Epicondylitis
Epicondylitis: Excerpt from Professional Guide to Diseases (Eighth Edition)
Lateral epicondylitis of the elbow (tennis elbow) is inflammation of the extensor tendons of the forearm. Medial epicondylitis (golfer’s elbow) is inflammation at the origin of the flexor muscles of the wrist.
Causes
Epicondylitis probably begins as a partial tear and is common among tennis players or persons whose activities require a forceful grasp, wrist extension against resistance, or frequent rotation of the forearm such as using a screwdriver. Untreated epicondylitis may become disabling as adherent fibers form between the tendons and the elbow capsule.
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, or restricted range of motion.
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
Treatment aims to relieve pain, usually by nonsteroidal anti-inflammatory drugs or local injection of corticosteroids and an anesthetic. 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’’ or counterface brace has helped many patients. This strap, which is wrapped snugly around the forearm approximately 1 (nbsp;(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
The following special considerations accompany diagnosis and treatment of epicondylitis:
❑ Assess the patient’s level of pain, range of motion, and sensory function. Monitor heat therapy to prevent burns.
❑ Advise the patient to take anti-inflammatory drugs with food to avoid GI irritation.
❑ 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.
❑ Tell the patient to check his equipment. For example, a tennis racquet may not be the right size or weight. Also, changing surfaces may help to reduce stress.
Book Source Details
- Book Title: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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