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Doctor Joël MIRBEY

Tel: +33 (0)3.80.30.26.03


Doctor Frédéric GIVRY

Tel: +33 (0)3.80.30.99.15

Epaule douloureuse

Elbow epicondylitis

Definition

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Tendinitis of the elbow or epicondylitis is a painful disease of the elbow. It is also called ‘tennis elbow’.

It is an inflammation near the projecting part of the arm (the humerus), just above the elbow joint on the outer face of the arm. It sometimes happens too that another area of the forearm and the elbow is painful.

The inflamed tendons close to the elbow are mainly responsible for the pain, besides the epicondylitis. The tendons are strong strips of tissue that attach the muscles to the bone.

When they suffer from a repeated tension or over-usage, the tendons become sensitive and swollen. The emergence of epicondylitis is often linked to the way some workers make certain moves such as gripping, twisting, stretching of the arm and moving.

These gestures can become dangerous if :

  • They are made in a stiff or bad position
  • They are reiterated constantly
  • They require extreme strength
  • They don’t leave any time for the organism to recover after over-use.

Anatomy

The elbow joint consists of several joint surfaces: the humerus, the radius and the ulna.

It is surrounded by a capsule, ligaments and also numerous tendons. The tendons affected by epicondylitis are the external tendons of the elbow called ‘epicondyle tendons’. There are 3 of them (1st ulnar tendon, 2nd ulnar tendon, common extensor tendon of the fingers).

The three tendons insert themselves onto the epicondyle which is the bone projecting part located on the external level of the elbow. They make it possible to move, especially when they are extended, the wrist and the fingers.

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Clinical Symptoms

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Epicondylitis can be felt through a high sensitivity on touching the external face of the elbow.

This sensitivity becomes painful when the wrist and the elbow achieve certain moves such as:
Folding the wrist while having the elbow stretched out

  • Trying to raise the wrist against a resistance while having the elbow stretched out
  • Trying to raise the fingers


There are no visible signs of redness or of swelling.

Epicondylitis can appear in several ways. Some people feel the symptoms appear gradually after having carried out the same type of tasks over several years. Others are suddenly affected after starting a new job. Sometimes, the symptoms appear immediately after a single violent muscular effort or after an elbow injury.

Radiological check-up:

  • A plain X-ray of the elbow can show calcifications on the spots where the epicondyle tendons insert themselves
  • The echography mainly will show an inflammation or a thickening of these tendons.

Evolution without any Treatment

It is often difficult to make the inflammatory symptoms disappear even with a medical treatment and infiltrations.

The only alternative when the evolution has become chronic is a surgical treatment.
 

Surgical Treatment

It consists in lengthening these three epicondyle tendons.

Actually, the pain is due to the tendons’ tension. An incision in the skin of about 4 cm is to be made over the epicondyle.

The tendons have to be disinserted in order to lengthen them. It is a quick operation and an easy one for the surgeon.
 

Complications

A sub-cutaneous fluid shed often occurs and can persist for 2 months but without anything to worry about.

A post-op infection is always possible but rarely occurs.

Stay in Clinic

The surgical treatment of an epicondylitis is realized in ambulatory surgery, that is to say the patient stays only a few hours in the clinic.

So he can leave quickly after the operation with a prescription for painkillers and dressings.

The elbow can be mobilized immediately.

Incapacity

It is possible to achieve all the gestures required by everyday life within days following the operation.

Strenuous movements will not be undertaken until two months have passed.

The resumption of professional activities can take a month or two, depending on the cases and the profession.
 

Results

The pain will go away after two months, but sometimes more, depending on the history of the symptoms.

A progressive recovery of muscular strength requires most of the time at least two months.