Epicondylitis of the forearm. Lateral epicondylitis of the elbow joint - symptoms and treatment

Epicondylitis of the elbow joint is considered a secondary form of the disease, which progresses against the background of numerous extensions (flexions) of the joint of a monotonous nature.

Certain groups of people are susceptible to the disease: construction workers, agricultural workers and professional athletes.

Epicondylitis of the elbow joint is a disease that affects the elbow joint area and is characterized by degenerative and inflammatory changes.

The medical term is used for inflammatory processes in the area of ​​the epicondyle and the tendons and vagina attached to it.

The pathology is not limited to a single bone lesion - inflammatory processes are localized in the area of ​​muscle attachment to the forearm.

It is believed that this disease is not classified as severe, and therefore is not associated with loss of ability to work. However, patient complaints about epicondylitis of the elbow joint and their visits to local clinics are not decreasing.

Characteristic symptoms

Epicondylitis of the elbow joint comes in two forms:

• Internal (medial). In this form, the disease affects the muscles responsible for the processes of flexion (extension) of the hand - the inner zone of the elbow joint. The internal form of the disease occurs more often and is considered the most common dysfunction of the human musculoskeletal system.
• External (lateral). It is characterized by muscle damage in the outer area of ​​the forearm. This place is popularly called “tennis elbow”, which is why it is often observed among tennis fans and professional tennis players.

There are several mild symptoms:

• pain of the epicondyle when palpated;
• decreased strength in the hand;
• increased pain attacks during pronation and flexion of the dorsal zone cyst.

Muscle weakness is recognized by the following symptoms:

• Thompsen's sign: the hand quickly drops when trying to hold it in a clenched fist during dorsiflexion.
• Welsh's sign: with simultaneous extension and supination of the forearms, you can notice a lag on the affected side.
• Dynamometry is accompanied by weakness of the hand in the affected side of the joint.
• When you try to hold your hand behind your lower back, pain of an intensifying nature occurs.

How to recognize the disease?

Often the disease cannot be identified in time. Most people do not pay attention to pain attacks in the elbow area, and do not associate this with serious disorders.

As a result, epicondylitis of the elbow joint may have a hidden form, which is difficult to treat in the future.

With epicondylitis of the elbow joint, pain attacks are localized in the elbow area, but the joint itself is usually not damaged.

Inflammatory processes affect the tendons.

As a result of physical overload, tendon fibers are torn at the junctions with the periosteum, which is accompanied by swelling and inflammatory processes.

The zones of tendon fibers that connect the tendon to the ulna bone are more likely to be injured.

Video: cause of pain in the elbow joint

Reasons for the development of the disease

At present, the exact causes of epicondylitis of the elbow joint have not been identified.

It is known that people suffer from this disease due to numerous movements of a monotonous nature (flexion and extension of the elbow joint).

The causes of epicondylitis of the elbow joint can be:

• characteristics of professional activity (athletes, construction and agricultural workers are more often susceptible to the disease);
• lifting and carrying heavy objects;
• great physical activity;
• performing heavy construction (repair) work.

It is important to know!

• When performing monotonous movements, microcracks can form in the muscles of the forearm in the area of ​​the humerus. Because of this, an inflammatory process of an aseptic nature appears in adjacent skin areas.
• More often, the disease affects the lateral epicondyle in the area of ​​the humerus, resulting in the development of external epicondylitis.
• Internal epicondylitis occurs due to destruction of the muscle tendons of the flexor hand.
• These two forms of epicondylitis do not occur at the same time.

How to treat?

Treatment of epicondylitis of the elbow joint begins with identifying the true cause of the disease.

To prescribe effective treatment, it is necessary to conduct a thorough examination using magnetic resonance imaging and ultrasound.

This is required to exclude other possible diseases.

Often patients turn to the doctor when the inflammatory processes are progressive.

Because of this, there are certain difficulties in treating the disease.

When choosing a treatment method, several factors are taken into account:

• degree of elbow dysfunction;
• the nature of changes in muscles (tendons) in the area of ​​the forearm and hand.

Treatment of the disease has the main tasks:

1. Eliminate pain attacks in the affected area.
2. Restore or improve blood circulation in the affected area.
3. Restore motor function of the elbow joint.
4. Prevent the process of muscle atrophy in the forearm area.

To accomplish the assigned tasks, specific or complex treatment is used:

• drug treatment;
• physiotherapeutic treatment;
• surgical methods.

Drug treatment

Drug treatment for epicondylitis of the elbow joint is quite effective.

It helps eliminate painful attacks and the disease itself in the initial stages of its occurrence.

Drug treatments include:

Ointments

To relieve pain and inflammation in epicondylitis of the elbow joint, special ointments and gels are used (Nurofen and others).

Dimexide

A 50% Dimexide solution is used for various dysfunctions of the musculoskeletal system, including epicondylitis of the elbow joint.

A napkin is moistened with the medicinal solution and applied to the affected joint. After which the affected area is wrapped with polyethylene and cotton cloth.

Daily compresses from Dimexide help eliminate pain in the elbow.

Pills and antibiotics

For primary forms, antibacterial therapy is used.

In this case, the patient’s sensitivity to the effects of medications and individual intolerance should be taken into account.

Antibiotics such as macrolides, penicillins and cephalosporins can be prescribed by injection or in tablet form.

To relieve pain syndromes, the attending physician may prescribe non-steroidal anti-inflammatory drugs for oral administration (Nimesil, Nise, Ketorol and others), as well as in the form of ointments and gels.

Iodine

Pain when bending the elbow joint can be relieved with iodine.

Rubbing an iodine solution not only relieves pain, but also improves blood supply to the affected joint.

Blockade

Corticosteroid drugs in the form of injections – Dispropane, Kenalog – can relieve pain syndromes and improve the patient’s condition.

To relieve pain and improve trophism, blockades are performed at the attachment point of the fingers and the extensor hand.

They use Novocaine, Lidocaine. The patient is prescribed 5 blockades with a time interval of 2 days.

Intra-articular injections of drugs are very effective in treating the disease.

Such injection procedures are performed with strict adherence to aseptic and antiseptic standards in order to prevent purulent complications.

The puncture of the synovial bursa is made with a special needle, through which a solution of antibiotics and hydrocortisone is administered.

Physiotherapeutic treatment

A course of physiotherapeutic procedures for any form of epicondylitis of the elbow joint is a mandatory component of treatment.

The methods used are:

Ultraphonophoresis

Ultraphonophoresis is a type of ultrasound treatment: this procedure is in some cases more effective than conventional ultrasound.

Ultrasonic vibrations effectively affect the affected joint and promote rapid penetration of medications into the body.

For treatment to be effective, it is important to choose the correct dose of medication, set the required frequency and operating mode of the equipment.

