Types of shoulder fractures. Supracondylar process of the humerus (clinical aspects) Supracondylar fracture of the humerus

The content of the article

Symptoms of a supracondylar fracture of the humerus

Diagnosis of supracondylar fracture of the humerus

Treatment of supracondylar fracture of the humerus

The invention relates to medicine, namely to orthopedics and traumatology. An incision is made along the posterior medial surface of the elbow joint. A notch is made on the lower pole of the maternal bed of the humerus perpendicular to the direction of the muscles attached to the internal epicondyle. A step is formed on the proximal fragment. The distal fragment is moved to the formed step. In a particular case, fixation of the epicondyle is carried out with two needles, crossed through the center of the distal fragment. EFFECT: method makes it possible to exclude skeletonization of the distal fragment, preserve the main sources of blood supply, and prevent the development of secondary ulnar nerve neuritis. 1 z.p. f-ly.

The invention relates to medicine, namely to traumatology and orthopedics, and can be used mainly for stale, chronic avulsion fractures of the internal epicondyle of the humerus. Known methods of holding the distal fragment in the reduced position due to the imposition of cotton-gauze, adhesive patches on the area of ​​the internal epicondyle after a closed reposition of the fragment. Also known is a method of using a more advanced pelota - pneumopelota ("Surgery" N 10, 1968, S. 86-88). The disadvantage of these methods is that after the edema subsides, the pelota is not able to keep the fragments in the correct position, resulting in a secondary displacement of the internal epicondyle. A known method of treating a fracture of the internal epicondyle of the humerus ("Orthopedics and traumatology" N 10, 1981, p. 53 - 54), including an incision along the posterior medial surface of the elbow joint, reposition and fixation of the distal fragment. The disadvantage of the method chosen as a prototype is that it has a rather complex design, difficult to use, in addition, when installing and removing the retainer causes significant injury to the soft tissues of the elbow joint. The task set by the authors is to eliminate these shortcomings due to sparing manipulations, exclusion of skeletonization of the distal fragment, preservation of the main sources of blood circulation and prevention of the development of secondary neuritis of the ulnar nerve. To do this, in a method for treating a fracture of the internal epicondyle of the humerus, including an incision along the posterior-medial surface of the elbow joint, reposition and fixation of the distal fragment, it is proposed to additionally make a notch on the lower pole of the maternal bed of the humerus perpendicular to the direction of the muscles attached to the internal epicondyle, to form a step on proximal fragment, and then move the distal fragment to the formed step. In addition, it is proposed to fix the epicondyle with two wires passed through the center of the distal fragment crosswise. The proposed operation allows you to achieve 100% bone union of fragments. The method is carried out as follows. Under general anesthesia, an arcuate anterior incision 4-5 cm long is made along the posterior-medial surface of the joint, bypassing the area of ​​damage on the humerus. The proximal point of the incision is the projection upper pole of the fracture plane. After careful removal of blood clots on the upper-posterior edge of the surgical wound, the maternal bed of the internal epicondyle opens. At the lower pole of the mother bed, a notch is made using a straight chisel of the appropriate width, perpendicular to the plane of the fracture and the direction of the muscles attached to the internal epicondyle, 0.3 cm deep. Then a step is formed on the proximal fragment of the same depth. Reposition is performed by inserting a pin under the base of the torn epicondyle at the site of muscle attachment. Rotational movements introduce a metal needle sharpened under a round awl. Its sharp end is brought into the corner of the step and partially fixed in it. Then, with simultaneous flexion of the forearm, but not less than 90 o in the elbow joint, as if on a lever, the torn fragment is moved to the formed step. In this case, in order to avoid separation of the fragment, it is impossible to apply a large effort. The epicondyle in the correct position is fixed with the same and the second needle with a similar sharpening, drawn through the center of the fragment across the first. Example 1. B. Ya., born in 1982 , (C/B 576/1283), suffered an injury to the elbow joint on May 22, 1995, after falling from a height of 2.0 meters. In the Central Regional Hospital at the place of residence, R-grams of the elbow joint were made in two projections, a posterior plaster splint was applied. Upon admission to the clinic, on the 10th day after the injury, the internal epicondyle was repositioned according to the described method. On the control R-gram, 4 weeks after the operation, bone consolidation of the fracture is determined. After removing the metal wires, he received a monthly course of complex rehabilitation treatment. An outpatient examination, 3 months after the operation and in the long-term period, a year after discharge from the clinic, determines the full range of motion in the injured joint, there are no vascular and neurological disorders. Example 2. Patient Yu., 9 years old, (c/b 284/96), went to the clinic 2.5 months after the injury. At the place of residence received treatment with plaster immobilization for three weeks, after the termination of which - rehabilitation treatment without effect. Clinical examination revealed: movements in the left elbow joint are sharply limited, painful; violation of tactile and pain sensitivity in the projection of the innervation of n.ulnaeis sin., the impossibility of active extension of the IV and V fingers of the left hand. On a radiograph in two projections, a fracture of the internal epicondyle with an infringement in the joint cavity is determined. During the operation, in addition to confirming the x-ray picture, an infringement in the joint cavity of a section of the ulnar nerve was revealed. Produced neurolysis of the latter and reposition of the fragment according to the developed method. On the first day after the operation, the full range of motion of the IV-V fingers of the hand. After a course of intravenous Cerebrolysin, neurological disorders in the area of ​​innervation n.ulnaris sin. are not detected. On the control radiograph after 4 weeks - bone consolidation. An outpatient examination 6 months after the operation showed a full range of motion in the elbow joint, there were no vascular and neurological disorders. The advantage of the proposed method is to avoid injury to the elbow joint, which contributes to strong consolidation and eliminates the secondary displacement of the fragment and the formation of pseudarthrosis, and also does not lead to secondary complications from the ulnar nerve.

