Epicondylitis of the shoulder (shoulder joint)
Content:
- What is epicondylitis
- Types of shoulder epicondylitis
- Causes of shoulder epicondylitis
- Shoulder epicondylitis symptoms
- Diagnostics
- Treatment of shoulder epicondylitis
What is shoulder epicondylitis?
Epicondylitis of the shoulder is a degenerative-inflammatory lesion of tissues in the area of the shoulder joint: the epicondyles and the tendons attached to them.
The humerus bones have at their ends the so-called condyles - bony thickenings, on the surface of which there are other protrusions - epicondyles, which serve to attach muscles.
The main cause of epicondylitis is chronic overstrain of the muscles of the forearm, in most cases - in the course of professional activity.
Shoulder epicondylitis accounts for 21% of occupational hand diseases.
Types of shoulder epicondylitis
There are two main types of epicondylitis:
- External (lateral), in which the tendons extending from the external epicondyle of the humerus are affected;
- Internal (medial), when the site of attachment of muscle tendons to the inner epicondyle of the humerus is affected.
The muscles extending from the external epicondyle extend the elbow, hand and fingers, and are responsible for supination (outward rotation) of the hand and forearm. The tendons of the flexor muscles of the elbow, wrist, and fingers are attached to the inner epicondyle. These muscles provide pronation of the forearm and hand.
Causes of shoulder epicondylitis
The main cause of epicondylitis of the shoulder joint is the regular injury of the tendons with light but systematic stress. The constant continuous work of muscles and tendons causes ruptures of individual tendon fibers, in the place of which scar tissue is subsequently formed. This gradually leads to degenerative changes in the joint area, against which the inflammatory process begins to develop.
The risk factors that trigger the disease include:
- The specifics of professional activities;
- Doing certain sports;
- The presence of concomitant diseases.
Epicondylitis of the shoulder is often diagnosed in people whose main activity is associated with repetitive hand movements: drivers of various vehicles, surgeons, masseurs, plasterers, painters, milkmaids, hairdressers, typists, musicians, etc.
Among athletes, tennis and golfers are most prone to this disease. It is not for nothing that lateral epicondylitis is also called "tennis elbow", and medial epicondylitis is called "golfer's elbow".
Among other diseases, epicondylitis is often accompanied by cervical and thoracic osteochondrosis, periarthritis of the shoulder scapula, osteoporosis.
Shoulder epicondylitis symptoms
The peak incidence is in the 40-60 age range. External epicondylitis occurs 10 times more often than internal. Also, this type of epicondylitis affects mainly men, while medial epicondylitis is diagnosed mainly in women.
Common symptoms of the disease:
- Spontaneous pains in the elbow joint, intense and burning during exacerbations, dull and aching in the chronic course of the disease;
- Increased pain syndrome during loading on the elbow joint and forearm muscles;
- Gradual loss of muscle strength in the arm.
With epicondylitis of the shoulder, joint pain appears only with independent active movements and muscle tension. Passive movements (extension and flexion), when the doctor himself performs them with the patient's hand, are painless. This is the difference between this disease and arthritis or arthrosis.
With lateral epicondylitis, the pain increases with wrist extension and supination (turning the forearm outward, palm up). With medial epicondylitis, pain increases with flexion and pronation of the forearm (turning the hand palm down).
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Diagnostics
The diagnosis is made on the basis of complaints and external examination. Radiography in epicondylitis is informative only in the case of a long chronic course, when structural changes become noticeable in the affected joint: a decrease in bone density (osteoporosis), pathological outgrowths (osteophytes).
MRI and biochemical blood tests are performed when it is necessary to differentiate epicondylitis from other diseases or injuries (fracture, tunnel syndrome, or SGS).
Treatment of shoulder epicondylitis
With mild pain in the shoulder, it is recommended to exclude the movements that cause them to appear, temporarily providing peace to the elbow joint (take sick leave at work or take a break from sports training).
In case of severe pain syndrome in the exacerbation phase, short-term immobilization of the joint is performed using plaster or splints. You can also wear a special orthopedic orthosis, but its long-term use is ineffective.
Drug treatment includes:
- Use of NSAIDs for external use (ointments and gels): Diclofenac, Voltaren, Indomethacin, Nurofen;
- Blockade with corticosteroid drugs (hydrocortisone or methylprednisolone), which are injected directly into the area of inflammation;
- B vitamins injections.
A wide range of physiotherapy procedures can also be used:
- Shock wave therapy;
- Magnetotherapy;
- Phonophoresis and electrophoresis;
- Bernard's currents;
- Paraffin applications;
- Cryotherapy, etc.
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Experts have different opinions about massage. Some of them believe that massage for epicondylitis is useless and even harmful.
The prognosis is generally favorable, with the observance of the correct regime of work, physical activity and rest, a stable remission can be achieved.
After the end of the acute stage of the disease, therapeutic exercises help to restore the functionality of the joint, the purpose of which is to stretch and relax the muscles and tendons. Exercises of exercise therapy include flexion and extension of the hand and elbow joint, pronation-supination of the forearm. At first they are performed as passive movements, i.e. with the help of a healthy hand, then move on to active movements carried out by the muscles of the developed hand.
The author of the article: Volkov Dmitry Sergeevich | c. m. n. surgeon, phlebologist
Education: Moscow State University of Medicine and Dentistry (1996). In 2003 he received a diploma from the Educational and Scientific Medical Center of the Presidential Administration of the Russian Federation.
