An epicondyle is a rounded prominence of bone. The humerus has two such prominences near the elbow joint. The medial epicondyle is the one present medially and the lateral one is called the lateral epicondyle. The medial epicondyle bears the origin of the common flexor tendon and the lateral epicondyle has that of the common extensor tendon. Inflammation of the common tendons is called Epicondylitis in general. Over exertion can cause inflammation at the common tendon origins, leading to conditions called medial Epicondylitis and lateral Epicondylitis depending on whether the medial or lateral tendon origin is inflamed respectively.
Medial Epicondylitis is also known as golfers elbow, Pitcher’s elbow or Climber’s elbow. It is called thus as playing golf, throwing objects like baseballs and rock climbing, all put a strain on the flexor muscles of the forearm and ultimately on the common flexor origin. Local trauma can also cause inflammation locally. Patients present with pain on the medial aspect of the elbow joint. The ulnar nerve traverses in the groove behind the medial epicondyle. Hence if there is local injury, the extent of the injury must be assessed and in all cases the physician must rule out injury to the ulnar nerve owing to its close proximity to bone. On examination, tenderness is elicited on the medial epicondyle of the humerus. Also there will be varying degrees of restriction of movement due to pain and local inflammation of the tendon.
The other type of Epicondylitis is Lateral Epicondylitis which is also known as tennis elbow, shooter’s elbow, Archer’s elbow. This condition is most commonly seen in tennis players, also other activities like local trauma, lifting heavy weights, forceful wringing of clothes etc. can cause this condition. The patient complains of severe pain at the lateral aspect of the elbow joint on the lateral epicondyle. Also terminal extension of the elbow joint may cause severe pain. On examination there is severe tenderness on the lateral epicondyle and restriction of extension of the elbow joint. Occasionally there may be radiation of pain to the upper arm and neck. In such a condition the physician must rule out other conditions of radiating pain like cervical spondylitis, cervical rib etc.
Treatment of Epicondylitis:
Rest is most important as it helps decreasing the inflammation locally and avoids any strain on already damaged tissue. One must avoid sports which strain the tendon origin, avoid any activity which causes pain and strictly avoid lifting heavy weights.
Non steroidal anti inflammatory drugs may be administered in order to reduce the pain and swelling.
Local ice application may be helpful in acute cases.
Physiotherapy must be started in all cases as local ultrasound therapy proves quite effective in reducing pain.
Local steroid injections are useful in some cases; however cortisone injection has its own side effects as it causes local hypo pigmentation at the site on injection and in the long run causes atrophy of the surrounding tissues.
In cases of Epicondylitis where in the pain has not subsided inspite of all the above methods, surgical intervention is advised.
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