Claim

1. A method for treating a fracture of the internal epicondyle of the humerus, including an incision along the posterior-medial surface of the elbow joint, reposition and fixation of the distal fragment, characterized in that a notch is made at the lower pole of the maternal bed of the humerus perpendicular to the direction of the muscles attached to the internal epicondyle, a step is formed on the proximal fragment, then the distal fragment is moved to the formed step. 2. The method according to claim 1, characterized in that the fixation of the epicondyle is carried out with two needles, crossed through the center of the distal fragment.

A fracture of the humerus is a fairly common injury. It accounts for approximately 7% of all possible fractures and occurs due to the impact of a large force that the bone tissue cannot withstand.

The structure of the humerus

Between the elbow and shoulder joints is a bone called the humerus. It has a tubular structure. According to the anatomical structure, several sections of the bone are distinguished: the body or diaphysis, the proximal epiphysis (upper end) and the distal epiphysis (lower end).

At the proximal end there is a head that serves to connect with the scapula. Immediately behind it is a narrowing called the anatomical neck. Further there are tubercles to which muscles are attached. Immediately behind the tubercles there is another narrowing called the surgical neck. It is she who is the most vulnerable place.

At the top, the body of the bone is rounded, towards the bottom it acquires a triangular section. The diaphysis has a groove in which the radial nerve runs.

On the lower part of the bone, there are 2 articular surfaces at once, with the help of which it connects to the bones of the forearm. There is a block at the distal end for connection with the ulna. The protrusions on the sides of the lower end of the bone are called epicondyles. They serve to strengthen the muscles.

Causes of fractures and their types

Fractures are classified according to several characteristics. The main among them is the place of bone damage, as this affects the choice of treatment tactics. A fracture of the humerus has an ICD 10 code, which means that this injury in the international classification of diseases belongs to the section “injuries of the shoulder girdle and shoulder”.

Depending on the location of the bone injury, a diaphysis fracture, a fracture of the lower and upper ends of the humerus are distinguished. In each of these varieties, subspecies are distinguished depending on the characteristics of the damage.

Upper section

Fractures of the upper end of the humerus include violations of the integrity of the surgical and anatomical neck, a large tubercle, the upper epiphysis and the proximal end. The reason for their appearance is a blow directly to the bone or a fall on the elbow or abducted arm. And a fracture of the tubercle can happen due to a very strong muscle contraction.

middle department

Fractures of the body of the humerus are distinguished by localization: the upper, middle and lower thirds. This damage occurs if you fall on a straight arm, elbow, or due to a strong blow.

By nature, these fractures are open, closed, comminuted, offset, helical, oblique or transverse.

In the lower section

In this department, violations of the integrity of the articular process, the lower epiphysis, the supracondylar region, the internal epicondyle, and the condyles themselves can occur. This type of injury occurs due to an unsuccessful landing on the palm or elbow.

Supracondylar fractures of the shoulder

This is the most common fracture of the humerus in children. The integrity of the bone is broken along an oblique or transverse line slightly above the epicondyles. There are extensional and flexion fractures of this type. The first ones occur when falling on an extended arm, therefore they are called extensor, and the second - flexion, as they are formed during an unsuccessful fall on an arm bent at the elbow.

Fractures of the condyles

With such fractures, both the condyles themselves and pieces of the block along with them can be separated. The fracture usually passes along the oblique and penetrates the elbow joint, which swells strongly, deforms and increases in size.

Transcondylar fractures of the shoulder

These are intra-articular fractures, which are characterized by simultaneous damage to the integrity of both condyles and the supracondylar region. Such injuries usually occur in accidents and when falling from a great height. This is a rather severe injury, which is accompanied by serious damage to the nerves, muscles and blood vessels.

Other types of fractures

Violations of the integrity of the bones are classified according to other criteria:

Characteristic symptoms of fractures of different localization

Proximal humerus

Damage to the upper epiphysis is characterized by:

• severe sharp pain;
• tissue swelling;
• limitation or complete lack of mobility in the shoulder joint;
• bruising.

Body of the humerus

With a fracture of the diaphysis, there are:

If the radial nerve is damaged, then loss of sensitivity is possible up to complete paralysis of the limb.

Distal

For a fracture in the lower section are characterized by:

• severe pain at the site of injury and throughout the arm;
• hemorrhage and swelling;
• deformity and lack or difficulty of mobility of the elbow joint.

In some cases, such a fracture causes ruptures and serious damage to the nerve fibers and blood vessels. This condition is characterized by numbness of the hand and forearm, their pallor and “marbling”, a feeling of “goosebumps” and tingling. In such cases, the victim must be immediately taken to a medical institution, since with a long absence of treatment, a complete loss of part of the arm is possible.

Features of a fracture of the humerus in a child

Children, due to their increased mobility, are quite often exposed to fractures and other injuries. In most cases, treatment tactics do not differ from adult patients. Of particular danger in childhood are fractures of the lower part of the humerus, since it is there that the points of growth are located. If they are damaged, growth stops, which leads to deformation and disruption of the functioning of the elbow joint.

Shoulder fracture in old age

In old age, the risk of fractures increases significantly, since with age, the nutrition of bone tissue is disturbed, and it loses its strength. The treatment of such injuries is of particular difficulty, as the processes of regeneration and recovery slow down. In addition, most older people suffer from osteoporosis.

Diagnostics

To diagnose a fracture of the humerus, it is usually sufficient to examine and conduct x-rays in 2 projections.

In some cases, damage to surrounding tissues or intra-articular fractures may require ultrasound, CT or MRI.

First aid

First of all, the victim after the injury must be reassured. If a person is very worried and panicking, sedatives can be used, for example, tincture of valerian or motherwort, Novo-Passit, Sedavit.

