Medial epicondylitis of the hip code according to ICB 10. Epicondylitis (golfer's elbow, tennis player's elbow). Elbow epicondylitis treatment

11.08.2020 Diets

Epicondylitis is treated on an outpatient basis by a traumatologist or orthopedist. The scheme and methods of treatment of epicondylitis are determined taking into account the severity functional disorders, the duration of the disease, as well as changes in the muscles and tendons. The main goals of treatment:
Elimination of pain syndrome.
Restoration of blood circulation in the affected area (to ensure favorable conditions for the restoration of damaged areas).
Restoration of full range of motion.
Restoration of strength of the muscles of the forearm, prevention of their atrophy.
If the pain syndrome in epicondylitis is not very pronounced, and the patient goes to the doctor mainly in order to find out the reason for the appearance of unpleasant sensations in the elbow joint, it will be enough to recommend the patient to observe a protective regime - that is, to carefully monitor their own feelings and exclude movements in which pain appears.
If a patient with epicondylitis is involved in sports or his work is associated with great physical exertion on the muscles of the forearm, it is necessary to temporarily ensure the rest of the affected area. The patient is given a sick leave or is advised to temporarily stop exercising. After the pain disappears, the load can be resumed, starting with a minimum and gradually increasing. In addition, the patient is advised to find out and eliminate the cause of the overload: revise the sports regimen, use more convenient tools, change the technique for performing certain movements.
With severe pain in the acute stage of epicondylitis, short-term immobilization is required. A light plaster or plastic splint is applied on the elbow joint for a period of 7-10 days, fixing the bent elbow joint at an angle of 80 degrees and hanging the hand on a kerchief bandage. At chronic course for epicondylitis, the patient is recommended to fix the elbow joint and forearm with an elastic bandage in the daytime. The bandage must be removed at night.
If symptoms of epicondylitis appear after an injury, cold should be applied to the affected area (an ice pack wrapped in a towel) during the first days. In the acute period, patients suffering from epicondylitis are prescribed physiotherapy: ultrasound, phonophoresis (ultrasound with hydrocortisone), paraffin, ozokerite and Bernard's currents.
The pain syndrome in epicondylitis is caused by the inflammatory process in the soft tissues, therefore, in this disease, non-steroidal anti-inflammatory drugs have a certain effect. NSAIDs are used topically, in the form of ointments and gels, since inflammation in epicondylitis is local in nature. The appointment of non-steroidal anti-inflammatory drugs orally or intramuscularly in modern traumatology for epicondylitis is not practiced due to their insufficient effectiveness and an unjustified risk of development side effects.
With persistent pain that does not subside for 1-2 weeks, therapeutic blockade with glucocorticosteroids is performed: betamethasone, methylprednisolone or hydrocortisone. It should be borne in mind that when using methylprendizolone and hydrocortisone during the first day, there will be an increase in pain due to the tissue reaction to these drugs.
A glucocorticosteroid is mixed with an anesthetic (usually lidocaine) and injected into the area of maximum pain. With external epicondylitis, the choice of the injection site is not difficult, the blockade can be performed in the patient's position, both sitting and lying. In case of internal epicondylitis, to carry out the blockade, the patient is placed on a couch face down with arms extended along the body. This position provides access to the area of the internal epicondyle and, unlike the sitting position, excludes accidental damage to the ulnar nerve during the procedure.
At the end of the acute phase of epicondylitis, the patient is prescribed electrophoresis with potassium iodide, novocaine or acetylcholine, UHF and warming compresses on the affected area. In addition, starting from this moment, the patient with epicondylitis is shown therapeutic exercises - repeated short-term overextension of the hand. Such movements help to increase the elasticity of the connective tissue structures and reduce the likelihood of subsequent microtraumas. In the recovery period, massage and mud therapy are prescribed to restore range of motion and prevent muscle atrophy.
At conservative therapy without the use of glucocorticosteroids, the pain syndrome in epicondylitis is usually completely eliminated within 2-3 weeks, with blockades - within 1-3 days. In rare cases, persistent pain is observed that does not disappear even after injections of glucocorticosteroid drugs. The likelihood of such a course increases with chronic epicondylitis with frequent relapses, joint hypermobility syndrome and bilateral epicondylitis.
In the chronic course of epicondylitis with frequent exacerbations, patients are advised to stop playing sports or switch to another job, limiting the load on the muscles of the forearm. If the pain syndrome persists for 3-4 months, it is indicated surgery- excision of the affected areas of the tendon in the area of its attachment to the bone.
The operation is carried out in a planned manner under general anesthesia or conduction anesthesia. In the postoperative period, a splint is applied, the sutures are removed after 10 days. Subsequently, restorative therapy is prescribed, which includes physiotherapy exercises, massage and physiotherapy procedures.