DDT

A type of physiotherapeutic treatment is DDT (dynamic currents).

This effective method normalizes trophic processes, improves blood circulation, promotes wound healing, and eliminates inflammatory processes in tissues.

The DDT method is very effective for diseases of the musculoskeletal system, including elbow dysfunction.

Magnetotherapy

The main goal of magnetic therapy is the elimination of pain syndromes.

Low-frequency magnetic fields affect the damaged surface of the joint, as a result of which the patient's pain is relieved or completely eliminated.

Magnetic therapy is easily tolerated by elderly people and patients with weakened bodies. This is the main advantage of this method.

Shock wave therapy

With shock wave therapy, a special device affects damaged tissues and joints.

This method of physiotherapy is highly effective:

• under the influence of shock waves of various frequencies, calcium salt crystals are destroyed;
• blood flow increases;
• salt deposits are washed away from ligaments and tendons.

Under the influence of shock wave therapy, the affected elbow joint is cleansed and restored.

The procedures help completely eliminate pain.

Surgery

In advanced forms, surgical intervention may be required.

Among the surgical methods for treating epicondylitis of the elbow joint, Homan's operation has won recognition - excision of a section of tendon in the extensor cyst and fingers.

Currently, such excision is performed at the site of attachment of the tendon to the bone.

In addition, a laser is used to open and treat the damaged area.

The device allows you to reduce tissue trauma, effectively eliminating the infectious agent.

At the end of the laser operation, the wound is sutured and a tight bandage is applied to it.

Exercises

Therapeutic exercises are considered an effective method of treating epicondylitis.

Special exercises are aimed at stretching connective tissues. For the elbow joint with epicondylitis, these are exercises for straightening the wrist joint.

After 5 correctly selected exercises, painful muscle spasms in the arm decrease.

Video: gymnastics

Manual therapy

Manual therapy is considered a traditional, proven method that is effective in treating dysfunction of the musculoskeletal system.

Functional blockade during manual therapy affects the surface of the joints and restores the normal range of joint movements.

The indication for manual therapy is pathogenesis, when the clinical picture of the disease is based on limited joint mobility.

Hirudotherapy

Hirudotherapy is a method of treating disease with leeches. A medicinal leech is called a “mini-factory”, which contains many biologically active substances.

The main components of the leech interfere with the process of blood clotting and resolve blood clots.

Medical leeches have excellent bactericidal properties, which can effectively eliminate inflammatory processes.

Massage

To prevent muscle atrophy and restore the functionality of the joint, therapeutic massage is prescribed.

The manipulations affect the forearm area.

In addition to massage, mud therapy and dry air baths are prescribed.

Treatment at home

When conservative treatment does not bring tangible results, you can use traditional methods at home.

The most effective folk recipes are:

• You need to purchase horse sorrel roots, put them in a jar and pour ½ liter of vodka. Wait 10 days for the herbal solution to infuse well. It is recommended to apply the resulting composition to the injured elbow before going to bed. Such compresses help relieve pain and inflammation. The duration of the procedures is 10 days.
• You need to take vegetable oil (200 gr.) and 4 tbsp. bay leaf (finely chopped). Mix the two components in a container and close with a lid. The composition should brew for 7 days. Next, the oil is filtered and rubbed into the damaged elbow. You can make oil compresses, which must be kept for 20 minutes. This recipe allows you to relieve pain and warm the surface of the damaged joint.
• If the disease develops as a result of injury, you can prepare a cold compress at home to help relieve pain. The compress must be applied to the affected area several times a day.

Disease prevention

To prevent the occurrence of epicondylitis of the elbow joint, it is necessary to follow certain preventive rules:

• Athletes should do a light warm-up before starting intense training to prepare their joints for physical activity. This is especially true for tennis players.
• Don't forget about the beneficial properties of massage. Light kneading and stroking will be useful before starting physical exercise.
• Professional athletes should not forget about strength training. They will help strengthen the articular tendons, which will prevent their possible damage during basic physical activity.
• If you have a chronic infection, you should immediately consult a doctor. Progressive infectious diseases can undermine the protective properties of the immune system and weaken the entire body. And this can lead to the destruction of cartilage and tendons.
• During monotonous work, you need to take short breaks so that your muscles can relax.
• You need to remember about vitamins. For the ligaments to function properly, a sufficient amount of vitamins B1, B6 and B12 is necessary. You can include foods rich in these vitamins in your diet, or take them in tablet form.
• When playing sports, it is recommended to use fixing bandages and special creams that will avoid damage to the elbow joints.

The human body is a complex system that requires proper care.

If you experience any pain in the elbow area, you should immediately consult a doctor.

If treatment of the disease is started in a timely manner, symptoms disappear after 3 weeks.

For quotation: Belenky A.G. Epicondylitis // Breast cancer. 2006. No. 25. S. 1786

Epicondylitis of the elbow joint is one of the most common forms of soft tissue periarticular lesions. The disease is based on degenerative-inflammatory changes at the site of attachment to the humerus (in the area of ​​the elbow joint) of the tendons of the muscles of the outer and inner region of the forearm. The external epicondyle is most often affected (Fig. 1), in this case a diagnosis of external epicondylitis is made, much less often the flexor tendons of the hand are involved in the process (internal epicondylitis). The genesis of epicondylitis includes overload (absolute or relative) of these entheses with the secondary development of an inflammatory reaction. It should be noted that epicondylitis never occurs as a manifestation of a primary inflammatory process within the framework of seronegative spondyloarthritis, in contrast to enthesopathies of other localizations (plantar fasciitis, Achilles' disease) (Fig. 1).