Then you need to eliminate the pain. To do this, you can use almost any analgesic or NSAIDs: Analgin, Diclofenac, Ibuprofen, Ketanov, Nimid, etc.

It is important to immobilize the injured limb. To do this, you can use various improvised means: planks, sticks, strong rods. They are tied to the shoulder or forearm as carefully as possible so as not to provoke displacement of fragments. Next, the hand is suspended on a scarf bandage.

If the fracture is open, then the site of soft tissue rupture should be washed in case of contamination and a bandage should be applied. This is where first aid ends. The victim should be taken to a medical facility. Transported in a seated position.

Treatment and recovery after a fracture

The choice of treatment tactics depends entirely on the characteristics of the fracture. In most cases, treatment is carried out on an outpatient basis, but sometimes a hospital stay is required.

Treatment of a non-serious fracture

For a closed fracture of the humerus, not accompanied by displacement, it is necessary to fix it with plaster or a special splint. The fixation period depends on the nature of the damage and can be 1-2 months. The plaster bandage covers not only the damaged bone itself, but also the elbow and shoulder joints. If the diaphysis is damaged, then partial coverage with a plaster of the chest is required. At the end of wearing a cast, a short use of a kerchief bandage may be recommended.

Treatment of a displaced fracture

A fracture of the humerus with displacement has its own characteristics of treatment. First of all, the fragments are compared. It must be carried out within the first hours after the injury, until the hand is very swollen. The procedure is performed under general anesthesia. To prevent re-displacement, skeletal traction is used, and then a special splint or orthosis is applied to the arm.

Surgery

A comminuted fracture of the humerus requires surgical intervention. Also, the operation is necessary in case of violation of the integrity of nerve fibers and blood vessels, with osteoporosis, with infringement of tissues between fragments, if it is impossible to compare the bone with a closed method.

During the surgical intervention, fragments are fixed using special metal plates, screws, knitting needles and other devices. This intervention is called osteosynthesis. If a split of the head of the bone occurs and the joint is seriously damaged, endoprosthesis is performed, which involves the use of an artificial prosthesis.

Complications and prognosis

A fracture of the humerus without displacement usually grows together without negative consequences. And complex injuries, accompanied by displacement, damage to the joint or the formation of a large number of fragments, can later manifest themselves as various complications in the form of:

• partial or complete loss of sensation in the hand due to rupture of nerve fibers;
• arthrogenic contracture, manifested by limitation of joint movements;
• the formation of a false joint when it is impossible to splice the fragments due to the restrained tissues between them.

Rehabilitation

To resume the full functioning of the hand, it is necessary to carry out rehabilitation measures. They include massages, physiotherapy, therapeutic exercises.

Physiotherapy

Physiotherapy usually begins immediately after the removal of the immobilizing splint or gypsum. It is aimed at restoring and improving blood circulation and tissue nutrition, accelerating regeneration, eliminating pain, and reducing swelling. May be prescribed: electrophoresis, ultrasound, ultraviolet irradiation.

Massage

Massage is also prescribed immediately after the removal of the cast. Its action is aimed at improving microcirculation and tissue trophism, restoring muscle strength and joint mobility.

How to develop a hand after a fracture of the humerus

To restore the functionality of the hand, physiotherapy exercises are fully prescribed. A set of exercises is selected individually, with a gradual complication. A few days after the plaster is applied, it is necessary to try to move your fingers. A week later, you can begin to strain the muscles of the shoulder, and after removing the plaster cast - active movements in the elbow and shoulder joints.

Prevention

Prevention of fractures of the forearm is the avoidance of traumatic situations. In addition, it is recommended to lead a healthy lifestyle, eat well, and, if necessary, take vitamin and mineral complexes to strengthen bone tissue.

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Most often found in children and adolescents from 7 to 17 years. Separation of the internal epicondyle occurs with significant abduction of the forearm and excessive extension in the elbow joint. At the same time, the internal lateral ligament is sharply strained, which is attached to the epicondyle at one end. Since this ligament is very strong, it does not rupture, but breaks away from its attachment along with a piece of the epicondyle in adults or the entire epicondyle in children. A fracture of the epicondyle can also occur with direct trauma - a direct blow to the back surface of the elbow joint.

The epicondyles have independent ossification nuclei, which appear at different times: in the outer epicondyle at the 12-13th year of life, in the inner - at the 5-6th year. Fusion of both epicondyles with the metaphysis of the humerus occurs at the age of 17-18, so many believe that before this age, each epicondyle fracture is epiphysiolysis.

Fracture of the epicondyle- this is, as a rule, extra-articular damage (the articular capsule is attached distal to the epicondyle), however, in some cases, with excessive abduction of the forearm, a transverse tear of the articular bag occurs and dislocation or subluxation of the forearm occurs outward, which can be reduced independently. At the same time, due to the traction of the muscles attached to the epicondyle (the superficial flexor of the fingers, the ulnar flexor of the hand, the radial flexor of the hand, the long palmar muscle, etc.), it shifts downward and can be pinched between the articular surfaces of the humerus and ulna. Infringement can also occur with inept reduction of a dislocated forearm.

When detached from the internal epicondyle determine the characteristic signs: sharp pain on palpation of the fracture area, hemarthrosis, hematoma and swelling, which are somewhat less pronounced than with other fractures in this area. In the first hours, when the swelling is small, you can feel the detached epicondyle. Movement in the joint is possible and not very painful. When the epicondyle is infringed, the movements are sharply limited and painful, passive movements are sharply painful and when trying to make a full extension of the forearm or increase the abduction of the forearm of the cranium. An x-ray of the elbow joint, made in two projections, allows us to clarify the nature of the fracture (Fig. 28). Sometimes for comparison it is necessary to resort to radiography of an intact elbow joint. When examining the victim, it is necessary to check the motor and sensory conduction of the ulnar nerve, which is located in the groove running along the posterior surface of the epicondyle, as a result of which it is often injured.