Video about epicondylitis of the elbow joint from the program "Health": The solution of the first problem in the treatment of epicondylitis is carried out using traditional and surgical methods.

Construction workers (plasterers, painters, bricklayers);

Since the disease itself refers to chronic pathology, the treatment process will be long. First of all, it is required to create rest for the sore hand, to limit movements that cause acute pain. You can purchase special elbow pads or fix the joint with an eight-band bandage. In case of chronic course, it is recommended to apply an elastic bandage during the day, and remove it in the evening. You should not lift weights, otherwise all therapeutic measures will be useless.

Do not ignore the warm-up before the power load;

Types of shoulder epicondylitis

Treatment of the disease is carried out on an outpatient basis, for this you need to contact a traumatologist or orthopedist. The main objectives of therapy are:

Sudden movement that could result in injury.

When the first signs of the disease appear, you should immediately contact an experienced specialist, and not try to treat the damaged forearm on your own. This is very important because epicondylitis has symptoms similar to those of other diseases. It can be easily confused with arthritis. shoulder joint, arthritis and osteoarthritis of the brachioradial joint, as well as bursitis of the supracondylar bursa.

The prognosis is generally favorable, with the observance of the correct regime of work, physical activity and rest, you can achieve a stable remission.

Causes of shoulder epicondylitis

With mild pain in the shoulder, it is recommended to exclude the movements that cause them to appear, temporarily providing peace to the elbow joint (take sick leave at work or take a break from sports training).

Treatment of lateral epicondylitis in the acute stage occurs by such a method as immobilization of the upper limb for a period of 7-8 days with the forearm bent at the joint (80 degrees), and the wrist joint - with small dorsal extension.

Athletes (kettlebell lifters, weightlifters, wrestlers, boxers) and others.

Great success can be achieved with the help of physiotherapy exercises, only all exercises must be performed for a long time - several weeks, or even months. Also used hirudotherapy, massage of the affected area, mud therapy.

It is better to conduct classes in the gym under the supervision of a trainer;

The basis for the development of inflammation is small tears of the tendons and muscles at the site of their attachment to the epicondyle. These injuries lead to the appearance of a limited traumatic periostitis. Epicondylitis can be accompanied by calcifications and inflammation of the joint capsule (bursitis).

The disease can be diagnosed using dynamometry or thermography methods. X-ray studies are also used, but on early stages it is not always possible to identify signs of pathology. Finding foci of compaction in the epicondyle is possible only with a long-standing disease.

Symptoms of shoulder epicondylitis

After the end of the acute stage of the disease, therapeutic exercises help to restore the functionality of the joint, the purpose of which is to stretch and relax the muscles and tendons. Exercises of exercise therapy include flexion and extension of the hand and elbow joint, pronation-supination of the forearm. At first, they are performed as passive movements, i.e. with the help of a healthy hand, then they move on to active movements carried out by the muscles of the developed hand.

In case of severe pain syndrome in the exacerbation phase, short-term immobilization of the joint is carried out using a plaster of Paris or a splint. You can also wear a special orthopedic orthosis, but it long-term use ineffective.

