EPICONDYLITIS OF THE ELBOW
Terminology
Epicondylitis refers to inflammation at the lower end of the arm bone (humerus). Here above the elbow joint there are two ridges that flare out from which groups of muscles arise.
On the inside of the arm (medial) the muscles arise which bend (flex) the hand and wrist. Inflammation at the origin of this muscle group is called medial epicondylitis or 'Golfer's elbow.'
On the outside of the arm (lateral) the muscles arise which straighten (extend) the hand and wrist. Inflammation at the origin of this muscle group is called lateral epicondylitis or 'Tennis elbow.'
Treatment
The goal of treatment is to eliminate or reduce the discomfort so a patient can resume regular activities without any difficulty. Early treatment before the condition becomes established is more successful.
Conservative treatment involves avoidance of precipitating activities and may include a change in work practices or curtailing sporting activity. Splints and braces may reduce the pull of the muscle from the inflamed area and anti-inflammatory medications may be prescribed to help with the pain and swelling.
Cortisone injections are often used to confirm the exact site of pain and may reduce pain and swelling. There are very small risks with steroids of skin thinning, depigmentation, infection and tendon thinning.
Surgical treatment
Conservative treatment often fails to control the symptoms. In general, surgery aims to remove the degenerate tissue around the epicondyle stimulate an improved blood supply to the involved area. Release of a portion of the involved muscle is required.
A surgical incision is placed in the line of the epicondyle. Extreme care is taken with the release because of the proximity of the nerves that supply the muscles in the hand. On the medial side the ulnar and to a lesser extent median nerve are close by and indeed recalcitrant golfer's elbow may be secondary to these nerves being entrapped. Likewise on the lateral side the radial nerve is at risk.
Surgery may be performed as either an in-patient or day-case and can be performed under regional block or general anaesthesia.
Prior to your operation you will be asked to attend a pre-operative assessment clinic. At this appointment the operation will be discussed with you again, making sure that you are fit and well and that you still wish to go ahead with the operation. You will have the opportunity to ask any questions you may have.
You will have dressings that are bulky around the elbow that should be reduced on the second day following surgery and you may require a sling for a number of weeks. You should be able to drive from the third or fourth week.
It may be difficult to remember what you are told immediately after the operation and an explanation will be given to you when you re-attend clinic.
Physiotherapy will only be prescribed if indicated. It may take as long as three to six months to return to heavy lifting.
Indications
Persistent localised pain despite conservative treatment. Often patients will have had a course of injections and physiotherapy.
Benefits
There is a 70% chance of fully abolishing the patient’s symptoms dependent on their chronicity and a further 10-20% chance of improving (but not fully abolishing) those symptoms.
Return to work and normal activity after a period of rehabilitation
Risks
The commonest is swelling which lasts two to six weeks and is helped by elevation in the first few days and by anti-inflammatory medication where indicated. Elbow stiffness can sometimes develop and is treated with physiotherapy
Neurological compromise maybe transient and secondary to swelling. However even with careful technique there is a reported 1% chance of permanent neurological injury.
Rare complications
Infection is surprisingly rare (1 in 250).
The artery and veins may also rarely be injured (1 in 1000).
There is a risk of reflex sympathetic dystrophy a neurologically provoked pain syndrome of uncertain origin that can be prevented by rigorous adherence to moving the fingers.
Terminology
Epicondylitis refers to inflammation at the lower end of the arm bone (humerus). Here above the elbow joint there are two ridges that flare out from which groups of muscles arise.
On the inside of the arm (medial) the muscles arise which bend (flex) the hand and wrist. Inflammation at the origin of this muscle group is called medial epicondylitis or 'Golfer's elbow.'
On the outside of the arm (lateral) the muscles arise which straighten (extend) the hand and wrist. Inflammation at the origin of this muscle group is called lateral epicondylitis or 'Tennis elbow.'
Treatment
The goal of treatment is to eliminate or reduce the discomfort so a patient can resume regular activities without any difficulty. Early treatment before the condition becomes established is more successful.
Conservative treatment involves avoidance of precipitating activities and may include a change in work practices or curtailing sporting activity. Splints and braces may reduce the pull of the muscle from the inflamed area and anti-inflammatory medications may be prescribed to help with the pain and swelling.
Cortisone injections are often used to confirm the exact site of pain and may reduce pain and swelling. There are very small risks with steroids of skin thinning, depigmentation, infection and tendon thinning.
Surgical treatment
Conservative treatment often fails to control the symptoms. In general, surgery aims to remove the degenerate tissue around the epicondyle stimulate an improved blood supply to the involved area. Release of a portion of the involved muscle is required.
A surgical incision is placed in the line of the epicondyle. Extreme care is taken with the release because of the proximity of the nerves that supply the muscles in the hand. On the medial side the ulnar and to a lesser extent median nerve are close by and indeed recalcitrant golfer's elbow may be secondary to these nerves being entrapped. Likewise on the lateral side the radial nerve is at risk.
Surgery may be performed as either an in-patient or day-case and can be performed under regional block or general anaesthesia.
Prior to your operation you will be asked to attend a pre-operative assessment clinic. At this appointment the operation will be discussed with you again, making sure that you are fit and well and that you still wish to go ahead with the operation. You will have the opportunity to ask any questions you may have.
You will have dressings that are bulky around the elbow that should be reduced on the second day following surgery and you may require a sling for a number of weeks. You should be able to drive from the third or fourth week.
It may be difficult to remember what you are told immediately after the operation and an explanation will be given to you when you re-attend clinic.
Physiotherapy will only be prescribed if indicated. It may take as long as three to six months to return to heavy lifting.
Indications
Persistent localised pain despite conservative treatment. Often patients will have had a course of injections and physiotherapy.
Benefits
There is a 70% chance of fully abolishing the patient’s symptoms dependent on their chronicity and a further 10-20% chance of improving (but not fully abolishing) those symptoms.
Return to work and normal activity after a period of rehabilitation
Risks
The commonest is swelling which lasts two to six weeks and is helped by elevation in the first few days and by anti-inflammatory medication where indicated. Elbow stiffness can sometimes develop and is treated with physiotherapy
Neurological compromise maybe transient and secondary to swelling. However even with careful technique there is a reported 1% chance of permanent neurological injury.
Rare complications
Infection is surprisingly rare (1 in 250).
The artery and veins may also rarely be injured (1 in 1000).
There is a risk of reflex sympathetic dystrophy a neurologically provoked pain syndrome of uncertain origin that can be prevented by rigorous adherence to moving the fingers.
