EPICONDYLITIS

From Big Medical Encyclopedia

EPIKONDILYT (epicondylitis; annate. epicondylus an epicondyle + - itis) — a periostitis of an epicondyle of a humeral bone; the disease which is often found at persons the profession to-rykh is connected with the uniform repeating movements of hands, especially pronation and supination, and also at athletes, napr, at tennis players.

Patol. process has character of an aseptic inflammation of a periosteum and the tendinous and copular device in the field of an epicondyle of a humeral bone in the beginning, in the subsequent dystrophic changes develop. Thus, the term «epicondylitis» does not reflect completely essence patol. process, and nek-ry researchers consider that it is more correct to use the term «epikondilez».

Concerning an etiology and a pathogeny E. there are two points of view. Supporters of one of them attach major importance to local processes and believe that the muscle tension in places of their attachment to bone ledges is resulted by microtraumatization of fabrics (anguishes, hemorrhages), the aseptic inflammation, hypostasis of fabrics develops that causes irritation of peripheral receptors. Adherents of other point of view consider the main reason for a disease of change in an intervertebral disk, the irritations causing abnormal reaction from century of N of page and neyrodistrofi-chesky disturbances in places of an attachment of fibrous fabrics to bone ledges. It is important to note that at most of patients E. osteochondrosis of cervical department of a backbone comes to light. Most likely, osteochondrosis is a background, on Krom under the influence of a mikrotravmati-zation or without it the epicondylitis develops.

Clinically distinguish acute, subacute and chronic forms E. At an acute epicondylitis the pain which arose in the field of outside is more rare than both epicondyles humeral kostp, constant intensive character (epikondilalgiya) has, irradiates on the course of muscles of a forearm. Function of an elbow joint is broken, first of all the rotational movements of a forearm, then extension suffer. Patients feel pains at compression of a brush in a fist and cannot hold at the same time the hand unbent in an elbow joint (Tomsen's symptom) are not capable to hold a load on an outstretched arm (a symptom of exhaustion). There is a weakness in a hand, working capacity is lost; оя^ morbidity at a palpation redelyatsya corresponding nadmyshchel. Nevrol. frustration at E. have preferential character of vegetative disturbances with existence of ir-ritatnvny, reflex, painful, miotonichesky and dystrophic symptoms. Existence of vegetative disturbances is confirmed by a spasm of capillaries, disturbance of sweating, and sometimes cyanosis of extremities, change of skin temperature.

At a subacute form of a disease pain in the field of epicondyles of a humeral bone and in a hand develops at first only at load of a brush, and at rest disappears, and only later

1 — 1V2 month gains constant character. A wedge, signs during this period the same that at an acute current. When treatment was not timely and effective, the disease can pass into a chronic form. However also the primary and chronic current of an epicondylitis is possible. At hroniche-whom E. pains have the stupid, aching character, arise at load of a hand, can amplify at night; on the party of defeat the atrophy of muscles of a shoulder and forearm is noticeable.

At rentgenol. a research in an elbow joint approximately in 30% of cases (is more often at patients hron. a form of a disease) periosteal growths, para-articular ossificates, an osteoporosis, sites of an eno-stoz, occasionally — elbow spurs come to light.

The diagnosis is based hl. obr. on typical a wedge, signs and data of the anamnesis. Differential diagnosis is carried out by hl. obr. with an exacerbation of the deforming arthrosis of an elbow joint and a bursitis of area of an epicondyle of a humeral bone. At patients morbidity at a palpation decides on the deforming arthrosis in the field of proximal a shoulder of a beam joint, over an elbow shoot and in a pole of an elbow shoot; all movements in an elbow joint are painful, and epicondyles of a shoulder are painless. On the roentgenogram reveal narrowing of a joint crack, osteoarticular growths at the edges of the joint ends of bones, a sclerosis of joint surfaces. At a bursitis local changes — a swelling, a hyperemia are expressed. The movements in an elbow joint are kept in full, painless.

Treatment E. complex also depends on a form of a disease and expressiveness a wedge, manifestations. At acute E., when aseptic inflammatory process prevails, appoint an immobilization of an extremity plaster (or polyethylene) the tire in the provision of small bending in an elbow joint (25 — 30 °) and supinations of a forearm. At the same time produce alcohol - new kainovuyu blockade of area of a painful epicondyle. Local injections of a hydrocortisone of a gemisuktsinat on 25 — 50 mg with novocaine (2 — 4 injections at an interval of 3 — 4 days) or dexamethasone (Dexasonum) were widely used. At subacute E. injections of a hydrocortisone can be replaced a phonophore-zom of hydrocortisone ointment. Use also paraffin or ozokeritovy applications (at t ° to 38 °), an electrophoresis of novocaine. The good effect gives laser impact on juxtaspinal points of cervical department of a backbone at the level C „— Sui on the party of defeat and area of a painful epicondyle. According to E. S. Zaslavsky and E. G. Guttman (1975), favorable results can be received at treatment E. proteolytic drug of a plant origin — papain. In some cases, especially at bilateral localization of process, the reflexotherapy gives good effect (see).

In the presence of vegeto-vascular changes (a spasm of capillaries, cyanosis of an extremity) in a complex to lay down. actions recommend to include a local barotherapy with influence by local negative pressure. At clinicoradiological symptoms of cervical osteochondrosis the corresponding treatment is shown (see Osteochondrosis).

At unsuccessfulness of conservative therapy E. a number of operative measures in the field of an epicondyle of a shoulder is offered: miofastsioto-

a miya — excision of the site of fabrics together with a periosteum in the form of a rhombus at the place of an attachment of muscles to an epicondyle; Z-shaped lengthening or full cutting off of a short beam razgibatel of a wrist; neurotomy of a superficial branch of a beam nerve, etc. However results of operative measures do not give the grounds to speak about their prospects. Can keep development of rubtsovospayechny changes in fabrics in a zone of operation patol. process and to provoke an exacerbation of pains.

The forecast at timely begun persistent treatment usually favorable, however in some cases a recurrence is observed. Prevention consists in the rational mode of an exercise stress. Bibliograstapenko M. G. and Eryalis P. S. Extraarticular diseases of soft tissues of a musculoskeletal system, M., 1975; Having sent

to sky E. S. and Guttman E. G. Treatment of a humeroscapular periarthritis and epicondylitis of a shoulder proteolytic enzyme papain, Ortop. and travmat., No. 1, page 68, 1975; Zulkarneevr. And. «A painful shoulder», humeroscapular periarthritis and syndrome «shoulder brush», Kazan, 1979, bibliogr.; The multivolume guide to surgery, under the editorship of B. V. Petrovsky, t. 11, book 1, page 257, M., 1960; Osteochondrosis of a backbone, under the editorship of

A. I. Osn, L., 1975; P about p e l I am a N -

with to and y Ya. Yu. Cervical osteochondrosis, M., 1966; Tyshchenko V. G. An epicondylitis of a shoulder at miners, Ortop. and travmat., Ne 3, page 24, 1974; E l to and M. A N, Occupational surgical diseases of hands, L., 1971. M. A. Berglezov.

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