The presence of concomitant diseases.

- This is a degenerative-inflammatory tissue damage in the area of the shoulder joint: the epicondyles and the tendons attached to them.

By themselves, such activities do not cause epicondylitis. This disease occurs with constant monotonous flexion and extension of the elbow joint, when there is a load on the arm. Accordingly, the dominant hand suffers the most. In other words, the main version of the reasons for the development of epicondylitis is tendon overload, as well as some tissue microtrauma that provoke the development of inflammation processes.

Other methods of physiotherapy are also effective. Your doctor will advise you on how to treat elbow epicondylitis without surgery. Electrophoresis with acetylcholine, potassium iodide is prescribed. Often, the patient is relieved by phonophoresis with hydrocortisone.

Diagnostics

With regular sports, daily massage sessions are required;

Treatment of shoulder epicondylitis

Depending on the cause that caused the development of the disease, the following forms can be distinguished:

Treatment of shoulder epicondylitis involves the use of conservative and surgical methods.

Medical treatment includes:

Epicondylitis of the shoulder is often diagnosed in people whose main activity is associated with repetitive hand movements: in drivers of various vehicles, in surgeons, massage therapists, plasterers, painters, milkmaids, hairdressers, typists, musicians, etc.

The humerus bones have at their ends the so-called condyles - bony thickenings, on the surface of which there are other protrusions - epicondyles, which serve for the attachment of muscles.

Ultrasound has a good analgesic effect in the treatment of epicondylitis of the elbow joint, but it is even better to use phonophoresis (the so-called ultrasound with hydrocortisone).

Epicondylitis is of two types.

Take complex vitamins regularly;

When contacting a doctor immediately after an injury, cold must be applied to the damaged area;

Traumatic - occurs due to the presence of microtraumas of tendons and muscles in athletes and people engaged in heavy physical labor. A factor that can provoke the development of traumatic epicondylitis is the presence of deforming arthrosis.

Epicondylitis of the shoulder is a disease resulting from overstrain and microdamage of the muscles that attach to the epicondyle of the humerus.

Use of NSAIDs for external use (ointments and gels): Diclofenac, Voltaren, Indomethacin, Nurofen;

Among athletes, tennis and golfers are most prone to this disease. No wonder lateral epicondylitis is also called "tennis elbow", and medial - "golfer's elbow".

The main cause of epicondylitis is chronic overstrain of the muscles of the forearm, in most cases - in the course of professional activity.

Symptoms and treatment of shoulder epicondylitis

Bernard currents, ozokerite and paraffin applications are also widely used.

- degenerative-dystrophic process in the places of muscle attachment to the epicondyle of the humerus.

Cure all chronic foci of infection.

Signs of the disease

Locally, the use of ointments and gels is prescribed, which include non-steroidal anti-inflammatory drugs; Post-traumatic - can occur after dislocations, sprains or other damage to the joint. The likelihood of developing post-traumatic epicondylitis increases significantly if the doctor's recommendations are not followed during the rehabilitation period after injury.

You can also fix the affected arm with an elastic neoprene bandage, which also performs a warming function and performs micromassage.

Epicondylitis is a very common condition in the working arm. The general decrease in the load, which is observed due to high level production mechanization, and at the same time increasing specific gravity small movements carried out by the muscles of the forearms leads to the onset of the development of muscle overstrain.

Blockade with corticosteroid drugs (hydrocortisone or methylprednisolone), which are injected directly into the area of inflammation;

Among other diseases, epicondylitis is often accompanied by cervical and thoracic osteochondrosis, periarthritis of the shoulder scapula, osteoporosis.

Shoulder epicondylitis accounts for 21% occupational diseases hands.

Diagnostics and treatment

In order to anesthetize the area and improve local trophism, blockades are carried out at the attachment point of the extensors of the fingers and hand with novocaine or lidocaine, which are very often combined with hydrocortisone.

