Where does it hurt and what does it mean?
Localization of pain is the main clue. Pain on the outside of the elbow, aggravated by straightening the wrist, turning the key, and lifting the cup, is typical of external epicondylitis. Pain on the inside when bending the hand and clenching the fist is characteristic of internal epicondylitis. Swelling and tenderness on the posterior surface above the olecranon indicate bursitis. Numbness of the little and ring fingers along with pain on the inside is a sign of compression of the ulnar nerve. Pain deep in the joint with limited flexion and extension is more often associated with arthritis or the consequences of injury.
- Externally - external epicondylitis
- From the inside - internal epicondylitis
- Posteriorly with swelling - bursitis
- With numbness of the fingers - compression of the ulnar nerve
- In the depths of the joint - arthritis or consequences of injury
Why does it occur
The main cause of epicondylitis is repeated similar loads on the muscles of the forearm. Not only athletes suffer: painters, builders, cooks, hairdressers, musicians and office workers who spend a lot of time with a mouse and keyboard also get sick. Microdamages accumulate in the tendon, the tissue is rebuilt and becomes painful. Bursitis develops after a bruise, prolonged use of the elbow, or infection. Compression of the ulnar nerve is caused by prolonged bending of the arm and leaning on the elbow. Arthritis occurs with rheumatoid disease, gout and after fractures.
- Repetitive movements of the hand and forearm
- Working with tools and lifting weights
- Tennis, golf, strength training
- Long-term support on the elbow
- Past injuries and fractures
- Rheumatoid arthritis and gout
Diagnostics
Usually, an examination is enough: the doctor determines the painful point, checks the strength and range of movements, and performs resistance tests. X-rays are prescribed after an injury, when movement is limited and arthrosis or loose bodies in the joint are suspected - the tendons are not visible in the image. Ultrasound shows well the condition of the tendons, the presence of fluid and bursitis, it is accessible and does not require preparation. MRI is used when the picture is unclear, when ligament damage is suspected, and before surgery. If numbness and weakness of the hand are a concern, electroneuromyography is performed to evaluate the nerve.
- Inspection with functional tests
- X-ray of the elbow joint
- Ultrasound of tendons and bursae
- MRI for unclear picture
- Electroneuromyography for numbness
- Blood tests for suspected arthritis and gout
Treatment
The first step is to remove the provoking load, but not to immobilize the arm completely: prolonged complete rest worsens recovery. Cold in the first days after an exacerbation, short-course non-steroidal anti-inflammatory drugs, an elbow pad or orthosis during work help. Exercises are key: gradually stretching and strengthening the forearm muscles, especially with slowly lowering the weight. Additionally, shock wave therapy, magnetic therapy and other physical procedures are used. Injections of hormonal drugs give a quick but short-term effect and should not be repeated frequently. Surgery is rarely required if treatment fails for many months.
- Limiting provocative movements
- Short course non-steroidal anti-inflammatory drugs
- Weight-bearing orthosis or elbow pad
- Forearm stretching and strengthening exercises
- Shockwave therapy and physical therapy
- Injections according to strict indications
- Surgery - for long-term ineffectiveness
How to reduce the risk of recurrence
After the pain subsides, it is important not to immediately return to previous activities. The load is increased gradually, adding weight and repetitions no earlier than the previous level ceases to cause discomfort. It is useful to reconsider the workplace: the height of the table and chair, forearm support, a comfortable mouse, breaks every 40-60 minutes. Athletes should check their technique and equipment: racket strings that are too tight and an unsuitable handle increase the load. When working with tools, cushioned gloves and alternating types of work help so that the same muscles are not stressed for hours on end.
- Gradual return to exercise
- Regular forearm exercises
- Proper organization of the workplace
- Breaks every 40–60 minutes
- Checking equipment and equipment in sports
- Alternation of types of work
- Warm-up before exercise