Rice. 28. Fractures of the internal epicondyle.

Treatment of fractures of the internal epicondyle depends on the nature of the displacement of the fragment. In case of fractures without displacement, when only a narrow gap is determined on the radiograph, it is possible to limit the application of the posterior plaster splint in children for no more than 1 week, and in adults for 2-21/2 weeks. Longet should be deep enough, it is applied when the forearm is bent at the elbow joint at a right angle. After the specified period, the splint is removed and functional treatment is started. The function of the elbow joint is restored in children after 2-21/2, and in adults 4 weeks after the injury.

When the epicondyle is displaced reposition is needed. As with other fractures in the elbow joint, local anesthesia should not be used, since the introduction of novocaine infiltrates the already edematous tissues even more, which makes it difficult to compare the fragments. It is best to use general anesthesia. Reduction of the epicondyle is best done in the x-ray room. After anesthesia is given, they begin to compare the fragments. When the epicondyle is displaced downward, it is necessary to bend the arm at the elbow joint to a right angle and give the palmar flexion to the hand. In this position, the muscles attached to the internal epicondyle relax. This allows thumb pressure on the detached epicondyle to move it up and put it in place. When the correct standing of the epicondyle is confirmed radiographically, the arm is fixed in the given position with the help of a posterior plaster splint.

When the epicondyle is displaced downward and at an angle open upward or downward, the epicondyle is adjusted as follows. If there is an angle open upward, the arm is bent at the elbow to a right angle, the thumb of one hand is shifted upward, and the thumb of the other is pressed against the epicondyle to the humerus. When the epicondyle is displaced at an angle open downwards, the forearm is first given a valgus position, then it is bent at the elbow joint to a right angle and the epicondyle is pressed against the humerus. The position of the epicondyle is checked radiographically, after which a posterior plaster splint is applied from the upper third of the shoulder to the metacarpophalangeal joints.

The time of fixation with a plaster splint is slightly longer than for non-displaced fractures. In children, plaster immobilization lasts 12-14 days, in adults - from 3 to 4 weeks. After removing the plaster splint, they begin active movements in the elbow joint. Usually, mobility in the elbow joint is completely restored in children by the 3-5th week, in adults - by the 5-6th.

In case of chronic fractures of the epicondyle, when more than a week has passed after the injury, patients should be referred to a hospital for surgical reduction and fixation of the torn epicondyle. The operation is. that a small incision is made and the epicondyle is sutured or fixed with a needle.

In cases of infringement of the epicondyle in the elbow joint between the articular ends of the ulna and humerus, you can try to remove the incarcerated epicondyle in a bloodless way. For this, the forearm is sharply valgus; the muscles attached to the torn epicondyle tense, and it can come out of the joint. If by such actions it is possible to remove the epicondyle from the joint, further treatment is carried out as described above. If the infringement of the condyle remains or the patient asked for help 7-10 days after the injury, when it is impossible to remove the epicondyle from the joint, then the patients are sent to the hospital for surgical treatment.

N. G. Damier (1960) for such cases developed a technique for extracting the strangulated epicondyle closed, without surgical intervention. Under X-ray control, a single-toothed sharp hook is inserted through the skin of the anterointernal surface of the elbow, a fragment or a ligament attached to it is hooked with it and pulled inwards; while the fragment is easily removed from the joint space. After removing the hook, the arm is bent at the elbow joint to a right angle, the fragment is advanced upwards with a finger and pressed against the humerus. Further treatment is the same as for non-strangulated fractures of the epicondyle.

Dubrov Ya.G. Outpatient traumatology, 1986

• What is epicondylitis
• Types of epicondylitis of the shoulder
• Causes of epicondylitis of the shoulder
• Shoulder epicondylitis symptoms
• Diagnostics
• Shoulder epicondylitis treatment

What is epicondylitis of the shoulder joint?

Epicondylitis of the shoulder is a degenerative-inflammatory lesion of tissues in the area of ​​the shoulder joint: epicondyles and tendons attached to them.

The humerus has at its ends the so-called condyles - bone thickenings, on the surface of which there are other protrusions - epicondyles, which serve to attach muscles.

The main cause of epicondylitis is chronic overstrain of the muscles of the forearm, in most cases - in the course of professional activity.

Shoulder epicondylitis accounts for 21% of occupational hand diseases.

Types of epicondylitis of the shoulder

There are two main types of epicondylitis:

External (lateral), in which the tendons coming from the external epicondyle of the humerus are affected;

Internal (medial), when the place of attachment of the muscle tendons to the internal epicondyle of the humerus is affected.

Muscles coming from the external epicondyle extend the elbow, hand and fingers, are responsible for supination (turning outward) of the hand and forearm. The tendons of the flexor muscles of the elbow, wrist and fingers are attached to the internal epicondyle. These muscles provide pronation of the forearm and hand.

Causes of epicondylitis of the shoulder

The main cause of epicondylitis of the shoulder joint is regular traumatization of the tendons with mild, but systematic loads. Constant continuous work of muscles and tendons causes ruptures of individual tendon fibers, in place of which scar tissue is subsequently formed. This gradually leads to degenerative changes in the joint area, against which the inflammatory process begins to develop.

Risk factors for the disease include:

Specificity of professional activity;

Participation in certain sports;

Presence of comorbidities.

Epicondylitis of the shoulder is often diagnosed in people whose main activity is associated with repetitive hand movements: drivers of various vehicles, surgeons, massage therapists, plasterers, painters, milkmaids, hairdressers, typists, musicians, etc.

Among athletes, tennis players and golfers are most prone to this disease. No wonder lateral epicondylitis is also called "tennis elbow", and the medial - "golfer's elbow".

