Epicondylitis (or tennis elbow) is an injury that causes pain on the outside of the elbow. It is caused by repetitive movements of wrist extension and supination of the forearm. This causes fibrillar microroturas and inadequate repair of the tendons of the muscles that originate in that region, mainly of the tendon of the short radial extensor carpi radialis muscle.
It is the inflammation of the epicondylar tendons, which are those that give origin, mainly, to the extensor musculature that originates in the epicondyle, in the external face of the elbow and arrives until the hand.
When these muscles are used over and over again, small micro-injuries occur in the tendon. Over time this leads to irritation and pain on the outside of the elbow. In general, any activity involving repetitive twisting of the wrist can lead to this injury.
It is caused, then, by such repetitive movements of extension and supination of the forearm, which cause tendonitis in the muscles and tendons of that area. End epicondylitis is caused by repeated microtrauma.
Inflammatory changes occur in acute processes, but these do not occur if the lesion becomes chronic epicondylitis. At this stage, tendinosis occurs and involves a degenerative process of the tendon fibers.
Prevalence of epicondylitis and groups at greater risk of suffering from it
The incidence of epicondylitis occurs mainly between the ages of 34 and 54. Although no differences have been demonstrated between men and women, it is known that the lesion is more frequent in the elbow corresponding to the dominant hand.
Also, some professionals of certain sports activities (especially those of racket) and professions, are more prone to suffer from epicondylitis, due to the fact of repeating a particular gesture. Some examples are: painters, mechanics, laborers or people who work long hours at the computer, handling the mouse.
Symptoms or warning signs to suspect epicondylitis
There are certain symptoms that can alert of a possible epicondylitis:
– Pain on the outside of the elbow.
– Pain and functional impotence when extending the wrist and supination of the forearm.
– Pain when palpating the epicondylar area.
– Pain when performing simple actions such as lifting a bottle or a cup of coffee. Also when executing a backhand stroke in tennis or paddle, for example.
– If these symptoms do not remit with relative rest, local cold and treatment with anti-inflammatory drugs or are aggravated by daily actions.
How to prevent epicondylitis
Postural hygiene is the best method to prevent epicondylitis. Performing proper movements when playing sports or at work will prevent the tendons from being subjected to excessive stress.
In addition, resting the elbow after sessions of heavy activity helps to avoid injury. Stretching and preventive massages, as well as the use of orthoses or elbow pads, will be very beneficial in this regard.
Treatment of epicondylitis
The treatment that the experts in Traumatology will apply must follow a logical order, advancing from more to less, as if ascending a staircase:
1) On the first step would be:
a. Non-steroidal anti-inflammatory drugs (NSAIDs) administered orally or topically, with creams or gels.
b. Rest of the joint. Reduction of those activities that cause pain, reducing the time of activity and intensity.
c. Physiotherapy, with the application of local heat, ultrasound, electrotherapy, laser, massage techniques, shock waves or certain exercises and techniques.
2) In the second step would be:
a. Infiltrations. These are local injections of corticoids, associated or not with an anesthetic. Those injected around the epicondyle can resolve pain for weeks or months. Sometimes 3 successive injections are given at intervals of 1 or 2 weeks between them. As there is a small risk of local rupture of the tendon and tendon insertion, infiltrations are limited to 3. In this regard, platelet-rich plasma infiltration has recently been used, although it has not been shown to be more effective than corticosteroids.
b. Occupational therapy. It is recommended to limit the movements that cause epicondylitis. An ergonomic study of the workstation would avoid the repetitive movements that cause it, something that would be key in the cure rate.
3) In the third step, surgery would be used:
a. Epicondylitis operation. It is recommended in certain cases that do not respond to the previous measures. It can be operated with open incision or with arthroscopy. The advantages of arthroscopy lie in the fact that it allows treating the lesion through two small incisions, introducing a camera into the joint. In addition to being less invasive and allowing a faster recovery with less pain, it makes it possible to explore other possible intra-articular lesions that cause pain in the external part of the elbow and can be confused with epicondylitis (synovial plaques, articular cartilage lesions or inflammatory processes). Also, the procedure is usually performed on an outpatient basis and under locoregional anesthesia in the arm.