Epicondylitis is a typical painful syndrome that in most of the cases recognizes an overload pathogenesis and frequently affects tennis players, golfers, baseball players and fencers.
At first you feel pain only during exercise, or palpation the lateral epicondyle; after that the pain also occurs at rest and in the everyday life in simple gestures such as shaking hands, raise a bottle or turn a handle.
The diagnosis is essentially clinical. The doctor during the visit will then take specific clinical tests. He may also ask a muscle tendon ultrasound or magnetic resonance imaging (MRI).
The first treatment chosen is always conservative. In the acute phase you will be advised to rest for about 20 days from the activity thought to have caused the symptoms, local physical therapy accompanied by stretching exercises and massage to relax.
The gradual resumption of the sport activity will take place only after strengthening the flexor muscles of the shoulders. In case of recurrent chronic pain, also the shock waves can be added to the treatment
Surgical treatment is reserved only for disabling cases, or chronic persistent forms.
All surgical methods have the purpose to achieve a lengthening of the miotendinal structures. The most traditional techniques are open-air; these are accompanied by a more recent arthroscopic technique.
After the surgery, a brace with springs is applied for 2-3 days and after about 10 days it is important to start the rehabilitation treatment for the complete recovery of motion. Then we proceed to muscle strengthening and to the resumption of the sport that takes place after about 50 days.
Tendinopathy of the insertional lateral epicondyle (lateral epicondylitis) or medial epicondyle (medial epicondylitis) is a typical syndrome that in most cases, is caused by pathogenesis of overload and frequently affects athletes (tennis elbow) or professionals who use repetitive movements with the ‘forearm (dentists, massage therapists).
Rehabilitation treatment and prognosis depend on the clinical phase in which you are: acute, chronic-relapsing, chronic-persistent. The rest and the suspension of gestures that are evoking the pain is the first absolute indication in the treatment of this disease.
The first phase of the rehabilitation protocol is focused on pain relief through physical therapy (laser, tens and ice daily applications) and the resolution of the muscular contraction that determines the tendinopathy through decontracting massage therapy of forearm muscles, deep transverse massage of tendon flexor and extensor muscles (especially in the distal portion, near epicondyle). It is important to inform the patient that pain, being of functional origin, will not disappear entirely but will persist even during the later stages of rehabilitation until full rebalancing of the tendon and muscle.
The next phase of the rehabilitation protocol is characterized by the strengthening of the epicondylus and epitrochlear muscles such as the short radial extensor carpi, the anconeus, the extensor carpi and the common extensor of the finger, mainly eccentrically, both manually and with the use of rubber bands and ballast. Very important at this stage is the rebalancing of the muscles flexed/extensors of the wrist and shoulder muscles (especially external rotation) to allow better control and stabilize the movement of the forearm.
After the complete remission of symptoms and the use of a specific tutor, the rehabilitation program ends with the last phase on the sports field, with the introduction of preparatory exercises, catching objects for neuromotor control and sport specific technical exercises for a gradual recovery the complex gestures and education to the right habits for the prevention of re-injury.