Among other diseases, epicondylitis is often accompanied by cervical and thoracic osteochondrosis, humeroscapular periarthritis, and osteoporosis.

Shoulder epicondylitis symptoms

The peak incidence occurs in the age range of 40-60 years. External epicondylitis is 10 times more common than internal epicondylitis. Also, this type of epicondylitis affects mainly men, while medial epicondylitis is diagnosed mainly in women.

General symptoms of the disease:

Spontaneous pain in the elbow joint, intense and burning during exacerbations, dull and aching in the chronic course of the disease;

Strengthening of the pain syndrome during the load on the elbow joint and muscles of the forearm;

Gradual loss of muscle strength of the arm.

With epicondylitis of the shoulder, pain in the joint appears only with independent active movements and muscle tension. Passive movements (extension and flexion), when the doctor himself makes them with the patient's hand, are painless. This is the difference between this disease and arthritis or arthrosis.

With lateral epicondylitis, pain increases with wrist extension and supination (turning the forearm outward with the palm up). With medial epicondylitis, pain increases with flexion and pronation of the forearm (turning the arm with the palm down).

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Diagnostics

The diagnosis is made on the basis of complaints and external examination. Radiography for epicondylitis is informative only in the case of a long chronic course, when structural changes become noticeable in the affected joint: a decrease in bone density (osteoporosis), pathological outgrowths (osteophytes).

An MRI and a blood chemistry test are done when it is necessary to differentiate epicondylitis from other diseases or injuries (fracture, tunnel syndrome, or CGS).

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Shoulder epicondylitis treatment

In case of severe pain in the acute phase, a short-term immobilization of the joint is performed with the help of a plaster cast or splint. You can also wear a special orthopedic orthosis, but its long-term use is ineffective.

Medical treatment includes:

The use of NSAIDs for external use (ointments and gels): Diclofenac, Voltaren, Indomethacin, Nurofen;

Blockade with corticosteroid drugs (hydrocortisone or methylprednisolone), which are injected directly into the area of ​​​​inflammation;

Vitamin B injections.

A wide range of physiotherapy can also be used:

shock wave therapy;

Magnetotherapy;

Phonophoresis and electrophoresis;

Currents of Bernard;

Paraffin applications;

Cryotherapy, etc.

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Regarding massage, the opinions of experts differ. Some of them believe that massage for epicondylitis is useless and even harmful.

The prognosis is generally favorable, with proper work, physical activity and rest, stable remission can be achieved.

After the completion of the acute stage of the disease, therapeutic exercises help to restore the functionality of the joint, the purpose of which is to stretch and relax the muscles and tendons. Exercise therapy exercises include flexion and extension of the hand and elbow joint, pronation-supination of the forearm. At first they are performed as passive movements, i.e. with the help of a healthy hand, then they move on to active movements carried out due to the muscles of the developed hand.

Treatment of epicondylitis should have a combined approach. To determine the required volume of therapy, it is necessary to take into account the degree of structural changes in the tendons and muscles of the hand and elbow joint, impaired motor activity of the joints, and the duration of the pathological process. The main objectives of the therapeutic direction are to eliminate pain in the focus of inflammation, restore local blood circulation, resume the full range of motor activity in the elbow joint, as well as prevent atrophic processes in the muscles of the forearm.

Treatment of epicondylitis with folk remedies

Treatment of epicondylitis with folk remedies should begin with a doctor's consultation, since, despite the fact that natural substances and herbs are used to a greater extent, the risk of side effects is always present.

Milk compresses with propolis are prepared by dissolving 5 g of pre-crushed propolis in one hundred milliliters of warm milk. After that, a napkin of several layers of gauze must be soaked with this mixture and wrap the affected joint with it. After making a further compress with cellophane and a layer of cotton wool, leave it for 2 hours.

Restorative ointment for ligaments and periosteum is made from natural fat. First, it (200 g) is melted in a water bath, the fat is separated and used for the base of the ointment. Next, 100 g of fresh comfrey root must be crushed and mixed with warm fat. The mixture must be stirred until a homogeneous thick mass is obtained. Store the resulting ointment in the refrigerator. One procedure requires approximately 20 g of the medicinal mixture. Before use, it must be heated in a water bath and soaked in a napkin from several layers of gauze. Further, as a normal compress, the treatment lasts about 2 hours. Treatment of epicondylitis with folk remedies can both get rid of the main clinical symptoms of the disease and restore the structure of the damaged joint.

Gymnastics with epicondylitis

Gymnastics with epicondylitis is directed to the gradual stretching of the formed connective tissues to restore the functioning of the joint. Of course, without medical intervention, physical exercises will not be as effective as with their combination, but the result will still be noticeable.

Gymnastics with epicondylitis is performed using active movements and passive ones using a healthy hand. All exercises should be gentle in order to avoid aggravating the situation and further damage to the joint. In addition, a special complex does not include strength exercises, since they are not indicated for the treatment of epicondylitis. Moreover, the use of gymnastics is allowed only after consulting a doctor and the extinction of the acute stage of the disease.

Exercises for epicondylitis

For the purpose of treatment and rehabilitation for the disease, exercises for epicondylitis were specially developed. So, it is necessary to carry out flexion and extension of the forearm with a fixed shoulder girdle; with your arms bent at the elbows, you need to clench your fists; alternating hands, you should perform circular movements with your shoulders and forearms in opposite directions; connecting the hands of both hands, it is necessary to carry out flexion and extension in the elbow joint.

In the absence of contraindications and the permission of the doctor, you can perform such exercises for epicondylitis as "mill" or "scissors".

Ointment for epicondylitis

Ointment for epicondylitis has a local effect, due to which it is possible to have an anti-inflammatory, analgesic and anti-edematous effect on the affected joint. Ointments can include both non-steroidal anti-inflammatory components and hormonal preparations.