Is a disease in which there is inflammation of the muscle attachment site to the lateral epicondyle of the bone. Often this disease is called "tennis elbow", as this problem is quite typical for those people who practice this sport. Nevertheless, lateral epicondylitis sometimes occurs not only in athletes. The cause of lateral epicondylitis of the elbow joint is muscle overstrain at the site of their attachment to the epicondyle of the shoulder bone. Such overvoltage occurs when playing tennis, but it can also appear during other monotonous work (sawing wood, painting a wall, etc.). The disease usually appears between the ages of 30 and 50.

What is the difference between external and medial epicondylitis of the elbow joint? The prognosis of the disease is always favorable, it does not threaten the patient's life, and with the appointment of adequate treatment, remission can be achieved, which will last for a long time if you follow the rules of prevention.

With prolonged intractable pain, a blockade with glucocorticosteroids can be used;

The severity of symptoms and signs of epicondylitis depends on the stage of development of the inflammatory process and destructive changes in the joint. Experts point out:

After the acute pains disappear, the patient will need to switch to physiotherapy: diadynamic therapy and paraffin applications. Massage is contraindicated in this case, as it can exacerbate inflammation.

Epicondylitis of the knee: causes, symptoms, treatment

Epicondylitis can be external and internal. The first occurs many times more often.

B vitamins injections.

The reasons for the development of the disease

The peak incidence occurs in the age range. External epicondylitis occurs 10 times more often than internal epicondylitis. Also, this type of epicondylitis affects mainly men, while medial epicondylitis is diagnosed mainly in women.

There are two main types of epicondylitis:

Over the entire period of treatment for epicondylitis of the elbow joint, 4 blocks are performed (an interval of a couple of days). When the plaster splint is removed, use warming compresses with petroleum jelly, camphor alcohol, or ordinary vodka compresses.
Medial epicondylitis
Medical treatment for epicondylitis is aimed at relieving pain and inflammation. Ointments containing ibuprofen or diclofenac are recommended; nanoplasts are also used.
The answer to the question: "How to treat epicondylitis of the elbow joint?" can be obtained from an orthopedic surgeon or surgeon. Pain localized to the elbow can also be a sign of arthritis, myositis, or arthrosis. Therefore, it is better to go for a consultation and determine what kind of pathology you have. Often, patients themselves postpone the treatment process until the process becomes chronic, when recovery takes place with great effort.
Restoration of blood supply to the affected area;

The acute stage of the disease, characterized by the presence of acute or burning pain, which has a different duration and duration, painful sensations intensified when moving in the joint and can radiate (spread) along the muscle fibers, while the focus of pain is clearly defined;

If conservative methods do not work, a surgical operation is indicated - fasciomyotomy.

The most susceptible to the development of this disease are people who constantly rotate their forearm and at the same time often bend and unbend the elbow. These are workers in such professions as: blacksmith, bricklayer, ironer, painter-plasterer, locksmith, hand-milking milkmaid, cutter and so on. Among the patients there are also seamstresses, draftsmen, typists.
A wide range of physiotherapy procedures can also be used:

Epicondylitis symptoms

Common symptoms of the disease:

External (lateral), in which the tendons extending from the external epicondyle of the humerus are affected;
To improve regional blood circulation in the affected area, UHF therapy, electrophoresis with acetylcholine, novocaine or potassium iodide is used.
Known as golfer's elbow. However, this does not mean that only golfers can suffer from this ailment. However, golf is a common cause of medial epicondylitis. In addition, other repetitive movements lead to epicondylitis. These include throws, sports, use different types hand tools, the consequences of trauma.

In a severe form of the disease, local injections of glucocorticoids in combination with anesthetics, for example, betamethasone or hydrocortisone, together with novocaine, are indicated. These injections are made at the most painful point in cases where other medical measures do not help.