External epicondylitis is one of the most common diseases of the musculoskeletal system. Its true incidence is unknown due to the high frequency of mild forms for which patients do not seek medical help. In the English-language literature, the term “tennis elbow” is used to refer to this disease, due to the high frequency of this pathology in tennis players. This is due to the fact that when playing tennis, especially with an incorrectly selected racket and defects in the backhand technique, the extensor tendons of the hand are overloaded, with the subsequent development of the characteristic symptoms of external epicondylitis. In Russia, tennis is not yet a popular sport, and in the vast majority of patients, overload of the proximal attachment zones of the forearm muscles is associated with more prosaic reasons (professional activity, carrying heavy loads, performing repairs, home canning).
The disease affects middle-aged people (40-60 years old). The process involves predominantly the dominant limb (right hand). The pathogenesis of the disease is the occurrence, as a result of overload, of microtraumatization of tendon tissue with the subsequent development of an inflammatory reaction. In some cases, the disease is preceded by direct trauma. The pre-existing condition of the ligamentous apparatus is also important. Thus, hypermobile individuals (with signs of congenital weakness of the ligamentous apparatus) have a tendency to develop this disease; They also have a more severe course.
Anamnesis
The disease can begin after an episode of overload (in the variants mentioned), in which case repeated movements of the hand in the position of abduction and flexion at the elbow joint are important. However, pain in the elbow joint often occurs against the background of the normal rhythm of life. In the latter case, we are talking about gradual involutive changes in the musculoskeletal system, which are manifested by degenerative processes in the area of ​​the epicondyles of the humerus without visible external causes. Once present, the pain caused by epicondylitis can last for weeks or months.
Clinical picture
With lateral epicondylitis, patients complain of pain in the elbow joint, provoked by the load associated with straightening the fingers and supination of the hand. In this case, the load can be very small, for example, an attempt to take an object from the table (even as small as a cup of tea). The pain is well localized - patients confidently point to the outer (with external epicondylitis) or inner (with internal epicondylitis) surface of the elbow joint. The pain may radiate distally along the outer or inner surface of the forearm or up to the lower third of the shoulder. There is no pain at rest. An important sign that allows you to distinguish epicondylitis from damage to the elbow joint itself is the absence of pain during active and passive flexion-extension of the elbow joint.
Diagnostics
The diagnosis of epicondylitis is based solely on clinical examination. Strictly localized tenderness of the external or internal epicondyle is determined (simultaneous involvement of both structures does not occur). In some cases, the painful area includes adjacent areas of the tendons. Additional information supporting the diagnosis is obtained using active motion resistance tests. In the case of lateral epicondylitis, this is resistance to extension of the hand (Fig. 2); with medial epicondylitis, pain is provoked by resistance to flexion in the wrist joint. An attempt to move is made in the wrist joint, but pain occurs at the site of muscle attachment in the elbow joint (external or internal epicondyle) (Fig. 2).
The list of diseases with which the differential diagnosis of epicondylitis is made includes lesions of the elbow joint itself (arthritis, aseptic necrosis of the articular surfaces) and tunnel syndromes of this area (pronator teres syndrome - entrapment of the median nerve, cubital tunnel syndrome - entrapment of the ulnar nerve). Differential diagnosis of epicondylitis and damage to the elbow joint is not difficult. In the case of arthritis, the pain is reproduced by movements in the elbow joint; often with arthritis, a flexion contracture is formed. The pain is localized not in the area of ​​the epicondyle, but in the projection of the joint itself. Neurological causes of pain are accompanied by signs of damage to peripheral nerves - impaired sensitivity and weakness of the corresponding muscles.
When developing the clinical picture of epicondylitis in young people, it is advisable to search for signs of systemic pathology in the patient - joint hypermobility, the presence of other non-inflammatory lesions of connective tissue structures, which would allow classifying this pathology as a manifestation of a systemic disease - hypermobility syndrome.
Instrumental and laboratory methods are usually not used in the diagnosis of epicondylitis. Only in cases of obvious trauma can conventional radiography exclude bone damage (possible fracture of the lateral epicondyle), and normal laboratory tests (acute phase indicators) exclude inflammatory joint disease. In case of chronic or often recurrent epicondylitis (which is extremely rare), the x-ray can show changes typical of chronic enthesopathies - loosening of the cortical layer, cyst-like restructuring of the bone tissue in the area of ​​the affected enthesis and ossification of the enthesis in the form of a “spur”.
The affected structures in epicondylitis are so superficial that the use of soft tissue imaging methods (ultrasound, magnetic resonance imaging) does not provide any additional useful information.
Treatment
Treatment of epicondylitis is exclusively conservative. In the case of minor pain (when the patient is more concerned about the cause of his discomfort than the pain itself), treatment may be limited to a protective regime for the affected limb - “do not make movements that cause pain.” If epicondylitis occurs in a person engaged in physical labor or an athlete, the logical advice is to take a break from physical activity (stop training) until the symptoms disappear completely, followed by a gradual increase in the volume of exercise. In these cases, it is advisable to establish the cause of the overload - improper working conditions or inconvenient tools. If the patient really plays tennis, then recommend that he use a lighter weight racket. However, these tips do not apply to all patients. As a rule, people seek medical help who have a long history of pain and who, despite a gentle regimen, are tired of waiting for an independent recovery.
In case of severe pain, short-term immobilization is used - a light splint on a scarf. When epicondylitis develops after injury, local cold is effective - applying ice to the painful area several times a day. The effectiveness of therapeutic exercises aimed at stretching connective tissue structures has been shown - in the case of external epicondylitis, these are daily courses of short-term hyperextension in the wrist joint.
Since the main cause of pain in epicondylitis is an inflammatory reaction, the use of anti-inflammatory therapy is pathogenetically justified. Due to the superficial location of the epicondyles, a good effect can be expected from the local use of nonsteroidal anti-inflammatory drugs (NSAIDs) in the form of ointments and gels. One of the most effective products from this group is Nurofen Gel.
The main active ingredient of Nurofen Gel is ibuprofen, which provides its analgesic and anti-inflammatory activity. The gel is applied in a 3-5 cm strip to the painful area and rubbed in thoroughly until completely absorbed. Frequency of application 3-4 times a day. Nurofen Gel has a rapid effect by suppressing the synthesis of inflammatory mediators directly in the lesion, which in epicondylitis is located directly under the skin. The drug extremely rarely causes side effects, mainly in the form of skin hyperemia caused by individual sensitivity to ibuprofen. This reaction quickly disappears when you stop using the drug.
With epicondylitis, we are talking about suppressing inflammation in a very small structure, and therefore oral, and even more so parenteral, administration of NSAIDs, in which the drug is distributed throughout the body, is inappropriate. In comparative studies, the effectiveness of oral NSAIDs did not differ from the effect of placebo.
In case of persistent pain syndrome that does not respond to local use of NSAIDs, the method of choice is local injection of microcrystalline glucocorticosteroids (GCS) mixed with an anesthetic. Of the GCS drugs available to the doctor, betamethasone dipropionate can be considered the most suitable. The use of triamcinolone preparations is extremely undesirable, since if it gets under the skin, it can cause severe degenerative changes (depigmentation, cicatricial adhesion of the skin to the epicondyle). The use of a suspension of hydrocortisone or methylprednisolone is possible, but in this case the patient must be warned about the mandatory increase in pain in the first day after the injection due to the development of severe microcrystalline inflammation (tissue reaction to the injected drug crystals).
Due to the distinct localization of the process in the area of ​​the epicondyle, the choice of injection site is not a problem. This is the point of maximum pain, which can be located both in the center of the epicondyle and along its edges. The scheme and the administration of GCS itself for external epicondylitis are shown in Figures 3 and 4. In some cases, it is necessary to infiltrate additional painful points, determined by palpation, in the projection of the adjacent tendons. Adding an anesthetic (2% lidocine) to the GCS preparation allows literally 1-2 minutes after the injection to assess the correctness of the diagnosis and the accuracy of the injection itself - the pain should disappear. If it persists somewhere, then the rest of the suspension is introduced into this zone. Since the enthesis in the area of ​​the external epicondyle is a very dense tissue, the injection must be performed with high pressure on the piston, which requires fixing the needle (0.6-0.4 mm-25 mm) with the fingers of the other hand. This also limits the total volume of the administered suspension - the syringe contains 1.5-2 ml of a mixture of GCS and anesthetic. 0.5-0.7 ml of suspension is injected into one point. The procedure is carried out once, in rare cases it is necessary to re-administer after 7-10 days. Injections are not repeated more than 2 times.
Certain inconveniences arise when it is necessary to carry out infiltration in the area of ​​the internal epicondyle with the patient sitting. With medial epicondylitis, it is much more convenient to place the patient on the couch with his stomach down and his arms extended along the body (Fig. 5). In this position, the entire internal area of ​​the elbow joint is easily accessible to the doctor, and accidental injury to the ulnar nerve (passing between the internal epicondyle and the olecranon process) is practically excluded.
In the vast majority of cases, the above treatment methods have an effect - pain completely disappears within 2-3 weeks with conservative treatment and 2-3 days after GCS injection. Relapses are possible; to prevent them, it is important to explain to the patient the need to adhere to an optimal motor regimen that eliminates overload of the entheses involved in the process.
However, in some patients, the pain caused by epicondylitis is persistent. The pain is difficult to respond to even GCS infiltration (the effect is limited to a few days). Factors of poor prognosis (frequent relapses, incomplete relief of pain) are bilateral lesions, the presence of systemic weakness of the ligamentous apparatus (articular hypermobility) and the simultaneous identification of signs of astheno-depressive syndrome (fibromyalgia). In the latter case, the complex of treatment measures must include the use of antidepressants (amitriptyline).
In persistent cases of epicondylitis, the use of a relatively new treatment method, extracorporeal shock wave therapy, is indicated. This method is based on the impact of high-energy ultrasound on the affected structure. Also described are individual cases of successful surgical treatment of epicondylitis - excision of detectable enthesis ossification.
Thus, epicondylitis of the elbow joint is a common form of soft tissue periarticular pathology that is relatively easy to diagnose and treatable (except for rare persistent cases). The capabilities available to modern medicine make it possible to cure the vast majority of patients.

