Tennis elbow

Epicondylitis (also Epicondylitis; Epikodylose or Epikondyalgie ) is an acquired, painful irritation of the tendons of the muscles of the forearm, on the two bony prominences above the Gelenkknorrens ( epicondyle ) originate at the distal part of the humerus. Disease of the group enthesiopathies ( tendon disorders, tendon inflammation = Ansatztendinose, insertion tendinopathy ) is assigned. There are two forms:

Causes

A epicondylitis is caused by overuse of the forearm muscles, that is extreme or continuous repetitive movements or congestion situation of the affected muscle. Possible triggers include:

• Unilateral stress ( eg Tastatur-/Mausbenutzung, see also: Repetitive strain injury syndrome, sport climbing )
• Wrong attitude ( at work, in the house and garden work or leisure )
• Improper technique during racket sports (tennis, badminton, golf - the grip circumference probably does not matter )
• Incorrect sleeping posture in lateral position: use of the strongly bent arm as a headrest.
• Conditions such as fibromyalgia

Symptoms

Typical is a circumscribed pain on pressure over the neck muscles at the elbow and cause pain or amplification upon actuation of these muscles.

Important differential diagnoses, but also can often occur in combination, are:

• Supinatorlogensyndrom, pressure pain in the elbow more radial side ( compression syndrome of the radial nerve )
• Pronator teres syndrome, pressure pain in the elbow ulnar more ( compression syndrome of the median nerve ).

Therapies

There are various therapeutic approaches. In addition to physiotherapy methods also include, for example, watchful waiting, cooling with ice, ultrasound, laser therapy, interferential therapy, high-voltage therapy, electrical stimulation therapy, muscle strengthening exercises, arm sling, bandage, bandages, radiation, shock wave therapy (ESWT and lithotripsy), use of diclofenac -containing creams and gels Manipulative therapy (eg, transverse friction by James Cyriax ), acupuncture, leech therapy, local friction massages and the administration of cortisone. Should also diseases of the cervical spine as an important differential diagnoses later than in the absence of therapeutic success are checked, such as intervertebral disc degeneration ( esp. height C5 -7), Foramenstenosen at this level or clinically mainly to meet functional disorders of the lower cervical and thoracic spine, here then as a consequence of therapeutic chiropractic and / or physical therapy.

Studies using physiotherapy techniques ( stretching exercises, physiotherapy) suggest that this may be superior in some respects other .. Important For A Cure is a corresponding load break. Also physiotherapy exercises should be carried out usually only when the pain is largely subsided. A complete immobilization, however, is not necessary and sometimes even permanently relapse -promoting.

In rare cases, surgical treatment is indicated, which is basically just an emergency measure. In the area of the radial epicondyle of the humerus ( tennis elbow) is typically the operation after Wilhelm Hohmann used. Here, a relief of muscle tension by partial transection of the tendons at the affected Epicondyle (Disc Ision tenotomy ) is brought about ( = OP according to Hohmann ). In addition, a transection of the radial nerve plexus, which lies directly to the radial epicondyle performed. For this, the bone surface is simply obliterated ( method according to Wilhelm ).

In the area of the medial epicondyle of the humerus ( golfer's elbow ), it is necessary to seek the sulcus and ulnar nerve and accurately represent. As on the radial side of the tendon lengthening ( tenotomy ) is carried out, the forearm flexor tendons here. Concomitant Ulnariseinklemmung has the nerve freed (decompression) and possibly offset ( transposition).

After the operation a stabilizing bandage is applied, but the arm does not need to be sedated. In sulcus ulnaris transposition can be applied for immobilization for a short time a rail. After about five weeks usually occurs a healing. Competitive sports is possible after about three months.

In chronic suffering of more than four months, there is also the alternative therapy using botulinum toxin. Here, the neurotoxin botulinum toxin is low-dose injected into the muscle. The toxin inserted after a single injection of muscles and tendons lame two to three months so that they can recover. When the effect wears off, the symptoms have decreased in the rule or is even completely disappeared. As a side effect of the third finger of each hand temporarily suspended because of the debilitating effect down a bit if you stretched out his hand.