Epicondylitis is the generic term used to indicate a painful syndrome that affects the elbow area.
Due to the high incidence in tennis, the epicondylitis is also nicknamed " tennis elbow ".
It is caused by functional overload, or excessive and continued use of the joint. There is an individual predisposition but, following incorrect attitudes, anyone could fall ill with epicondylitis.
The most involved sports are: tennis, basic ball, golf, fencing, badminton, squash, javelin or discus throwing etc.
The most interested jobs are: plumber, mason, gardener, carpenter, butcher, cook, carpenter, tailor, painter etc.
Other activities affected are: playing, gardening (pruning plants) etc.
The epicondylitis concerns above all a range between 30 and 50 years old.
Initially symptomatological only during the movement of the inflamed tendons, if severe the epicondylitis can worsen to determine a painful picture even at rest.
What to do
- Prevention is always the most effective means of reducing the possibility of injury (see under Prevention).
- Recognition of the disorder: when it comes to tendon compromises it is absolutely necessary to intervene promptly as they are difficult to heal. The symptoms are:
- Mild but increasing pain on the outside of the elbow.
- Swelling and tenderness at rest.
- Weakness in manual gripping force.
- Morning stiffness.
- Difficulty in extending the pulse.
- Medical examination: the recognition of symptoms must NOT be aimed at self-management of therapy, but rather at understanding the extent of the disorder. The diagnosis will be made by the orthopedist or more rarely by the general practitioner. To confirm the suspicion of the functional examination (palpation, Cozen test, Millis test) and perform a differential diagnosis, the specialist will prescribe some investigations such as:
- X-ray and ultrasound: they offer an image (albeit of poor quality) of inflamed tendons.
- X-rays: to rule out osteoarthritis and arthritis in the elbow or any tendon calcifications.
- Cervical magnetic resonance: to exclude the disc herniation.
- Electromyography (EMG): to exclude nerve compressions.
- With a positive diagnosis, the orthopedist will start the non-surgical treatment (solution in 80-90% of cases):
- Total rest for several weeks:
- Initially forced by a splint or plaster.
- Subsequently dependent on the will of the subject, who must avoid any unnecessary or unplanned solicitation.
- Anti-inflammatory pharmacology therapy.
- For tennis players: suitable sports equipment (less rigid racket, less tight ropes, shock absorbers) etc.
- Rehabilitation therapy: physiotherapy extraction, serves to strengthen the muscles of the forearm.
- Medical treatments: technological (shock waves, ultrasounds, tecar etc), cryotherapy (if the compromise concerns the muscle portion) or heat therapy (if the damage is exclusively on the tendons) depending on the case.
- Use of guardians: eg elbow pads; I am a palliative but can diminish the symptoms.
NB : If the epicondylitis affects both the muscles and the tendons, between the heat and cryotherapy it is advisable to prefer cryotherapy.
- When necessary, resort to surgery (see under Medical Treatments).
- In chronic epicondylitis, complicate, destroy (with urine waves) or surgically remove any tendon calcifications.
What NOT to do
- Do not adopt any preventive rule, especially if a predisposition to recurrences is evident.
- Ignore the symptoms, especially in the presence of a significant clinical history.
- Do not seek medical attention and attempt to treat the condition by taking over-the-counter anti-inflammatory drugs.
- Do not carry out diagnostic investigations for epicondylitis.
- Do not carry out diagnostic investigations to rule out pathologies that may give rise to symptoms similar to epicondylitis.
- Use, load or even overload the already compromised elbow.
- Do not use the prescribed anti-inflammatory drug therapy.
- At the time of shooting, make early use of equipment that can re-ignite the disorder.
- Do not follow rehabilitation therapy.
- Do not take advantage of technological healing methods, if recommended.
- Exclude the occurrence of surgery a priori.
- If the epicondylitis continues to present itself repeatedly, eliminate the activity responsible for the acutia.