Literature
1. Astapenko M.G., Eryalis P.S. Extra-articular diseases of the soft tissues of the musculoskeletal system. - M.: Medicine, 1975; 65-68.
2. Bunchuk N.V. Diseases of extra-articular soft tissues. In a manual of internal medicine. Rheumatic diseases. Ed. V.A. Nasonova, N.V. Bunchuk. -M. Medicine.1997 - P. 418-19.
3. Doherty M.B., Doherty D. Clinical diagnosis of joint diseases. - Minsk. Tivali, 1993.
4. Hotchkiss R. Epicondilitis - lateral and medial. Hand clin., 2000;16; 505-8.
5. Speed ​​CA. Corticosteroid injections in tendon lesions. BMJ, 2001; 323; 382-6.
6. Smidt N. Corticosteroid injection, physiotherapy or “wait-and-see” policy for lateral epicondilitis: a randomized controlled trial. Lancet, 2002, 309; 657-62.
7. Melikian E.Y. Extracorporal shock wave treatment for tennis elbow. A randomized dowble-blind trial. J Bone Joint Surg Br, 2003; 85; 852-5.

The musculoskeletal system is an important system of the body that allows a person to move freely, defend himself and carry out other important functions for productive interaction with the environment. It is always unpleasant when some part of the skeleton, be it joints, muscles or bones, suffers from disease. After all, motor function is impaired, and, as you know, movement is life. A disease such as epicondylitis of the elbow joint especially affects the quality of life.

The elbow joint is an anatomical formation between the bones of the shoulder and forearm. It consists of three joints between the humerus, ulna and radius, surrounded by a single joint capsule, which is formed by dense connective tissue. Inside there is joint fluid.

Functionally, the joint provides such movements of the forearm as flexion, extension, upward rotation (supination) and downward rotation (pronation). The movements are caused by the work of muscles that, with the help of tendons, are attached to the epicondyles of the shoulder - these are bony protrusions designed specifically to fix the tendons. Tendons have elasticity - they are able to return to their original shape after being stretched. But this ability is slightly delayed in time, that is, after a mechanical load on the tendon, it remains stretched for a short period of time. If mechanical force acts again during this period, then the already altered tendon is stretched, and it simply does not have time to recover. Taking into account the fact that the blood supply to the tendon is quite insignificant compared to, for example, a muscle, the restoration of fibers under constant, similar loads slows down. This can lead to the formation of microcracks, as well as changes in the structure of the epicondyles themselves. Epicondylitis develops, literally – inflammation of the epicondyle.

– a disease that usually occurs as a result of physical overload and overstretching of the tendons, characterized by a disruption of the normal structure in the area of ​​the epicondyle, periosteum and tendon, and clinically manifested by pain.

The figure shows a semi-schematic representation of the elbow joint; tears are visible in the area where the tendon attaches to the epicondyle.

Epicondylitis can be external or internal, respectively, with damage to the tendons on the outside, responsible for extension in the elbow joint, and on the inside, responsible for flexion. External epicondylitis is more common, with equal frequency in men and women, mainly in persons over 30–35 years of age.

Causes of epicondylitis of the elbow joint

The following factors can provoke the development of epicondylitis:

1. Sports activities. Frequent loads, long-term training, monotonous movements invariably lead to the formation of cracks in the tendons and epicondyles of the shoulder, causing degenerative changes in the tendon. The elbow joint is most often affected during professional activities in the following sports:
- tennis – characterized by external epicondylitis, called “tennis elbow”,
- golf – characterized by internal epicondylitis, called “golfer’s elbow”,
- kettlebell lifting, weightlifting, barbell training.

2. Injuries. In approximately 25% of all cases, significant injuries to the elbow area lead to the development of epicondylitis.

3. Constant overstrain of the shoulder and forearm muscles in patients with certain professions. For example, pianists, drivers, machinists, milkmaids, painters, plasterers, carpenters, massage therapists, loaders and seamstresses often suffer from epicondylitis.

4. Constantly carrying heavy bags, doing household chores such as sawing firewood, painting surfaces, etc. can contribute to the onset of the disease. The presence of congenital connective tissue dysplasia in a patient can also contribute to the occurrence of degenerative changes in the tendons of the elbow joint due to a predisposition to an initial change in the structure of connective tissue fibers .

