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What is epicondylitis of the shoulder joint?
Shoulder epicondylitis – This is a degenerative-inflammatory lesion of tissues in the area of the shoulder joint: epicondyles and tendons attached to them.
The humerus has at its ends the so-called condyles – bone 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 epicondylitis of the shoulder
There are two main types of epicondylitis:
External (lateral), in which the tendons coming from the external epicondyle of the humerus are affected;
Internal (medial), when the place of attachment of the muscle tendons to the internal epicondyle of the humerus is affected.
Muscles coming from the external epicondyle extend the elbow, hand and fingers, are responsible for supination (turning outward) of the hand and forearm. The tendons of the flexor muscles of the elbow, wrist and fingers are attached to the internal epicondyle. These muscles provide pronation of the forearm and hand.
Causes of epicondylitis of the shoulder
The main cause of epicondylitis shoulder joint is a regular injury to the tendons with mild, but systematic loads. Constant continuous work of muscles and tendons causes ruptures of individual tendon fibers, in 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.
Risk factors for the disease include:
Specificity of professional activity;
Participation in certain sports;
Presence of comorbidities.
Epicondylitis of the shoulder is often diagnosed in people whose main activity is associated with repetitive hand movements: drivers of various vehicles, surgeons, massage therapists, plasterers, painters, milkmaids, hairdressers, typists, musicians, etc.
Among athletes, tennis players and golfers are most prone to this disease. No wonder lateral epicondylitis is also called “tennis elbow”, and the medial – “golfer’s elbow”.
Among other diseases, epicondylitis is often accompanied by cervical and thoracic osteochondrosis, humeroscapular periarthritis, and osteoporosis.
Shoulder epicondylitis symptoms
The peak incidence occurs in the age range of 40-60 years. External epicondylitis is 10 times more common than internal epicondylitis. Also, this type of epicondylitis affects mainly men, while medial epicondylitis is diagnosed mainly in women.
General symptoms of the disease:
Spontaneous pain in the elbow joint, intense and burning during exacerbations, dull and aching in the chronic course of the disease;
Strengthening of the pain syndrome during the load on the elbow joint and muscles of the forearm;
Gradual loss of muscle strength of the arm.
With epicondylitis of the shoulder, pain in the joint appears only with independent active movements and muscle tension. Passive movements (extension and flexion), when the doctor himself makes 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 with the palm up). With medial epicondylitis, pain increases with flexion and pronation of the forearm (turning the arm with the palm down).
Diagnostics
The diagnosis is made on the basis of complaints and external examination. Radiography for 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).
An MRI and a blood chemistry test are done when it is necessary to differentiate epicondylitis from other diseases or injuries (fracture, tunnel syndrome, or CGS).
Shoulder epicondylitis treatment
With mild pain in the shoulder, it is recommended to exclude the movements that cause them, temporarily providing rest to the elbow joint (take a sick leave at work or take a break from sports training).
In case of severe pain in the acute phase, a short-term immobilization of the joint is performed with the help of a plaster cast or splint. You can also wear a special orthopedic orthosis, but its long-term use is ineffective.
Medical treatment includes:
The 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;
Vitamin B injections.
A wide range of physiotherapy can also be used:
shock wave therapy;
Magnetotherapy;
Phonophoresis and electrophoresis;
Toki Bernarda;
Paraffin applications;
Cryotherapy, etc.
Regarding massage, the opinions of experts differ. Some of them believe that massage for epicondylitis is useless and even harmful.
The prognosis is generally favorable, with proper work, physical activity and rest, stable remission can be achieved.
After the completion 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. Exercise therapy exercises 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 they move on to active movements carried out due to the muscles of the developed hand.
[Video] Doctor Egorov – elbow hurts, treatment options: