Epicondylitis

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Epicondylitis is the inflammation of an epicondyle or of adjacent tissues. [1] Epicondyles are on the medial and lateral aspects of the elbow, consisting of the two bony prominences at the distal end of the humerus. These bony projections serve as the attachment point for the forearm musculature. [2] Inflammation to the tendons and muscles at these attachment points can lead to medial and/or lateral epicondylitis. This can occur through a range of factors that overuse the muscles that attach to the epicondyles, such as sports or job-related duties that increase the workload of the forearm musculature and place stress on the elbow. Lateral epicondylitis is also known as “Tennis Elbow” due to its sports related association to tennis athletes, while medial epicondylitis is often referred to as “golfer's elbow.”

Contents

Epicondylitis
Symptoms Elbow pain, pain with elbow movement, or pain at the elbow with wrist movement.

Burning sensation in the forearm.

Diminished grip strength.
TreatmentRest, ice, physical therapy, steroids, and NSAIDs.
Prognosis Usually well managed with conservative treatment within 6-12 months depending on duration and severity of symptoms.

Risk factors

Symptoms

Diagnosis

Golfers-Elbow Golfers-Elbow SAG.jpg
Golfers-Elbow

Pathophysiology

Tennis Elbow Tennis Elbow.png
Tennis Elbow

Treatment

Conservative treatment options found from the World Journal of Orthopedics include:

Should conservative treatment measures fail, non-conservative treatment options can include:

Prognosis  

Epicondylitis, both medial and lateral, has a good prognosis as it can be managed well with conservative treatment and usually does not require surgical intervention. [5]

Related Research Articles

<span class="mw-page-title-main">Median nerve</span> Nerve of the upper limb

The median nerve is a nerve in humans and other animals in the upper limb. It is one of the five main nerves originating from the brachial plexus.

In human anatomy, extensor carpi radialis brevis is a muscle in the forearm that acts to extend and abduct the wrist. It is shorter and thicker than its namesake extensor carpi radialis longus which can be found above the proximal end of the extensor carpi radialis brevis.

In human anatomy, the extensor carpi ulnaris is a skeletal muscle located on the ulnar side of the forearm. The extensor carpi ulnaris acts to extend and adduct at the carpus/wrist from anatomical position.

<span class="mw-page-title-main">Flexor carpi radialis muscle</span> Superficial muscle in the anterior side of the forearm

In anatomy, flexor carpi radialis is a muscle of the human forearm that acts to flex and (radially) abduct the hand. The Latin carpus means wrist; hence flexor carpi is a flexor of the wrist.

<span class="mw-page-title-main">Wrist drop</span> Medical condition

Wrist drop is a medical condition in which the wrist and the fingers cannot extend at the metacarpophalangeal joints. The wrist remains partially flexed due to an opposing action of flexor muscles of the forearm. As a result, the extensor muscles in the posterior compartment remain paralyzed.

<span class="mw-page-title-main">Radius (bone)</span> One of the two long bones of the forearm

The radius or radial bone is one of the two large bones of the forearm, the other being the ulna. It extends from the lateral side of the elbow to the thumb side of the wrist and runs parallel to the ulna. The ulna is longer than the radius, but the radius is thicker. The radius is a long bone, prism-shaped and slightly curved longitudinally.

<span class="mw-page-title-main">Upper limb</span> Consists of the arm, forearm, and hand

The upper limbs or upper extremities are the forelimbs of an upright-postured tetrapod vertebrate, extending from the scapulae and clavicles down to and including the digits, including all the musculatures and ligaments involved with the shoulder, elbow, wrist and knuckle joints. In humans, each upper limb is divided into the arm, forearm and hand, and is primarily used for climbing, lifting and manipulating objects.

<span class="mw-page-title-main">Tennis elbow</span> Condition in which the outer part of the elbow becomes sore and tender

Tennis elbow, also known as lateral epicondylitis or enthesopathy of the extensor carpi radialis origin, is an enthesopathy of the origin of the extensor carpi radialis brevis on the lateral epicondyle. The outer part of the elbow becomes painful and tender. The pain may also extend into the back of the forearm. Onset of symptoms is generally gradual, although they can seem sudden and be misinterpreted as an injury. Golfer's elbow is a similar condition that affects the inside of the elbow.

<span class="mw-page-title-main">Flexor carpi ulnaris muscle</span> Muscle of the forearm

The flexor carpi ulnaris (FCU) is a muscle of the forearm that flexes and adducts at the wrist joint.

<span class="mw-page-title-main">Lateral epicondyle of the humerus</span> Structure of humerus

The lateral epicondyle of the humerus is a large, tuberculated eminence, curved a little forward, and giving attachment to the radial collateral ligament of the elbow joint, and to a tendon common to the origin of the supinator and some of the extensor muscles. Specifically, these extensor muscles include the anconeus muscle, the supinator, extensor carpi radialis brevis, extensor digitorum, extensor digiti minimi, and extensor carpi ulnaris. In birds, where the arm is somewhat rotated compared to other tetrapods, it is termed dorsal epicondyle of the humerus. In comparative anatomy, the term ectepicondyle is sometimes used.

The pronator teres is a muscle that, along with the pronator quadratus, serves to pronate the forearm. It has two origins, at the medial humeral supracondylar ridge and the ulnar tuberosity, and inserts near the middle of the radius.

<span class="mw-page-title-main">Medial epicondyle of the humerus</span> Rounded eminence on the medial side of the humerus

The medial epicondyle of the humerus is an epicondyle of the humerus bone of the upper arm in humans. It is larger and more prominent than the lateral epicondyle and is directed slightly more posteriorly in the anatomical position. In birds, where the arm is somewhat rotated compared to other tetrapods, it is called the ventral epicondyle of the humerus. In comparative anatomy, the more neutral term entepicondyle is used.

<span class="mw-page-title-main">Golfer's elbow</span> Tendon inflammation disease of the elbow

Golfer's elbow, or medial epicondylitis, is tendinosis of the medial common flexor tendon on the inside of the elbow. It is similar to tennis elbow, which affects the outside of the elbow at the lateral epicondyle. The tendinopathy results from overload or repetitive use of the arm, causing an injury similar to ulnar collateral ligament injury of the elbow in "pitcher's elbow".

The common flexor tendon is a tendon that attaches to the medial epicondyle of the humerus.

The common extensor tendon is a tendon that attaches to the lateral epicondyle of the humerus.

<span class="mw-page-title-main">Fascial compartments of arm</span> Anatomical compartments

The fascial compartments of arm refers to the specific anatomical term of the compartments within the upper segment of the upper limb of the body. The upper limb is divided into two segments, the arm and the forearm. Each of these segments is further divided into two compartments which are formed by deep fascia – tough connective tissue septa (walls). Each compartment encloses specific muscles and nerves.

The posterior compartment of the forearm contains twelve muscles which primarily extend the wrist and digits. It is separated from the anterior compartment by the interosseous membrane between the radius and ulna.

<span class="mw-page-title-main">Elbow</span> Joint between the upper and lower parts of the arm

The elbow is the region between the upper arm and the forearm that surrounds the elbow joint. The elbow includes prominent landmarks such as the olecranon, the cubital fossa, and the lateral and the medial epicondyles of the humerus. The elbow joint is a hinge joint between the arm and the forearm; more specifically between the humerus in the upper arm and the radius and ulna in the forearm which allows the forearm and hand to be moved towards and away from the body. The term elbow is specifically used for humans and other primates, and in other vertebrates it is not used. In those cases, forelimb plus joint is used.

<span class="mw-page-title-main">Median nerve palsy</span> Medical condition

Injuries to the arm, forearm or wrist area can lead to various nerve disorders. One such disorder is median nerve palsy. The median nerve controls the majority of the muscles in the forearm. It controls abduction of the thumb, flexion of hand at wrist, flexion of digital phalanx of the fingers, is the sensory nerve for the first three fingers, etc. Because of this major role of the median nerve, it is also called the eye of the hand. If the median nerve is damaged, the ability to abduct and oppose the thumb may be lost due to paralysis of the thenar muscles. Various other symptoms can occur which may be repaired through surgery and tendon transfers. Tendon transfers have been very successful in restoring motor function and improving functional outcomes in patients with median nerve palsy.

<span class="mw-page-title-main">Extrinsic extensor muscles of the hand</span>

The extrinsic extensor muscles of the hand are located in the back of the forearm and have long tendons connecting them to bones in the hand, where they exert their action. Extrinsic denotes their location outside the hand. Extensor denotes their action which is to extend, or open flat, joints in the hand. They include the extensor carpi radialis longus (ECRL), extensor carpi radialis brevis (ECRB), extensor digitorum (ED), extensor digiti minimi (EDM), extensor carpi ulnaris (ECU), abductor pollicis longus (APL), extensor pollicis brevis (EPB), extensor pollicis longus (EPL), and extensor indicis (EI).

References

  1. "Epicondylitis". Merriam-Webster.com Medical Dictionary.
  2. Stewart, Sophie. "Medial epicondyle of humerus". Kenhub.[ self-published source? ]
  3. Walker-Bone et al. 2012.
  4. 1 2 3 Chiarotto et al. 2023.
  5. 1 2 3 4 5 6 7 Taylor & Hannafin 2012.
  6. 1 2 Karabinov & Georgiev 2022.
  7. DeLuca et al. 2023.

Sources

  1. Walker-Bone, K.; Palmer, K. T.; Reading, I.; Coggon, D.; Cooper, C. (February 2012). "Occupation and epicondylitis: a population-based study". Rheumatology. 51 (2): 305–310. doi:10.1093/rheumatology/ker228. PMC   3427015 . PMID   22019808.
  2. Chiarotto, Alessandro; Gerger, Heike; van Rijn, Rogier M.; Elbers, Roy G.; Søgaard, Karen; Macri, Erin M.; Jackson, Jennie A.; Burdorf, Alex; Koes, Bart W. (April 2023). "Physical and psychosocial work-related exposures and the occurrence of disorders of the elbow: A systematic review". Applied Ergonomics. 108: 103952. doi: 10.1016/j.apergo.2022.103952 . PMID   36493677. S2CID   254397900.
  3. Taylor, Samuel A.; Hannafin, Jo A. (September 2012). "Evaluation and management of elbow tendinopathy". Sports Health. 4 (5): 384–393. doi:10.1177/1941738112454651. PMC   3435941 . PMID   23016111.
  4. Karabinov, Vesselin; Georgiev, Georgi P. (18 April 2022). "Lateral epicondylitis: New trends and challenges in treatment". World Journal of Orthopedics. 13 (4): 354–364. doi: 10.5312/wjo.v13.i4.354 . PMC   9048498 . PMID   35582153.
  5. DeLuca, Meridith K.; Cage, Emily; Stokey, Phillip J.; Ebraheim, Nabil A. (September 2023). "Medial epicondylitis: Current diagnosis and treatment options". Journal of Orthopaedic Reports. 2 (3): 100172. doi: 10.1016/j.jorep.2023.100172 . S2CID   258338795.