What is elbow epicondylitis?
Epicondylitis is a painful condition of the elbow that occurs as a result of repetitive movements or repeated lifting of weights (overuse of the arms). Some people perform the same repetitive motion daily, either due to their work or an activity, which causes microtraumas that gradually lead to inflammation, microtears, and vitreous degeneration of the tendon.
It is more common in women and in individuals aged 30-50 years.
It occurs in athletes and manual workers who follow a specific movement pattern daily and for many hours. Some professions commonly affected by epicondylitis include plumbers, painters, butchers, carpenters, cooks, pianists, and secretaries (and generally anyone who works many hours at a computer). Sports most often associated with epicondylitis include tennis, golf, throwing sports, swimming, fencing, and climbing.
However, there are cases where someone develops the disease without being a manual worker or athlete (idiopathic epicondylitis).
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What types of epicondylitis are there?
There are two types of epicondylitis depending on the location: medial (inside) and lateral (outside) epicondylitis. On both sides of the elbow are the epicondyles (medial and lateral epicondyles), which are two bony prominences from which the forearm muscles (the part from the elbow to the wrist) originate.
Lateral epicondylitis, which is more common, is tendinitis or tendinopathy (inflammation – degeneration of the tendons) of the forearm muscles that extend the elbow (extensors) and attach to the lateral epicondyle. It is also known as tennis elbow. The pain starts from the tendon on the outside of the elbow and can extend down the forearm to the wrist.
Medial epicondylitis is tendinitis of the muscles that flex the wrist, rotate the forearm inward (pronation), and originate on the inside of the elbow. It is known as golfer’s elbow. The inflammation is located at the tendon origin from the medial epicondyle on the inside of the elbow.
What are the symptoms of epicondylitis?
The main symptoms are pain in the elbow that may extend down the forearm to the wrist during arm use and weakness in the wrist when the patient tries to hold an object. These symptoms develop gradually and worsen with continuous arm use. In some cases, even shaking hands can be extremely painful.
In lateral epicondylitis, the patient may feel pain even when trying to hold a glass or grasp a door handle. In medial epicondylitis, mild stiffness may coexist and, more rarely, numbness in the fingers.
How is the diagnosis of elbow epicondylitis made?
The diagnosis of epicondylitis is usually made through a simple clinical examination by the doctor. During the examination, the doctor performs tests for local tenderness on both the inner and outer sides of the elbow, as well as some specific resisted flexion and extension tests of the elbow. The patient’s medical history combined with the clinical examination is generally sufficient for diagnosis.
If there is any doubt, the doctor may order an MRI, ultrasound, or X-ray to rule out other possible conditions. Less commonly, a nerve conduction study—electromyography (EMG)—may be needed to exclude the possibility of nerve compression.
How is elbow epicondylitis treated?
Treatment initially involves avoiding the activity that caused the condition.
If the pain is quite severe, the patient may need to take analgesics and anti-inflammatory medications. Additionally, ice therapy (applying ice 3-4 times a day for 15 minutes each time) can be applied.
It is important to identify if the movement or technique used is incorrect and causing the injury. For this reason, especially if it is related to a sports activity, the patient should ask a coach or trainer to explain the proper movement (e.g., how to hold the racket correctly). Also, a change or adjustment of sports equipment may be necessary, such as using a smaller or softer tennis racket.
Most patients (especially with lateral epicondylitis) will notice symptom improvement by following simple advice such as rest, ice, anti-inflammatory drugs, stretching, and eccentric strengthening exercises.
Even if the condition improves, the patient should continue exercises and try to reduce the movements that cause the problem, as there is a risk of recurrence and chronicity.
Effective treatments also include gentle stretching followed by eccentric strengthening exercises. It is advisable that a physiotherapist demonstrates these exercises first to avoid further injury.
Furthermore, the physiotherapist can help reduce pain and improve tendon healing using various methods, mainly shockwave therapy and manual therapy.
If the patient cannot avoid the activity that worsens the epicondylitis, there is a special brace (a counterforce brace) that can be worn during the aggravating movement.
If the above methods are ineffective, injection therapy with Platelet-Rich Plasma (PRP) into the affected area may be used. This procedure usually takes less than 20 minutes, is painless, does not cause allergic reactions, and rarely has complications.
Less frequently, corticosteroid injections may be administered.
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When is invasive treatment considered?
If after 6 months of conservative treatment there is no improvement in symptoms, a minimally invasive procedure may be necessary. This involves removing the scarred and degenerated tissue using microscopic instruments through very small incisions, and reattaching the healthy tendon to the epicondyle. The patient can usually leave the hospital immediately after the procedure.
What is the cost of treating elbow epicondylitis?
The appropriate specialists for treating epicondylitis are the orthopedic surgeon and physiatrist. The physiotherapist also plays a very important role, working together with the doctor to complete the patient’s treatment plan.
The cost of treatment depends on the therapeutic approach. The cost of medications and physiotherapy sessions should also be taken into account.