Symptoms of epicondylitis of the elbow joint

The main manifestation of epicondylitis is pain in the muscles of the shoulder and forearm. The pain is of a different nature - burning, aching, pulling, dull or sharp, and radiates to the hand. With external epicondylitis, pain occurs when trying to straighten the forearm, and with internal epicondylitis, pain occurs when bending the elbow joint.

Symptoms, as a rule, appear gradually - first, unpleasant sensations and discomfort arise when exerting stress on the affected limb, and then at rest. Sometimes intense shooting pains occur suddenly, without previous discomfort. Often the pain syndrome is so severe that the patient finds it difficult to shake a friend’s hand, take a glass, hold a spoon when eating, or perform other household functions.

According to the course, acute, subacute and chronic types of the disease are distinguished. The acute stage of epicondylitis is characterized by attacks of pain during exercise and at rest. When the process subsides, the pain only bothers you while working with your hand and disappears during rest - this is the subacute stage. If treatment was not started in a timely manner, and the symptoms persist for three months or longer, they speak of the formation of chronic epicondylitis of the elbow joint.

In addition to pain, a feeling of numbness of the affected limb, a tingling or crawling sensation is characteristic. Active movements in the elbow joint are difficult, while passive flexion and extension of the forearm by another person or a healthy arm does not cause pain.

Diagnosis of epicondylitis

If symptoms similar to those of epicondylitis appear, you should consult a traumatologist or orthopedist.

To establish a diagnosis, a questioning and examination of the patient by a doctor is crucial, since no abnormalities are observed in blood tests, and there are no changes in radiographs of the elbow joint. Sometimes x-rays reveal signs of calcium salt deposition in the tendon area, but, as a rule, in the advanced stage of epicondylitis, and only in 10% of cases.

The survey clarifies the nature of the complaints, issues related to profession and sports, as well as how long ago the symptoms appeared and their connection with the load on the limb.

During the examination, the following functional tests are carried out:

- Welt test. To carry it out, you need to stretch your arms forward in front of you and turn the open palms of both hands up and down at the same time. On the affected side there is a lag behind the healthy limb when performing movements.
- Mobility test. The doctor fixes the patient's elbow, turning the hand to the side. Next, he invites the patient to turn the hand in the opposite direction, overcoming the resistance of the doctor’s hand. With epicondylitis, intense pain occurs.

If epicondylitis is suspected, diseases such as osteoarthritis and arthritis of the elbow joint, fractures of the bones of the forearm and epicondyles of the shoulder should be excluded. They are characterized by symptoms that are not observed with epicondylitis, for example:

Passive movements in the joint with arthrosis and arthritis are sharply painful,
- there is swelling and redness of the skin in the joint area,
- blood tests detect inflammatory elements, increased C reactive protein, positive rheumatological tests for rheumatism, rheumatoid arthritis, etc.
- Ultrasound of the joints reveals effusion in the joint cavity, that is, inflammatory fluid,
- when x-raying a joint, arthrosis is manifested by a narrowing of the interarticular space and changes in the articular surfaces of the bones, and in the event of a fracture - a violation of the integrity of the bone and possible displacement of fragments.

If the doctor prescribed additional examination methods, and they did not reveal such signs, then most likely the patient has epicondylitis. But in most cases, the patient does not need such an examination to make a diagnosis.

Treatment of epicondylitis

To achieve the greatest effectiveness, complex treatment of epicondylitis is used, which includes the following areas. First, complete rest of the joint for at least 7 days, followed by medication and physical therapy.

Drug therapy.

In addition to creating rest for the affected limb and temporarily refusing for 7–10 days from the type of activity that caused the development of the disease, medications are prescribed:

- non-steroidal anti-inflammatory drugs (NSAIDs)– diclofenac (ortofen), nimesulide (nise), ibuprofen (ibuprom), meloxicam (movalis, mataren), etc., used twice a day for tablets and three to four times a day for ointments, gels and patches on the elbow joint, in a course at least 10 – 14 days. Tablet forms are rarely used, since ointments have a fairly good effect with regular use.

- glucocorticosteroids, also having a strong anti-inflammatory effect (GCS) - diprospan (betamethasone), hydrocortisone and prednisolone. They are used as a single intramuscular injection into the area of ​​the elbow joint; if there is no effect, it can be repeated after a few days, but no more than two injections per course of treatment,

- local anesthetics– lidocaine, ultracaine and others. Also used as an injection to relieve pain.

Physiotherapeutic procedures

These treatment methods are highly effective. Physical methods have a beneficial effect on inflamed and injured tissues, which leads to improved blood supply and metabolism in cells, and healing processes proceed much faster. A course of treatment is prescribed for 7–10 days. Applicable:

Pulse magnetic therapy – the effect of low-frequency magnetic pulses on the elbow joint,
- paraffin and ozokerite applications on the elbow area,
- diadynamic therapy - exposure to electric current of different polarity,
- electrophoresis using hydrocortisone or novocaine - deep, uniform penetration of the molecules of the active substance into the affected tissues,
- exposure to infrared laser radiation,
- cryotherapy - exposure to a stream of dry cold air.

Orthopedic benefits

As already mentioned, for a complete cure and reduction of unpleasant symptoms, a protective regime should be created for the limb on the affected side. For this, an elastic bandage, a scarf-type bandage, and an orthosis (“wristband”) that secures the arm in the upper third of the shoulder are used. In case of severe pain, the application of a plaster splint to the joint area may be indicated. All these measures help to give the limb the most physiological position at rest and reduce the load on the tendons and muscles.

Orthosis for fixing the forearm extensor muscles.

Therapeutic exercises for epicondylitis

Used to restore the function of tendons and muscles. Prescribed by a physical therapy doctor in the absence of pain in the elbow area as the acute stage of the process subsides. The following exercises can be performed for two to three minutes each twice a day:

The patient alternately squeezes and unclenches his hands, keeping his forearms bent at chest level,
- flexion and extension of the forearms of both hands separately,
- alternate rotation of the forearms in different directions,
- the patient clasps his hands together and flexes and extends the forearms of both hands together,
- the patient clasps the hand with his healthy hand and begins to slowly bend it at the wrist joint, holding it in the position of maximum flexion for several seconds,
- “scissors” exercises – horizontal swings with arms extended forward, alternating the right over the left and vice versa.

Any exercises should be used only as prescribed by the doctor conducting the treatment, since starting exercises prematurely can harm the tendons that have not yet recovered, leading to even greater overstretching.

Traditional methods of treating epicondylitis

They have an auxiliary value in therapy and should be used by the patient only after agreement with the attending physician. The following methods of traditional medicine have proven themselves well:

An ointment made from comfrey herb, honey and vegetable oil in proportions of one to one. Oil can be replaced with lard or beeswax. Currently, such an ointment can be purchased at a pharmacy. Use at night for seven days or more.