Elbow epicondylitis is an inflammatory-degenerative disorder associated with inflammation of those muscles that attach to the epicondyles of the humerus and forearm bones. Distinguish between external, or lateral epicondylitis, and internal (medial) epicondylitis.

Prevention of the development of muscle atrophy and restoration of the functional characteristics of the joint and the full range of motion in it:
Painful sensations in the subacute stage appear during the load on the joint or shortly after it;
Knee epicondylitis is called degenerative inflammatory process, which develops in the epicondyle, to which the muscles that provide the joint work are attached, and is characterized by the gradual destruction of these attachments. Late treatment leads to the development of inflammation in the structures and tissues surrounding the joints. The disease is more common in men over the age of 40.

How the doctor makes this diagnosis

Epicondylitis usually develops on the right limb, since most have it in a working limb.

Epicondylitis treatment

Spontaneous pain in the elbow joint, intense and burning during exacerbations, dull and aching in the chronic course of the disease;
Internal (medial), when the site of attachment of muscle tendons to the internal epicondyle of the humerus is affected.
In addition, for the treatment of medial epicondylitis of the elbow joint, medications such as nikoshpan and aspirin.
In other words, any activity in which the muscles of the forearm are actively used can cause medial epicondylitis.
If these methods are ineffective, shock wave therapy is used. This is a relatively new technique, when high power ultrasound is applied to the affected joint.
External develops with inflammation of the muscles on the outside of the elbow, most often this pathology is present in professional tennis players.
Massage;
Chronic epicondylitis of the knee is characterized by an undulating course with periodic remissions and exacerbations.
The prevalence of this disease has not been fully understood, since people suffering from epicondylitis often try to be treated with traditional medicine, contacting a doctor only if the condition worsens or there is no improvement. And even when contacting a traumatologist, the correct diagnosis is not always made, since clinical manifestations epicondylitis is similar to many joint diseases.
The first symptoms of the disease are pain in the area of the epicondyle of the humerus, aching, pulling or stabbing. At the initial stage, pain can occur only directly during work. Over time, they become permanent, and with rotation and flexion / extension of the forearm, they become stronger. At the slightest touch of the epicondyle, the pain becomes so pronounced that patients have to limit the movements of the injured limb, wrap the elbow joint with bandages, thus trying to protect it.

Strengthening of pain syndrome during loading on the elbow joint and muscles of the forearm;

Prevention and prognosis

The muscles extending from the external epicondyle extend the elbow, hand and fingers, and are responsible for supination (outward rotation) of the hand and forearm. The tendons of the flexor muscles of the elbow, wrist and fingers are attached to the internal epicondyle. These muscles provide pronation of the forearm and hand.

To change the trophism of tissues at the site of tendon attachment, blockade with bidistilled water is used. Although such blockages have a good effect, it should be said that the very process of drug administration is quite painful. In the case of a chronic course of the disease, injections of vitamins such as B1, B2, B12 are prescribed.
Treatment of epicondylitis is complex, based on the duration of the disease, the level of dysfunction of the joint, as well as changes in the tendons and muscles in the area of the hand and forearm.
It should be noted that epicondylitis is a rather insidious disease. Treatment activities are able to relieve pain in a short time, but when returning to the previous physical activity all symptoms may recur. It will take a long time for the affected areas to fully recover.
Internal epicondylitis occurs with inflammation of the muscle tendons located on the medial side of the elbow joint.
Gymnastics;
Experts consider professional sports to be the main reason for the development of the disease

This disease is more common in men over the age of 40

How to treat elbow epicondylitis

Then weakness appears in the hand, which makes it impossible for the patient to hold even light objects. He constantly drops tools, dishes and other things. If the hand is left alone and slightly bent at the elbow, then the pain stops.

What is epicondylitis?

Phonophoresis and electrophoresis;

Gradual loss of muscle strength in the arm.
The main cause of epicondylitis

To prevent and treat muscle atrophy and restore joint function, massage of the muscles of the forearm and shoulder, mud therapy, exercise therapy and dry air baths are used. In addition, special exercises for elbow epicondylitis help well.

