Epicondylitis
Epicondylitis: Excerpt from Handbook of Diseases
Also known as tennis elbow and epitrochlear bursitis, epicondylitis is inflammation of the forearm extensor supinator tendon fibers at their common attachment to the lateral humeral epicondyle. This inflammation produces acute or subacute pain.
Causes
Epicondylitis probably begins as a partial tear and is common among tennis players and people whose activities require a forceful grasp, wrist extension against resistance, or frequent rotation of the forearm. Untreated epicondylitis may become disabling.
Signs and symptoms
The patient’s initial symptom is elbow pain that gradually worsens and commonly radiates to the forearm and back of the hand whenever he grasps an object or twists his elbow.
Other associated signs and symptoms include tenderness over the involved lateral or medial epicondyle or over the head of the radius and a weak grasp. In rare instances, epicondylitis may cause local heat, swelling, and restricted range of motion (ROM).
Diagnosis
Because X-rays are almost always negative, diagnosis typically depends on clinical signs and symptoms and a patient history of playing tennis or engaging in similar activities. The pain can be reproduced by wrist extension and supination with lateral involvement or by flexion and pronation with medial epicondyle involvement.
Treatment
The aim of treatment is to relieve pain, usually by systemic anti-inflammatory therapy and by local injection of a corticosteroid and a local anesthetic.
Supportive measures
Supportive treatment includes an immobilizing splint from the distal forearm to the elbow, which generally relieves pain in 2 to 3 weeks; heat therapy, such as warm compresses, short wave diathermy, and ultrasound (alone or in combination with diathermy); and physical therapy, such as manipulation and massage to detach the tendon from the chronically inflamed periosteum.
A “tennis elbow strap” has helped many patients. This strap, which is wrapped snugly around the forearm about 1" (2.5 cm) below the epicondyle, helps relieve the strain on affected forearm muscles and tendons.
If these measures prove ineffective, surgical release of the tendon at the epicondyle may be necessary.
Special considerations
❑ Assess the patient’s level of pain, ROM, and sensory function. Monitor heat therapy to prevent burns.
❑ Instruct the patient to rest the elbow until inflammation subsides.
❑ Remove the support daily, and gently move the arm to prevent stiffness and contracture.
❑ Instruct the patient to follow the prescribed exercise program. For example, he may stretch his arm and flex his wrist to the maximum, then press the back of his hand against a wall until he can feel a pull in his forearm, and hold this position for 1 minute.
❑ Advise the patient to warm up for 15 to 20 minutes before beginning any sports activity.
❑ Urge the patient to wear an elastic support or splint during any activity that stresses the forearm or elbow.
Book Source Details
- Book Title: Handbook of Diseases
- Author(s): Springhouse
- Year of Publication: 2003
- Copyright Details: Handbook of Diseases, Copyright © 2003 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Handbook of Diseases
Authors: Springhouse
Publisher: Lippincott Williams & Wilkins
Copyright: 2003
ISBN: 1-58255-266-5
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