Epicondylitis, also known as ‘tennis elbow’, is an inflammation that affects the epicondyle, i.e. the bony prominence located at the level of the humerus and on which the extensor muscles of the forearm and wrist are inserted

This inflammation is due to repeated strain on the muscles that, with the traction exerted by the muscles on this bony insertion, causes a state of suffering of the bone itself and the tendon portion that inserts on it.

It is a condition that mainly affects sportsmen and women or those who practise heavy manual activities that involve continuous wrist and elbow movements.

Causes of epicondylitis in the elbow

The causes of epicondylitis are manifold and include all those activities that involve the use of the wrist and elbow extensor muscles such as, for example

• sports activities that involve continuous use of the upper limb, such as golf or tennis;
• heavy manual and repetitive work activities, such as heavy lifting (e.g. labourers);
• repetitive and precision work that mainly involves the use of wrist and elbow extension.

When we strain the extensor muscles of the forearm and wrist, a reaction is exerted on the epicondyle through the tendon insertion.

This pull causes chronic suffering of the bone and tendon interaction which, in the long or long term, can lead to degenerative phenomena and tendon calcifications.

Diagnosis of elbow epicondylitis

The diagnosis is made, at an early stage, by means of a rather simple investigation, namely ultrasound, which makes it possible to observe the:

• muscular suffering;
• bone insertion suffering.

It is a rather reliable if operator-dependent examination.

In the event of persistent symptoms or particularly painful situations, an MRI scan can also be used if more complex injuries are suspected at the elbow.

Treating tennis elbow

Once the diagnosis has been made, we proceed with treatment, which must above all be considered and carried out in stages.

This can be:

• conservative;
• surgical.

Conservative treatment

In the first case, we speak of simple and less invasive treatments involving the use of a bandage brace that is positioned at the level of the proximal 3rd of the forearm and has the purpose of tightening and exerting compression on the extensor muscles in order to detract the traction that these muscles exert on the epicondyle.

In parallel with the brace, anti-inflammatory drugs are also used, both generally and topically, such as, for example, patches that can be placed directly on the sore spot and left on for about 12 hours for a treatment cycle of about 1 week.

In addition to these aids, one can also resort to classic physical therapies, initially and more frequently using tecar and laser, and later shockwaves with a more invasive, more painful, but certainly more effective effect.

This is especially so in treating calcifications that occur at a more advanced stage of the pathology, when the inflammation becomes chronic at the level of the insertional musculature of the extensors on the epicondyle.

When these therapies are no longer effective, infiltrations can also be used:

• with cortisone, in cycles of 2 or 3 infiltrations, once a week;
• with PRP, i.e. with platelet derivatives taken from the patient himself, which are then treated and re-injected at the level of the epicondyle with the aim of regenerating the tissue and healing it at the level of the lesion’.

Surgical treatment

Finally, there is also the surgical option, which is reserved exclusively for cases in which all other treatments have failed.

This consists of detangling the extensor muscles with small incisions in the tendon group that inserts on the epicondyle, through perforations made in the bone in order to regenerate the suffering tissue.

The procedure, which takes about 15-20 minutes:

• guarantees good results in the vast majority of cases;
• allows a rapid return to one’s own activities (albeit with an eye on certain movements!)’.

How to treat elbow epicondylitis with exercises and prevention

With regard to prevention and exercises, which are useful both curatively and preventively, it is of primary importance to remove the cause of the inflammation, i.e. to try to understand which movements are causing the pain and generating the pathology, and to try to avoid them by opting for alternative movements.

It is the patient who first feels stimulated to find more comfortable movements, as well as carrying out preventive exercises such as those strengthening both the extensor and flexor muscles, without over-stressing the extensors with related wrist extensions, which can even have a worsening effect.

Exercises alone can only cure if one is careful to understand and try to remove the movements that are the cause of the pain.

In the case, on the other hand, of degeneration leading to calcification, then the treatment to be preferred must be more important.

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Source:

GSD