What to eat
There is no diet designed to prevent and cure epicondylitis better or more quickly.
However, some precautions can be useful:
- Increase the intake of anti-inflammatory molecules:
- Omega 3: are eicosapentaenoic acid (EPA), docosahexaenoic (DHA) and alpha linolenic acid (ALA). They play an anti-inflammatory role. The first two are biologically very active and are found mainly in: Sardinian, mackerel, bonito, alaccia, herring, alletterato, ventresca of tuna, needlefish, algae, krill etc. The third is less active but constitutes a precursor of EPA; it is mainly contained in the fat fraction of certain foods of vegetable origin or in the oils of: soy, linseed, kiwi seeds, grape seeds, etc.
- Antioxidants:
- Vitaminics: the antioxidant vitamins are carotenoids (provitamin A), vitamin C and vitamin E. Carotenoids are contained in vegetables and red or orange fruits (apricots, peppers, melons, peaches, carrots, squash, tomatoes, etc.); they are also present in shellfish and milk. Vitamin C is typical of sour fruit and some vegetables (lemons, oranges, mandarins, grapefruit, kiwi, peppers, parsley, chicory, lettuce, tomatoes, cabbage, etc.). Vitamin E is available in the lipid portion of many seeds and related oils (wheat germ, maize germ, sesame, kiwi, grape seeds, etc.).
- Minerals: zinc and selenium. The first is mainly contained in: liver, meat, milk and derivatives, some bivalve molluscs (especially oysters). The second is contained above all in: meat, fishery products, egg yolk, milk and dairy products, fortified foods (potatoes, etc.).
- Polyphenols: simple phenols, flavonoids, tannins. They are very rich: vegetables (onion, garlic, citrus fruits, cherries, etc.), fruit and related seeds (pomegranate, grapes, berries, etc.), wine, oilseeds, coffee, tea, cocoa, legumes and whole grains, etc.
What NOT to Eat
- The only group of foods (or rather beverages) not recommended in the case of epicondylitis is alcohol. Ethyl alcohol exerts a diuretic action and interferes with the metabolism by altering the effectiveness of the active ingredients.
- Furthermore, we remind that an excess of omega 6 fatty acids "could" have an effect diametrically opposed to the intake of omega 3. It is good practice to limit the introduction of foods rich in linoleic, gamma-linolenic, diomo-gamma-linolenic acid and arachidonic. They are mainly contained in: seed oil (especially peanuts), most of the dried fruit, certain legumes, etc.
Natural Cures and Remedies
- Stretching: stretching can be static or dynamic, active or passive. For the epicondylitis it has a preventive but also therapeutic role in the chronic phase of the cure.
- Physiotherapeutic massage, osteopathic manipulations, cyriax and myofascial manipulations, diacutaneous myofibrolysis (see under Medical Treatments).
- Motor exercises for reinforcement: used both in conservative and rehabilitative therapy after surgery.
- Cryotherapy: cold therapy is useful in reducing pain and muscle inflammation. It should be performed 2 or 3 times a day. Ice should not be applied directly; on the contrary, it must be placed in a bag containing water and applied by interposing a woolen cloth to protect the skin.
- Hot packs: increase blood flow and speed up the recovery of tendon injuries. They should not be used in the presence of vascular lesions.
- Tutors, bandages and dressings: these are tools that are sometimes useful for symptom reduction. Their function is to absorb shocks and accompany movement. In sporting practice they cannot be very tight; on the contrary during work it is possible to tighten them more vigorously, taking care not to compromise the circulation.
Pharmacological care
- Analgesics: they are used to reduce pain. They are taken orally.
- Paracetamol: for example Tachipirina ®, Efferalgan ® and Panadol ®.
- Non-steroidal anti-inflammatory drugs (NSAIDs):
- Systemic for oral use: they are more used than topical ones, as the structures affected by inflammation are difficult to reach with dermal application. They are more powerful though generic than ointments and gels. They may require the use of a gastroprotector. Those who suffer from liver or kidney disorders are not always able to take them.