Warming clay compress. Mix 200 grams of cosmetic clay purchased at a pharmacy with hot water, apply to the elbow, wrap in several layers of gauze and woolen cloth. The compress has an effect similar to the effects of physiotherapy. Cannot be used in the acute stage. Apply three times a day, each time the compress should be kept on the hand for at least an hour, replacing it with a new portion of the mixture as it cools.

A compress made from an alcoholic tincture of horse sorrel, the disadvantage of which is long-term infusion (at least 10 days). It is prepared by mixing crushed leaves, ethyl alcohol and water.

Frequently rubbing the joint area with nettle leaves, which must first be doused with boiling water.

Surgical treatment treatment of epicondylitis

Surgical treatment is used quite rarely, in cases of advanced epicondylitis, when conservative complex therapy does not help the patient get rid of excruciating pain in the arm for six months or more. Then the following operation is performed - a small incision is made on the back surface of the forearm and the doctor cuts the tendon, after which the skin over the wound is sutured.

Restoration of limb function can begin one to two weeks after surgery.
A similar operation can be performed using a puncture instead of an incision - an arthroscopic technique under the control of special devices, arthroscopes.

Lifestyle

If it is unacceptable for the patient to change his occupation, he must follow a number of simple rules to prevent subsequent episodes of epicondylitis of the elbow joint. So, when playing sports, you need to train in special orthoses, and before starting the workout you should “warm up” and do a short warm-up to improve the blood supply to the muscles and tendons. If you have monotonous movements in the joint, you should take breaks more often and massage the elbow area before starting work.

In addition, you should avoid injuries, pay sufficient attention to proper and nutritious nutrition and lead a healthy lifestyle.

Complications and prognosis for epicondylitis

Due to the fact that the disease is easily treatable, complications develop extremely rarely, and the prognosis is favorable. In case of prolonged absence of therapy, bursitis of the elbow joint may develop - inflammation of the synovial membrane, which can cause a lot of discomfort and require surgical intervention.

General practitioner Sazykina O.Yu.

Epicondylitis is a degenerative disease of the elbow joint. It can be internal or external depending on the pathology of the site of muscle attachment to the epicondyle of the humerus bone.

Epicondylitis The elbow joint is characterized by regular pain syndromes of the forearm and elbow area in the absence of any noticeable functional abnormalities.

Only fourth part all identified cases of the disease affect left limb, the rest are fixed on the elbow of the right hand. This unpleasant illness, although it does not deprive a person of his work activity, does not have the best effect on the quality of life.

If there is a delay in seeking medical help, significant destruction of tendons and cartilage tissue occurs, and nearby parts of the body also become inflamed.

Causes

Epicondylitis mainly affects people who, due to their profession, are forced to regularly overload the shoulder girdle. Because of this, tendon and muscle tissues receive microtraumas, ligaments become inflamed, and functional cells are replaced by connective tissues. As a result, the tendon grows and, losing its former elasticity, responds to normal loads with inadequate pain.

Factors leading to inflammation of the elbow joint:

• hereditary tendon dysplasia;
• repeated monotonous dynamic loads on the forearm and elbow joint, typical for musicians, tennis players, builders and other manual labor specialists;
• mechanical damage in the elbow area;
• arthrosis of the elbow joint;
• osteochondrosis of the thoracic and cervical spine;
• osteoporosis - bone fragility due to the leaching of calcium from bone tissue, as a consequence of certain diseases or age-related menopausal changes;
• impaired blood circulation in joint tissues;
• extreme muscle strain.

Classification of the disease

Depending on the location and nature of occurrence, epicondylitis is divided into:

• Lateral, or external epicondylitis of the elbow joint is manifested by an inflammatory process at the site of attachment to the external epicondyle. This type of disease is characteristic of activities associated with constant tension of the extensor muscles (“tennis elbow”).
• Medial, or internal, epicondylitis of the elbow joint, as the name suggests, is characterized by inflammation of the tendon attachment to the internal epicondyle, including the ulnar nerve. This syndrome is caused by multiple, repetitive strains of the wrist flexor muscles (“golfer’s elbow”).
• Epicondylitis traumatic- a consequence of regular traumatic effects on the tendons of the same type of movements. Often this disease is accompanied by arthrosis and damage to the nerve of the elbow joint, osteochondrosis of the cervical spine, which is typical for the age group of 40 years and older due to a decrease in the activity of tissue regeneration processes in the body.
• Post-traumatic develops due to incorrect or insufficient therapeutic measures during the rehabilitation period of dislocations, sprains and other mechanical damage to the joint area.

ICD-10 code epicondylitis of the elbow joint is classified as “other enthesopathies” in the list of diseases of the musculoskeletal system. Code M 77.1 is used in case of damage to the external epicondyle, and M 77.0- when the medial tubercle is involved.

Symptoms of epicondylitis

In the initial stage of the disease, characteristic symptoms for epicondylitis of the elbow joint are periodically occurring minor pain radiating to the hand, as well as a slight burning sensation in the forearm and elbow area. Over time, the pain intensifies, the intervals between them become shorter, until the pain merges into continuous, exhausting torture.

Despite significant difficulties in everyday life and professional activities, X-ray does not show there are no anatomical changes in the internal structures of the elbow, and there is no swelling or hyperemia of the skin in the painful area.

Due to increased pain with physical strain on the limb, over time, a person reflexively reduces the activity of the affected arm, while flexion or extension of the elbow joint by an external force does not lead to pain. Epicondylitis is also manifested by a feeling of tingling and numbness in the elbow area.

• Lateral Epicondylitis is diagnosed by simply shaking hands, which causes severe pain. Pain is localized on the upper surface of the elbow. The most intense pain occurs when the arm is independently extended. Palpation of the affected area, identified through movement, gives only a slight pain response, and nearby tissues do not react to palpation at all.
• Medial epicondylitis can be identified by pressing on the internal epicondyle. In this case, severe pain is observed, which is intensified by turning the forearm inward. The pain syndrome persists with passive flexion of the arm and is localized on the inner side of the elbow. Imitating the movements of a milkmaid increases the pain several times.

Internal and external epicondylitis, as a rule, are chronic.

Forms of epicondylitis

Disorders in the elbow joint due to epicondylitis are divided into three conditions:

1. Acute form- severe persistent pain weakens the forearm. When the patient tries to clench his fingers into a fist with his outstretched arm, unbearable pain occurs.
2. Subacute form precedes the acute stage. The latent period for the development of the disease is about 30 days, after which the first pain appears during physical activity and the muscles weaken.
3. Chronic form develops in the complete absence or improper treatment of the acute phase of the disease. It is characterized by regular aching weather-dependent pain, which is especially intensified at night and leads to constant muscle weakness.

