What to do in practice in case of epicondylitis?
What is the treatment for epicondylitis?, If the pain persists, it is important to schedule a medical consultation so that the attending physician can verify the diagnosis. Usually, no further examination is necessary. Exceptionally, an ultrasound may be requested if disinsertion or rupture of the tendon is suspected. X-rays are of no use in the absence of joint damage.
What is the treatment for epicondylitis?
Epicondylitis is treated primarily by resting the affected arm and can heal spontaneously over several months. A work stoppage can be useful in certain professions. To speed up healing, medical treatment is prescribed. Beyond so-called “non-specific” analgesics, such as paracetamol, and non-steroidal anti-inflammatory drugs (or “NSAIDs”), administered locally or in tablets, it is possible to offer corticosteroid infiltration. Carried out by a trained practitioner, rheumatologist, or sports specialist, the infiltration obeys a particular technique that seeks to screen the damaged area of the tendon. Usually, it relieves pain in the short term. However, the infiltrations only relieve the pain. The tendon remains weakened for some time and it is not necessary to resume normal activity immediately, otherwise, the tendon will rupture.
This is why it is necessary to provide rehabilitation with a physiotherapist, once the acute pain has passed. Different techniques will be used, all of which aim to promote healing of the tendon and further relief.
In case of resistance, it is possible to offer an elbow immobilization splint for 3 weeks. In case of failure (rare) or in people with a ruptured tendon, surgery may be considered. This intervention, which aims to ensure the proper insertion of the tendon on the bone, is proposed from the outset in the event of an acute rupture or after 6 months to 1 year of well-conducted treatment. This form of the disease affects less than 10% of patients.
How to prevent epicondylitis?
Some general advice, to be applied at work or during leisure time, is useful for preventing the appearance of tendonitis and, in particular, of epicondylitis:
– it is necessary to seek to make movements flexible rather than jerky,
– above all force work, or effort, you must warm up carefully and drink water,
– during the effort, you must try to keep the elbow bent rather than tense,
– you must avoid any intensive tightening of a tool ( eg: hard screwing),
– try to alternate repetitive tasks with other types of work, or take breaks.
Companies are also taking action to prevent epicondylitis. This is usually done in collaboration with occupational medicine. After identifying the tasks at risk, certain measures can be applied:
– new organization of the activity, to limit any repetitive aspect,
– introduction of micro-breaks for recovery,
– reorganization of workstations,
– adaptation of tools, personal equipment, and protection (for example to reduce exposure to vibrations),
– reinforced medical monitoring of personnel performing risky work (exposure to vibrations).
For tennis, in addition to general advice, it is important to have equipment that is well suited to your morphology and to properly work on your technique with a teacher in order to avoid technical gestures that promote epicondylitis.
When to talk about epicondylitis?
Epicondylitis can come on suddenly or gradually. The pain appears following repeated and/or intensive movements of the hand and arm. Sometimes the bony lump on the outside of the elbow, the epicondyle, begins to become more tender to the touch before the actual pain appears.
When to consult in case of epicondylitis?
The first thing to do with epicondylitis is to put your elbow to rest.
In the event of sudden onset of pain during exertion, it is possible to apply an ice pack to the painful area, in order to limit the inflammation. Taking pain medication (paracetamol) or topical anti-inflammatory drugs in self-medication can also provide relief.
If the signs are not typical or if the pain persists, it is advisable to consult your doctor. A detailed clinical examination with specific “triggering” maneuvers is usually sufficient to make the diagnosis.
How to make the diagnosis of epicondylitis?
In front of the pain of the external face of the elbow and typically occurring during certain efforts, it is necessary to evoke epicondylitis. It is necessary to eliminate compression of a nerve root at the level of the neck which could give this type of pain, but the pain is then awakened during the mobilization of the neck.
It is necessary to seek to reproduce the pain during certain thwarted maneuvers typical of the solicitation of the muscles and the epicondylar tendon:
– by extending the arm straight, the fingers in extension, and by seeking to prevent the extension of the fingers;
– by hindering the realization of a voluntary movement of external rotation, for example turning the hand clockwise to open a door with a key with the right arm (for the left arm, it is by turning counterclockwise).
A classic sign of epicondylitis is “Crackling aye”: it is pain on palpation of the outside of the elbow with a sensation of slipping of the skin “as on sandpaper”.
These “triggering” signs and maneuvers are important to find because other conditions of the elbow (or neck) can be responsible for pain on the external face of the elbow.
These are mainly degenerative damage to the elbow joint, between the radius (forearm bone) and the humerus (the arm bone), which can affect the cartilage, meniscus, or ligaments.
It may be arthritis of the elbow (inflammatory or infectious).
Be wary of pain secondary to local compression of a nerve and projection at the elbow of irritating pain from a nerve root in the neck, during C6 cervicobrachial neuralgia.