Epicondylitis ointment based on corticosteroids has a powerful effect in reducing edema and the inflammatory response. For example, ointments with betamethasone and an anesthetic. This combination relieves a person at the same time of pain and bursting sensation in the affected area of ​​the forearm.

Non-steroidal anti-inflammatory ointments for epicondylitis

Non-steroidal anti-inflammatory ointments for epicondylitis are used to reduce the activity of the body's inflammatory response to damage to the tendon at the site of its attachment to the bone. Among the most common and used can be identified: ointment ortofen, ibuprofen and indomethacin. In addition, there are a large number of gels based on non-steroidal anti-inflammatory drugs, such as diclofenac, nurofen and piroxicam.

Non-steroidal anti-inflammatory ointments for epicondylitis are quite simple to use. During the day, it is necessary to apply a certain amount of funds to the affected area of ​​​​the joint. However, such ointments are not recommended as monotherapy, since the disease requires combined treatment.

Treatment of epicondylitis with Vitafon

Vitafon is a vibroacoustic device that uses microvibrations for therapeutic purposes. The principle of impact on the affected area is determined by the influence of different sound frequencies. As a result, there is an activation of local blood circulation and lymphatic drainage. Treatment of epicondylitis with Vitafon is possible even in the acute stage. It helps to reduce pain, which improves the quality of human life.

Treatment of epicondylitis with Vitafon has certain contraindications. These are oncological neoplasms in the joint area, severe atherosclerosis, thrombophlebitis, an acute stage of infectious diseases and fever.

Diprospan with epicondylitis

Despite the widespread use of non-steroidal anti-inflammatory drugs, diprospan remains the drug of choice for epicondylitis. Due to the presence of betamethasone in the form of sodium phosphate and dipropionate, the therapeutic effect is achieved quickly and for quite a long time. The action of diprospan is determined by its belonging to hormonal agents.

Diprospan with epicondylitis provides a strong anti-inflammatory, immunosuppressive and anti-allergic effect. The introduction of the drug should correspond to the desired effect. If a general effect is necessary, then the drug is administered intramuscularly, if local - then into the surrounding tissues or into the joint. There are also ointments, but they do not have the name "diprospan", but include the main component - betamethasone.

Bandage for epicondylitis

Immobilization of the joint is one of the main conditions for the complex treatment of epicondylitis. There are many ways to immobilize the affected area, one of which is considered to be a bandage for epicondylitis.

It is applied in the area of ​​the upper third of the forearm and provides a strong immobilization. The bandage provides unloading of the place of fixation of the inflamed tendon to the bone with the help of a directed compression effect on the muscles. Thanks to a special clasp, you can adjust the degree of compression.

The bandage for epicondylitis has a densely elastic body, which provides the necessary redistribution of pressure. It is very easy to use and does not cause discomfort.

Shock wave therapy for epicondylitis

Shock wave therapy for epicondylitis is considered a modern method of treating the disease, since its effectiveness in restoring lost joint function has long been proven. This type of therapy provides shorter periods of treatment of epicondylitis, which is based on damage to the tendons at the site of their attachment to the bone.

Shock wave therapy is of particular importance for athletes, as they must quickly recover from injuries. The essence of the impact of the method is based on the supply of acoustic waves of a certain frequency to the affected area of ​​the joint. In addition, thanks to it, local blood flow is greatly enhanced. As a result of this, there is a restoration of normal metabolism, activation of the synthesis of collagen fibers, local blood circulation, tissue metabolism, and the process of regeneration of the cellular composition of the affected area is also started.

Despite its high effectiveness, shock wave therapy for epicondylitis has some contraindications. Among them, it is worth highlighting the period of pregnancy, the acute phase of infectious diseases, the presence of exudate in the lesion, osteomyelitis, impaired blood coagulation, various pathologies of the cardiovascular system and the presence of an oncological process in the field of application of this type of therapy.

Elbow for epicondylitis

The elbow pad for epicondylitis provides moderate force fixation and compression of the tendons of the extensor and flexor muscles of the hand. In addition, he performs massage movements on the muscle structure of the forearm.

The composition of the elbow pad includes an elastic frame with a silicone pad that fixes the belt, which evenly distributes pressure on the muscles. It is universal, as it is suitable for the right and left hands of various diameters.

The elbow pad for epicondylitis is very convenient, as it prevents excessive lability of the joint, which adversely affects the treatment process.

Orthosis for epicondylitis

An orthosis for epicondylitis is used to reduce the load on the tendons of the muscles at the point of their attachment to the bone. Thanks to him, the pain syndrome is removed and the functioning of the affected joint is normalized.

Orthosis with epicondylitis has its own contraindications, namely ischemia (insufficient blood supply) to areas of the damaged limb. Its use is effective both separately and in combination with glucocorticosteroids. Due to the compression of the muscles of the forearm by it, a redistribution of the load on the flexors and extensors of the hand is observed, and the tension force of the tendon at the point of attachment to the humerus decreases. Orthosis is used in the acute phase of epicondylitis.

Surgery for epicondylitis

Conservative treatment in most cases leads to stable remission and long periods without exacerbation. However, there are some conditions in which epicondylitis surgery is performed.

Indications for its implementation are frequent relapses of the disease with vivid clinical manifestations and long acute periods, insufficient or complete ineffectiveness of drug treatment. In addition, it is necessary to take into account the degree of muscle atrophy and compression of the surrounding nerve trunks. With an increase in the symptoms of these conditions, an operation is indicated for epicondylitis.