Diagnostics

If you do not know which doctor to contact, at the first symptoms of the disease you should immediately contact your local physician, and he will refer you to the right specialist. The main methods for establishing an accurate diagnosis in this case are:

• detailed patient interview;
• examination in the clinic.

Main distinguishing feature external epicondylitis- absence of pain during passive movement of the arm in the elbow joint. Painful sensations appear only during active tension of muscles and tendons.

X-rays are practically not used in the diagnosis of epicondylitis due to their low diagnostic efficiency. External epicondylitis is not accompanied by anatomical changes; only deviations from the norm in bone density with concomitant diseases or bone fractures in the examined area are diagnosed.

The examination includes two main tests:

1. Mobility test. When the patient's elbow is motionless, the doctor begins to twist his hand to the side. When the patient, resisting, tries to return the hands to their original position, pain occurs.
2. Welt test. The patient tries to simultaneously turn his arms extended in front of him down or up with his palms. In this case, the affected arm will noticeably lag behind the healthy one.

If there is a suspicion of other complications, for example, a fracture, which is manifested by swelling of the soft tissues in the elbow area, additional examinations are carried out to identify hidden diseases:

• Arthrosis and arthritis also manifested by swelling of the elbow joint and pain during passive movement, are diagnosed using x-rays and blood tests for the inflammatory process. In addition, these diseases are indicated by pain in the joint itself, and not in the area of ​​the epicondyle.
• Neuritis, or pinched nerve, are determined by a change in sensitivity in the affected area and a decrease in muscle strength.
• Joint hypermobility, caused by congenital degeneration of connective tissues, is confirmed by the presence of longitudinal or transverse flat feet, pathological mobility of bone joints, back pain and frequent sprains.
• Carpal tunnel syndrome, leading to prolonged pain with simultaneous numbness of the fingers, is established using magnetic resonance imaging.

Treatment of epicondylitis

The specialist decides how to treat epicondylitis based on:

• degree of limb dysfunction;
• duration of the disease;
• anatomical changes in tendons and muscles.

The goals of therapy are:

• restoration of full range of motion in the elbow joint;
• relief of pain in the affected area;
• restoration of healthy blood circulation in the elbow joint area;
• prevention of complete atrophy of the forearm muscles.

In this case, symptoms and treatment are closely related:

1. Mild pain initial stage diseases are relieved by temporarily ensuring complete rest of the affected limb. Then you should clarify at what points in the activity overloads occur that provoke the development of the disease and try to eliminate these manipulations or change the technique of their implementation. After the pain has been relieved, new movements should be started, minimizing and gradually increasing the load to a working level. When this is not possible, it is necessary to change the field of activity.
2. Acute stage involves short-term (about a week) but rigid immobilization of the elbow joint using a plastic splint or plaster cast. After 7-10 days, you can remove the fixation and carry out various warming procedures, for example, compresses with camphor alcohol and other components.
3. IN chronic stage It is recommended to use an elastic bandage to secure the joint during the day, removing the bandage before going to bed. In case of frequent exacerbations, try to choose another type of activity where you will not have to subject your health to such tests.

Use of NSAIDs

• Depending on the stage of the disease and the severity of the changes, either local treatment with anti-inflammatory drugs in the form of ointments, such as Ketonal, Diclofenac, Indomethacin, Nurofen, Nimesil Nise, or injection therapy.
• Injection blockades zones of inflammation are indicated for unrelenting unbearable pain. The affected area is injected with corticosteroids: methylprednisolone or hydrocortisone. An unpleasant aspect of this procedure is increased pain in the first day after the injections.
• Also applies Glucocorticosteroid, which is bred for pain relief Lidocaine or Novocaine. Typically, the course of treatment includes 2-4 injections with an interval of 3 to 7 days.
• Blockades with drugs type of glucocorticosteroids allows you to eliminate pain within three days, while less radical drugs give results only after 2-3 weeks of therapy.
• Based on the patient’s condition, in addition, the doctor may prescribe Aspirin, Nikoshpan or Butadion. To improve tissue trophism, blockades with double-distilled water are used, which are quite painful, but very effective. Chronic pain relieved with injections Milgamma.

Physiotherapy

The entire range of physiotherapeutic procedures is used to treat epicondylitis.

The acute form is removed:

1. course high-intensity magnetic therapy, amounting to 5-8 sessions;
2. taping;
3. diadynamic therapy course of 6-7 sessions;
4. course laser infrared radiation 5-8 minutes for 10-15 procedures;

After stopping the acute stage, the following are prescribed:

1. phonophoresis from a mixture of hydrocortisone and anesthetic;
2. extracorporeal shock wave therapy;
3. electrophoresis with novocaine, acetylcholine or potassium iodide;
4. paraffin-ozokerite and naphtholone appliqués;
5. Bernard's currents;
6. cryotherapy dry air.

20-30 days after novocaine blockade and immobilization of the joint, paraffin applications are used.

Shock wave method provides precise direction of the acoustic wave to the joint area, so as not to have a negative impact on the blood vessels, as well as on the median, ulnar and radial nerves.

Massage, dry and wet air baths, mud therapy And Exercise therapy prevent muscle atrophy and restore the function of the elbow joints. Acupuncture also has a good effect.

In some cases, when the chronic bilateral course of the disease with regular exacerbations and increasing muscle atrophy and compression of nerve endings is not corrected even by injections of glucocorticosteroid drugs, more radical intervention is provided.

Surgical methods

If conservative treatment does not produce positive results after 3-4 months, this is sufficient reason to prescribe surgical intervention. Surgery involves removing calcifications and scar tissue and suturing the remaining tendon to the fascia.

Gokhman's operation

This is a planned operation with general anesthesia or regional anesthesia.

In the recent past, the modified tendons were simply excised where they became the extensor muscles. Today, surgical intervention takes place directly in the area where the tendon attaches to the bone.

The operation is performed through a small, about three centimeters, horseshoe-shaped incision above the external epicondyle. An incision is made in front of the opened epicondyle tendon fibers 1-2 centimeters in size. Only a small part of the extensor attachments is cut, while the bone remains intact.

Corrected muscle traction ceases to provoke pain at the insertion site, and the nerve and blood channels are not damaged. At the end of the surgical procedures, superficial sutures and a plaster cast are applied. The stitches are removed after about half a month.

Exercise therapy for epicondylitis

Therapeutic exercises are not sufficient therapy on their own, but are prescribed in conjunction with complex treatment to more quickly restore joint function.

A set of exercises aimed at stretching and relaxing tendons and muscles should be discussed with your doctor. It is strictly forbidden to start exercise therapy during the acute period of the disease.