Symptoms

The main objectives of the treatment of epicondylitis of the elbow joint can be formulated in a certain way:

Elbow epicondylitis is an inflammatory condition in the elbow area (where muscles attach to the forearm bone). The disease, depending on the place where the inflammation occurred, is external and internal. In this case, external epicondylitis of the elbow joint can develop during inflammation of the tendons that are located on the outside of the elbow joint.

What is the treatment for lateral epicondylitis of the elbow joint?

Physiotherapy: phonophoresis, cryotherapy, shock wave therapy, diadynamic therapy, pulse magnetotherapy.

How is shoulder epicondylitis treated?

Since the main reason for the development of knee epicondylitis is professional sports, experts distinguish several types of development of the process, which are somewhat different from each other:

Experts consider professional sports to be the main reason for the development of knee joint lesions, in addition to this, the following factors can contribute to the development of the disease:

During examination of the patient's elbow joint, the doctor may find slight swelling at the site of the epicondyle, accompanied by pain at the moment of touching the elbow. The doctor can fully extend the patient's elbow joint slowly and smoothly. If the patient himself unbends the elbow, then severe pains will occur in the epicondyle. There is no discomfort when flexing.

Bernard's currents; With epicondylitis of the shoulder, joint pain appears only with independent active movements and muscle tension. Passive movements (extension and flexion), when the doctor himself performs them with the patient's hand, are painless. This is the difference between this disease and arthritis or arthrosis.

Surgical methods for the treatment of medial epicondylitis of the elbow joint are used with unsuccessful conservative treatment for 3-4 months.

Eliminate pain at the site of the lesion;

Internal epicondylitis is an inflammation of those muscles that provide extension and flexion of the hand (in other words, the inner part).

The main complaint that patients present is a sharp pain in the elbow joint. Pain sensations can spread up and down the outer or inner side of the arm, reaching the middle of the forearm.

Elbow epicondylitis: treating inflammation

Treatment of the disease is performed on an outpatient basis

With the so-called "swimmer's knee" microtraumas develop during repulsion from the water, while the medially located ligament of the joint is constantly overstrained, which contributes to the development of the disease;

Stereotypical repetitive movements in the joint, which are performed by people engaged in some work or visiting the fitness room;

Causes of epicondylitis of the elbow joint

Rotational movements with a bent forearm are easy and painless for the patient, but when the arm is fully extended, they are difficult because of the severe pain that occurs.

Paraffin applications;
With lateral epicondylitis, the pain increases with wrist extension and supination (turning the forearm outward, palm up). With medial epicondylitis, the pain increases with flexion and pronation of the forearm (turning the hand palm down).
Is the regular trauma of the tendons with light, but systematic stress. The constant continuous work of muscles and tendons causes ruptures of individual tendon fibers, in the place of which scar tissue is subsequently formed. This gradually leads to degenerative changes in the joint area, against which the inflammatory process begins to develop.

The so-called Hohmann operation is widely used. In 1926, he proposed excising some of the tendon at the extensors of the fingers and hand. Today, such an excision is not performed at the point of transition into the muscle, as was proposed in the original version, but near the area of attachment of the tendon to the bone itself.

Types of epicondylitis

To restore or improve regional blood circulation;

It should be noted that the development of external epicondylitis occurs most often. This disease is considered one of the most common in the area of the musculoskeletal system.As a rule, pain occurs when the forearm is extended and rotated outward. A characteristic feature of epicondylitis is the absence of pain with passive hand movements (without the participation of the patient's muscular apparatus). This allows you to distinguish epicondylitis from other diseases of the elbow joint - arthritis and arthrosis.

