Occupational Diseases / / August 12, 2017
Epicondylitis shoulder is caused by overvoltage muscle extending from the outer or inner epicondyle shoulder strain and subsequent metaplastic changes developing in the periosteum of the epicondyle and in the surrounding ligaments and muscles.Thus, epicondylitis shoulder is a unique combination of periodontitis and tendomiofastsita in the area of external or internal epicondyle shoulder.The greatest practical importance is the outer shoulder epicondylitis, which occurs in 10-11 times more than the inner, and runs much harder last.
outer shoulder epicondylitis
disease develops between the ages of 35-45 years, mostly on the right hand.With bilateral external epicondylitis first, as a rule, it affected the right arm.Especially common in people whose work is connected with frequent flexion and extension of the forearm, combining with his pronation and supination (masons, grinders, fitters and so on. D.).
Unlike the professional post-traumatic outer shoulder epicondylitis develops gradually and beg
Contours Poltevo joint is not changed, and only very rarely and only at the very beginning of the disease can be noted a small swelling in the external epicondyle.Elbow flexion is not limited, and painless, while the maximum extension of the forearm (even passive) causes pain in the epicondyle.The tense forearm supination causes pain in the area of external epicondyle, but the same movement performed without tension, completely painless.On palpation of external epicondyle shoulder notes soreness.
typical and constant for epicondylitis shoulder is a symptom Thomsen (the appearance of sharp pain in the shoulder area of the outer epicondyle during intense extensions brush) and symptom Welch (acute pain in the same area with vigorous and rapid straightening arms bent at the elbow).When the disease is marked marked decrease in hand grip strength.The difference in the readings of the dynamometer - from 8 to 30 kg.Radiographic changes are detected at a significant limitation of the disease and presented in the form of seals of different size and shape from the contour of the outer epicondyle, or (rarely) in the form of resorption epicondyle region, the parallelism between the severity of radiological signs and severity of the disease there,
most effective method of conservativetreatment of the outer shoulder epicondylitis are hydrocortisone injections into the epicondyle zone (3-5 injections of 25 mg of hydrocortisone and 5-8 ml of 0.5% solution of novocaine with optional addition of a solution of 100,000 units of penicillin, the interval between injections - 2-3 days).Immobilization of the hand and forearm to the entire period of treatment injections.Persistent, cure was achieved in 75% of patients with shoulder epicondylitis.In case of failure of conservative treatment shows the operation, which is 80% leads to a stable recovery.
Proper treatment must necessarily provide temporary relief of the patient from work (for a period of immobilization and injections) followed by rational employment of the patient at work, not related to muscle tension, extending from the epicondyle (medical certificate for 5-8 weeks).
internal epicondylitis shoulder
much rarer outside and has a more mild.When an internal epicondylitis shoulder blurred marked decrease in hand grip strength, pain in the shoulder area of the internal epicondyle palpation, flexion and pronation strained forearm.
Treatment conducted under identical external epicondylitis (injection of hydrocortisone and novocaine).It must be remembered about the proximity to the inner shoulder epicondyle of the ulnar nerve.
Treatment combined with rational temporary employment usually leads to recovery.The indications for surgery and the grounds for transfer to disability at an internal shoulder epicondylitis not.