Physiotherapy for epicondylitis

Physiotherapy for epicondylitis is one of the main methods of treating the disease. It includes:

• ultraphonophoresis of hydrocortisone, during which ultrasonic waves make the skin more permeable to medicinal substances, as a result of which hydrocortisone penetrates into the deeper layers of the skin;
• cryotherapy, which involves exposure to the affected area of ​​the joint with a cold factor, usually with a temperature of -30 degrees. Due to low temperatures, pain is relieved and partly swelling due to inflammation;
• pulsed magnetotherapy uses a low-frequency magnetic field, as a result of which the blood supply to the inflamed area is activated with an acceleration of the metabolic process and regenerative capabilities;
• diadynamic therapy is characterized by the action of low-frequency monopolar pulse currents, as a result of which there is a large delivery of blood to tissues, an increase in the supply of oxygen and nutrients;
• shock wave physiotherapy for epicondylitis involves the impact of an acoustic wave on the affected areas of the joint tissue, due to which there is an increased blood supply to the affected joint, a decrease in pain and resorption of fibrous foci. This type of therapy is used as physiotherapy for epicondylitis in the absence of the effect of other methods of treatment.

Epicondylitis of the shoulder (tennis elbow) is an inflammatory and degenerative change in the periarticular tissues in the area of ​​the elbow joint, characterized by pain sensations of varying intensity, which lead to dysfunction of the limb.

In the case of involvement of the musculoskeletal apparatus attached to the external epicondyle, external (lateral) epicondylitis occurs, to the internal - internal epicondylitis (medial).

Epidemiology

Due to the rare negotiability with a mild course of the disease, there are no reliable data on the incidence of epicondylitis.

The disease is most common in middle-aged and elderly men.

The outer epicondyle of the dominant hand suffers more often than the inner one, 12–15 times.

Periarticular changes are observed in people who make long stereotyped movements (tennis players, drivers, blacksmiths, masons, pianists) in the elbow joint.

Etiopathogenesis

The disease develops as a result of muscle overstrain and, as a result, micro-ruptures that occur in them.

Most often, the disease begins with degenerative and inflammatory changes in the tendons and muscles of the forearm at the site of their attachment to the elbow joint; local aseptic inflammation occurs at the onset of the disease. A predisposing factor is osteochondrosis with its neurotrophic effects, the formation of a syndrome of connective tissue dysplasia in a patient, against which, under the influence of microtraumatization or without it, epicondylitis of the shoulder can develop. Degenerative changes in periarticular tissues precede inflammatory ones.

Clinical picture

Epicondylitis develops gradually. The subacute stage begins with aching pains in the epicondyle, which increase during physical work, especially during pronation and supination, maximum flexion of the forearm.

In the future, the disease passes into an acute stage, the pains increase and appear even with a slight tension of the hand, decreasing only in complete rest.

Palpation of the epicondyle becomes painful, the pain gradually increases in the hand, as a result of which the patient begins to fall out of objects from the sore hand, holding even a slight weight becomes impossible.

The leading symptoms are pain on palpation of the external or internal epicondyles of the shoulder, acute pain in the epicondyle with intense extension of the hand (Thomsen's symptom) and a significant decrease in dynamometric indicators on the affected side.

In the case of compliance with rest and without appropriate treatment, the pain gradually decreases. The inflammatory process can take a chronic course while maintaining symptoms for more than three months; a longer course of the disease causes atrophic changes in the muscles of the shoulder.

The defeat of the medial epicondyle is characterized by a clear localization, the pain can spread along the forearm to the hand and increases with an attempt to resist passive extension of the fingers.

A positive symptom of Welt is revealed (with simultaneous extension and supination of the forearms, which were originally located at the chin in the pronation position, there is a backlog of the diseased limb due to pain).

The abduction of the hands behind the back is accompanied by the occurrence of pain in the affected epicondyle.

The disease can be one of the manifestations of osteochondrosis of the cervical spine, the symptoms of which can be combined with the clinical manifestations of epicondylitis.

Disorders in epicondylitis from the nervous system are characterized by characteristic autonomic disorders with the manifestation of irritative, reflex pain, myotonic and dystrophic symptoms. The occurrence of autonomic disorders is confirmed by local thermoasymmetry, capillary spasm, changes in sweating, and in some cases, cyanosis of the limb.

Diagnostics

The diagnosis is confirmed by comparing the clinical manifestations and the nature of the physical activity that the patient performed before the illness; computed tomography results.

X-ray examination in the early stages of this pathology is uninformative.

Differential Diagnosis

Epicondylitis must be differentiated from reactive arthritis, myositis of the muscles of the forearm, neuritis of the radial and ulnar nerves, fracture of the epicondyle.

The joint must be immobilized with an orthosis or kerchief bandage. Non-steroidal anti-inflammatory drugs on an ointment basis are used externally. In the case of severe pain syndrome, non-steroidal anti-inflammatory drugs are used parenterally or in tablet form.

Physiotherapeutic treatment is widely used (ultrasound exposure, laser therapy, paraffin-ozocerite applications).

In a chronic and persistent process, it is possible to prescribe glucocorticoid hormones.

For the treatment of epicondylitis of the shoulder, with the failure of its conservative therapy, various methods of surgical interventions are resorted to.

For life, the prognosis is favorable. Subject to the regime of work and rest, it is possible to achieve stable remission.

The proposed operations are not radical and are not pathogenetically justified: the development of cicatricial adhesions in tissues can support the pathological reflex process and provoke pain.

Prevention

Primary (prevention of the onset of the disease) and secondary (prevention of exacerbations) prevention provides for compliance with the regime of work and rest. It is necessary to avoid the same type of movements carried out with a load on the joint.

Much attention, given the significant prevalence of pathology among athletes, must be paid to the correct choice of equipment and adherence to sports training methods. In case of exacerbation, it is recommended to reduce the load, use an elastic bandage or orthosis, kinesio tapes. Preventive conduct of therapeutic physical culture, timely prevention and treatment of osteochondrosis of the cervicothoracic spine.