Gymnastics also requires compliance with some rules:

• mandatory implementation of the complex 1 or 2 times every day;
• gradual increase in loads and duration of classes;
• immediately stop exercising if acute pain occurs and resume only after consulting your doctor.

Therapeutic exercise is designed to improve blood flow, stimulate the secretion of synovial fluid and lymphatic flow, increase muscle tone and elasticity of ligaments, which helps the elbow joint more easily bear significant loads.

Epicondylitis is one of the few diseases for which not only active, but also passive movements in exercises are prescribed.

Exercises with passive elements

• Exercise 1. Completely relax your healthy arm, placing it on a flat surface just below your chest. Grab the hand lying on the table with your other hand and slowly move it up, extending it to 90 degrees. It is important not to force the movement, but to achieve the desired position of the hand gradually, increasing the angle by a couple of degrees, every few days. At the extreme point, fix the brush for 10-15 seconds and also smoothly lower it back. Perform 2-3 approaches, 8-10 times.
• Exercise 2. It is performed similarly to the first, only the sore arm should lie with the hand hanging over the edge of the support, and it should be bent down towards the wrist.
• Exercise 3. Standing in front of a table or any other suitable surface, place your palms on it and tilt your body so that a right angle is formed between your forearms and the plane on which your palms lie. You should not force the movement, but achieve the desired angle gradually, adding a couple of degrees every few days. At the extreme point, linger for 10-15 seconds and also smoothly return to the starting position. Perform 2-3 approaches 8-10 times.
• Exercise 4. Similar to the third, but the hands lie on the surface with the back side (palms up) with the fingers facing you, the arms are slightly bent at the elbows. The desired angle is obtained by deflecting in the opposite direction.

After achieving maximum comfort when performing the passive part of exercise therapy, you can add exercises to strengthen muscles and ligaments.

Active motor exercises

• Exercise 1. Alternately bend and straighten your wrist to the maximum possible angle without feeling discomfort.
• Exercise 2. In a standing position with your arms hanging freely along your body, raise and lower your forearms, trying to keep your shoulders motionless.
• Exercise 3. With your hand bent at the elbow, clench and unclench your fist.
• Exercise 4. Interlace your fingers in front of your chest, straighten and bend your elbows. The exercise can be performed with your palms facing towards you and away from you.
• Exercise 5. Rotate forward and backward with your shoulders, repeat the same circular movements with your forearms.
• Exercise 6. Extend your arms straight in front of you, make a scissoring motion with your palms facing down and then up.
• Exercise 7. Secure one end of the rubber band in any convenient place, make a loop at the other end and grasp it with your affected hand. Stretch the tourniquet by bending the hand at the wrist, first with the palm facing the surface, then vice versa.
• Exercise 8. Standing position with a gymnastic stick in an outstretched hand in front of you. Turn the stick, like a propeller, all the way to the left, then to the original vertical position and then all the way to the right. Stay in this position for 10-15 seconds. Perform 2-3 approaches 15-20 times.

After mastering the entire complex of the active part of exercise therapy, it is permissible to begin strength exercises with a small load, for example, with a wrist expander, without allowing excessive strain on the sore arm.

Epicondylitis - treatment with folk remedies

In addition to injections, ointments, antibacterial therapy and exercise therapy prescribed by a doctor, treatment of epicondylitis of the elbow joint at home can be carried out using a variety of folk remedies:

• compresses
• rubbing
• baths
• tinctures
• massages and more.

Together with a fixing elastic bandage, all of the above methods are aimed at restoring the normal functioning of the limb, eliminating pain and returning the person to the ability to work and lead a comfortable lifestyle.

The best natural pharmacy recipes

It is impossible to describe in one article all methods of treating epicondylitis of the elbow joint with folk remedies. Their list would take at least a page. Therefore, the best methods are collected here.

Rubbing

These ointments can be combined with massage:

1. Ointment with propolis. Mix a small amount of propolis and linseed oil in a steam bath, cool and thoroughly rub into the skin of the elbow joint overnight. Secure with film and insulate with woolen cloth. Remove in the morning and repeat until cured.
2. Honey rub. If you are not allergic to honey, apply a little honey to the area of ​​pain, gently massage it for 10-15 minutes, wrap it in film and woolen cloth.

Compresses

1. Laurel oil compress warms and relieves pain. It can be rubbed into the forearm or applied as a compress for up to half an hour. If it is not possible to buy ready-made laurel oil, it can be easily prepared at home by mixing 150 g of vegetable oil with four tablespoons of crushed bay leaves and leaving for 7-14 days.
2. Blue clay compress. Diluted with warm water to the consistency of an ointment, apply it in a thick layer on a cloth and wrap the painful area, insulating it on top in any available way. The therapeutic effect of the compress is achieved when applied for 60 minutes, 3 times a day, for 1-2 weeks.
3. If we are talking about lateral epicondylitis of the elbow joint, then treatment with folk remedies offers effective compress of black radish, honey and vinegar. Grate the radish, add one teaspoon of honey and 3-5 drops of vinegar essence to 100 g of mass. Be sure to lubricate the skin with oil first so as not to burn it, and apply a compress for 1-2 hours. In case of severe burning, remove the bandage, rinse the skin and lubricate it with anti-burn agent.

Baths

Since the baths have a steaming effect, their use should be discussed with your doctor.

1. Salt. Dissolve 3 tablespoons of salt in 1 liter of warm water, dip your elbow in the solution for half an hour before bed. After which you can simply insulate the elbow joint or leave the saline solution on your arm in the form of a night compress.
2. From oat straw. Boil the straw over low heat for about ten minutes, cool to a safe temperature and keep the elbow in the warm broth.
3. Pine baths. Relieves inflammation well. Boil the pine needles and cones for 10-15 minutes over low heat, leave for 2-3 hours, wrapped in a towel, heat and keep your elbow in the warm broth.

Disease prevention

To prevent the development of epicondylitis of the elbow joint, it is necessary to comply with certain conditions in professional activities and everyday activities:

• Athletes should carefully select the appropriate sports equipment, be sure to use special elastic elbow pads, and do a full, high-quality warm-up before each workout.
• If there is a danger of acquiring this disease as a result of any activity, daily preventive massage of the forearms is necessary, including the elbow joint.
• Correctly dose the load on the elbow and forearm, do not lift the load with one hand if it can be done with two, etc.; introduce rest breaks and industrial exercises into the work schedule.
• Timely identify and treat all types of osteochondrosis, especially cervical.
• Follow the rules of a healthy diet, strengthening the body with vitamins and collagens, which have a positive effect on tissue elasticity. If it is not possible to diversify your daily diet, use periodic courses of food gelatin at a rate of 10 grams. per day for 2-3 weeks in a row.
• Eliminate from the diet foods that interfere with the absorption of calcium and its incorporation into tendons and bone tissue.

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