- Ibuprofen: eg Brufen ®, Moment ®, Spidifen ®, Nurofen ®, Arfen ®, Actigrip fever and pain ® and Vicks fever and pain ®).
- Ketoprofen: for example Artrosilene ®, Orudis ®, Oki ®, Fastum gel ®, Flexen "Retard" ® and Ketodol ®.
- Diclofenac: for example Dicloreum ®, Deflamat ®, Voltaren Emulgel ® and Flector ®.
- Naproxen: for example Momendol ®, Synflex ® and Xenar ®.
- For topical use: they are mainly ointments or gels. They have the advantage of acting locally without tiring the stomach and liver; however they are less effective. It must be specified that it is not the most suitable pharmacological category and to insist on their use (even in the initial phases) could favor the worsening of inflammation.
- Ibuprofen lysine salt 10% or Ketoprofen 2.5% (eg Dolorfast ®, Lasonil ®, Fastum gel ® etc).
- Corticosteroids:
- Injectable by infiltration: they are used only if the oral NSAIDs are not well tolerated due to: allergy, gastric ulcer, diabetes etc. If used for long periods they exert many side effects on the connective tissues. They constitute the most drastic but also the most effective pharmacological solution:
- Methylprednisolone: for example Depo-Medrol ® in combination with lidocaine (a local anesthetic).
Prevention
- Heating: it has the function of heating the muscles and tendons of the elbow, increasing the elasticity and functionality of the structures involved.
- In approaching a new sport (tennis, baseball, rackets etc.) it is advisable to progressively increase the intensity of the effort.
- Stretching and joint mobility: they are controversial and less effective than other body areas. To be practiced at rest with intense activity but ALWAYS HOT, they exert a primary importance in increasing elasticity and movement capacity. Nevertheless, recent studies have not found a correlation with the reduction of joint injuries.
- In the case of a pre-existing injury, the use of the functional bandage or special braces proved to be quite useful in reducing the risk of relapses.
Medical Treatments
- Physiotherapeutic massage, passive stretching and osteopathic manipulations: manual therapies can improve epicondylitis inflammation by relaxing contracted muscles (potentially responsible for the onset of epicondylitis and difficulty in healing).
- Cyriax and myofascial manipulations: they eliminate the fibrosis that can be formed during the healing process in the tissues. They are especially indicated when epicondylitis is associated with compromised muscles as well as tendons.
- Diacutaneous myofibrolysis: also aimed at counteracting fibrosis localized in the trigger points. It exploits the mechanical action exerted by manual pressure of instruments called fibrolithors.
- Shock waves: they can accelerate healing if the damage is to the soft tissues. They are based on the localized release of acoustic impulses. The effect is an increase in the metabolic activity of the target tissue and the rupture of any tendon calcifications manifested in chronic (more rare) forms.
- Laser therapy: it is a treatment that uses electromagnetic rays directly on the affected area. The laser electron beam acts on the cell membrane and mitochondria, increasing metabolic activity, reducing pain and inflammation, creating vasodilation and increasing lymphatic drainage.
- Tecar therapy: therapeutic method that uses an electric condenser to treat muscle joint injuries. The mechanism of tecarterapia is based on restoring the electric charge in the injured cells to make them regenerate more quickly.
- Kinesio taping: uses the traction of adhesive and elastic bandages that sometimes contain small pharmacological concentrations of anti-inflammatories. They should have a draining, slightly pain-relieving-anti-inflammatory and guardian function.
- Surgery: used only after 6-12 months from the beginning of unsuccessful conservative therapies. It almost always involves the removal of the diseased part of the muscle and re-insertion on the bone. It is performed mainly in the open and more rarely in arthroscopy.
- Post-surgical rehabilitation: starts after about 7 days. On the eighth week, we proceed with the strengthening and after 6 months it will be possible to return to the overload activities.