Epicondylitis is a degenerative-inflammatory lesion of the tissues surrounding the elbow joint, which accompanies reactive inflammation of adjacent tissues and intense pain. Clinically, this disease is divided into external epicondylitis of the shoulder (it is also called "tennis elbow"), the most common and internal epicondylitis of the shoulder (epitrochleitis). The external form of epicondylitis mainly occurs in persons who, as a result of their professional activities, produce stereotyped, often repeated flexion-extensor movements of the forearm (painters, tennis players, masseurs, carpenters, etc.). Most often, external epicondylitis affects the right hand, since it is usually dominant and, as a result, is loaded much more than the left. In women, this disease is observed much less frequently than in men. The median age at onset of the disease ranges between forty and sixty years.

Epicondylitis - causes of development

Epicondylitis occurs and subsequently develops due to microtraumatization and overstrain of the muscles that attach to the epicondyles of the humerus. Sometimes the disease manifests itself after direct trauma to the elbow (ulnar epicondylitis), or is caused by intense single muscle tension. Some researchers have noted a direct connection between epicondylitis and osteochondrosis of the cervical spine. An aggravating factor is the presence of a syndrome of connective tissue dysplasia in a patient.

In the pathogenesis of epicondylitis, the importance of microtraumas has long been revealed, but it cannot be denied that disturbance of local blood circulation and developing degenerative processes play an important role in the development of this disease. This is evidenced by concomitant humeroscapular periarthritis, osteochondrosis of the spine and the gradual onset of the disease. The trophic factor (violation of local blood circulation) is evidenced by osteoporosis that has developed in the places of attachment of the tendons

Epicondylitis - symptoms

Often epicondylitis begins after an episode of overload, and repetitive flexion in the elbow joint and repetitive movements of the hand in the allotted position of the arm are of no small importance. Quite often, pain in the elbow joint occurs even with the usual rhythm of life. This is due to the development of gradual involutive changes in the musculoskeletal system, manifested by degenerative processes that have arisen in the region of the subcondyles of the humerus without visible external causes. Once appeared, the pain caused by epicondylitis may not subside for weeks and even months. The pain caused by epicondylitis is quite clearly localized - with internal epicondylitis, patients confidently point to the internal, and with external epicondylitis, to the outer surface of the elbow joint. Often there is irradiation of pain along the inner or outer surface of the forearm. At rest, pain is absent. The appearance of the elbow joint does not change, passive movements are not limited.

With external epicondylitis, the appearance of pain with its subsequent intensification is provoked by extension and supination of the bone; with internal epicondylitis - flexion in the wrist joint is a provocateur. Sometimes pain with epicondylitis is localized in the adjacent areas of the tendons.

Downstream, external epicondylitis is chronic. After providing rest to the relevant muscles, after a few weeks (rarely months), the pain subsides. In the case of resumption of stress, relapses of pain are observed very often.

Unlike the external form, internal epicondylitis is more often observed in women who perform monotonous light physical activity (fitters, seamstresses, typists). In most cases, the patient is concerned about pain that occurs during pressure on the inner armpit, which also occurs and then intensifies when the forearm is flexed. Pain radiates along the inner edge of the forearm. Internal epicondylitis is also characterized by its chronic course.

Epicondylitis - diagnosis

The diagnosis of epicondylitis is established based solely on the findings of the clinical examination. Additional information confirming the diagnosis is obtained by conducting special tests that determine the resistance to active movement. Laboratory and instrumental methods in the diagnosis of this disease are usually not used, only in the case of an obvious injury, an x-ray is performed to exclude bone damage. Differential diagnosis is carried out with the following diseases: ulnar nerve pinching, median nerve pinching, septic necrosis of the articular surfaces, arthritis

Epicondylitis - treatment

Treatment of epicondylitis is necessarily complex, taking into account the degree of changes in the tendons and muscles of the hand and forearm, the degree of dysfunction of the elbow joint, and the duration of the disease. The main objectives of the treatment of epicondylitis: the elimination of pain in the lesion; improvement and/or restoration of regional blood circulation; restoration of full range of motion in the elbow joint; prevention of atrophic changes in the muscles of the forearm.

The elimination of pain in the lesion is solved using both conservative and radical methods of treatment. In the acute period of lateral epicondylitis, the upper limb is immobilized for seven to eight days with the forearm bent at the elbow.

In the case of a chronic course of epicondylitis, bandaging with an elastic bandage of the elbow joint and forearm is indicated (the bandage must be removed at night). Ultrasound with hydrocortisone (phonophoresis) has a good analgesic effect. Ozokerite and paraffin applications, Bernard currents are widely used. To reduce local trophism and for the purpose of pain relief, blockades (4-5 blocks, interval 2-3 days) with lidocaine and novocaine of the attachment sites of the fingers and extensor brushes are indicated. After removing the plaster splint, warming compresses with boron vaseline, camphor alcohol or just vodka are shown. In order to improve regional circulation in the affected area, electrophoresis with novocaine, potassium iodide, acetylcholine, or UHF therapy is indicated. In order to prevent and treat muscle atrophy, as well as to restore adequate functioning of the joint, the use of massage of the forearm and shoulder, exercise therapy, dry air baths, mud therapy is indicated.

If there is no result from conservative treatment for three to four months, radical (surgical) methods of treatment are resorted to. Today, Goman's operation is quite widely used, who proposed back in 1926 to excise part of the extensor tendon of the finger and hand.

Prevention of epicondylitis consists in the mandatory prevention of the presence of chronic overstrain of the above muscle groups, in the rational technique of sports or working (professional) movements, in the correct selection of the necessary equipment and the choice of working posture. In chronic epicondylitis with frequent relapses and unsuccessful complex treatment, the patient is recommended to change the nature of the work.