbow in extension. Normally the pain does not allow to perform the action.
- Mills maneuver: the patient is seated, with the shoulder separated to the horizontal, in internal rotation. There is usually an increase in pain when passively extending the elbow, keeping the forearm in pronation and the wrist and fingers in maximum flexion.
- Evaluation of pain when extending the fingers and wrist against resistance, and extending the third finger against resistance with the elbow extended.
- Analyze the mobility of the elbow and radial head, cervical spine, shoulder girdle and shoulder.
- To evaluate if there is a possible affectation at distal level of the radial nerve and of the brachial plexus, at proximal level.
What are the causes of epicondylitis?
The main cause of epicondylitis lies in a repetitive movement of extension and supination of the forearm, which causes tendonitis in the muscles and tendons located there. Final epicondylitis is caused by repeated microtrauma to the area.
Can it be prevented?
Epicondylitis can only be prevented by taking care of postural hygiene. Performing adequate movements during sports practice or at work will ensure that the tendons are not subjected to excessive stress. Likewise, resting the elbow well after high-activity sessions helps prevent epicondylitis. Stretching and preventive massages, as well as elbow pads, are practical in this regard.
Treatments for epicondylitis
Any treatment for an injury of these characteristics should be from less to more, according to the severity of the injury. In the first place will be recommended:
- Nonsteroidal anti-inflammatory drugs orally or topically.
- Rest of the elbow, reducing the activities that provoke the pain, as well as the intensity of the exercise and the time.
- Physiotherapy and application of local heat, massage, shock waves, ultrasound, as well as exercises and techniques.
If these procedures are not effective, a recommendation will be made:
- Infiltrations or local corticosteroid injections (with or without anesthesia). If they are injected near the epicondyle, they can improve pain for a certain period of time. In some cases three infiltrations are performed with an interval of 1 or 2 weeks between them. However, infiltrations are usually limited to 3, as there is a small risk of rupture of the tendon and tendon insertion. Platelet-rich plasma infiltrations are also currently used. Its application to the affected tendon area accelerates healing.
- Limiting the movements or activities that provoke epicondylitis. To this end, it will be useful to carry out a study of the patient’s work station, which will play a key role in healing rates. Also reduce the practice or intensity of playing racquet sports.
If the treatments mentioned above are not effective either and the patient continues to suffer the symptoms and pain of epicondylitis, surgery will be chosen. It can be performed in the traditional way, with an open incision, or by arthroscopy. This technique is currently the most widely used, as it allows the lesion to be approached with two or three small incisions that allow access to the area with a mini camera. It is a minimally invasive technique, so the patient will have a faster and less painful recovery.
Which specialist treats it?
Who treats epicondylitis is the specialist in traumatology, usually those who have obtained specific training in the approach to elbow pathologies. Traumatology is the specialty in charge of preventing, diagnosing and treating common pathologies and injuries of the musculoskeletal system.
In the recovery of the epicondylitis injury, other professionals may also intervene, such as specialists in Physiotherapy, who will prescribe practical exercises to restore movement.