If epicondylitis cannot be cured by conservative methods, surgical intervention can be prescribed.With the "jumper's knee", the inflammatory process is localized in the patella, pain is felt at the place of attachment of the ligaments at the bottom of the patella; basketball and volleyball players are susceptible to the development of such a pathology;

Joint injuries - shock, sprain, fall, tearing of ligaments when trying to lift or move a heavy load;

Elbow epicondylitis treatment

Epicondylitis is characterized by symptoms of Thomsen and Welsh. In the first case, an attempt to hold the hand clenched into a fist in the dorsiflexion position in the epicondyle of the affected limb is accompanied by acute pain, while the hand immediately drops. Identification of Thomsen's symptom involves conducting a test simultaneously on two hands.

Cryotherapy, etc.

The diagnosis is made on the basis of complaints and external examination. Radiography in epicondylitis is informative only in the case of a long chronic course, when structural changes become noticeable in the affected joint: a decrease in bone density (osteoporosis), pathological outgrowths (osteophytes).
The risk factors that trigger the disease include:
After such an operation, it takes some time to recover, carry out the appropriate procedures and perform special exercises with epicondylitis of the elbow joint.
Restore full range of motion in the elbow joint;

This inflammation doesn't just happen because epicondylitis is a secondary condition. The exact causes of elbow epicondylitis are not known to doctors. Experts were able to find out which groups of people are most susceptible to this disease. These include:

The projection of pain does not fall on the joint itself, but on the lower portions of the ulna. Often the patient can point with his finger the most painful place. The process of shaking hands, lifting small weights, for example, a tea cup, causes great difficulties.

It is possible to prevent the development of epicondylitis by following some simple recommendations:

The most common (practically in one third of all professional athletes-runners) the development of "runner's knee" pain is the result of compression of the nerves that innervate the patella.

Chronic increased stress on the knees;

Welsh's symptom is the appearance of severe pain in the epicondyle zone with simultaneous extension of the forearms, which are in a bent position at the level of the chin.

Experts have different opinions about massage. Some of them believe that massage for epicondylitis is useless and even harmful.

MRI and biochemical analysis blood tests are carried out when it is necessary to differentiate epicondylitis with other diseases or injuries (fracture, tunnel syndrome or GHS).

The specifics of professional activities;

In the case of a chronic course of this disease with frequent exacerbations and unsuccessful treatment, patients must change the nature of their work.

Prevent forearm muscle atrophy.

Workers Agriculture(milkmaids, tractor drivers, handymen);

Causes and symptoms of elbow epicondylitis

Follow the rules for performing physical exercises;

In order to prescribe adequate treatment, it is necessary to carefully collect data about the patient and carry out a qualified examination. In rare cases, an X-ray examination is additionally prescribed (in order to exclude the presence of a fracture) or MRI (to confirm the diagnosis if tunnel syndrome is suspected).

Inconsistent functioning of the muscles that ensure the work of the knee joint;

Other enthesopathies (M77)

[localization code see above]

Bone spur NOS

In Russia International classification diseases of the 10th revision (ICD-10) was adopted as a single normative document to take into account the incidence, reasons for medical institutions all departments, causes of death.

ICD-10 was introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Ministry of Health of Russia dated 05/27/97. No. 170

A new revision (ICD-11) is planned by WHO in 2017 2018.

As amended and supplemented by WHO

Processing and translation of changes © mkb-10.com

Epicondylitis: lateral, internal, medial and others

ICD-10 code: M77.0 (Medial epicondylitis), M77.1 (Lateral epicondylitis)

Lateral and medial epicondylitis of the elbow joint or shoulder epindicolitis is an inflammatory pathology.

The disease affects the elbow joint where muscles attach to the forearm bone. The humerus in the elbow region has special bony formations (epicondyles or epicondylosis). They represent the place where the flexor and extensor tendons attach, as well as the articular ligaments of the wrist and fingers.

The reasons for the development of pathology

Epicondylitis of the shoulder refers to secondary diseases and therefore develops not suddenly, but gradually. The exact causes of the onset of the pathology are not known, experts only single out the main risk groups.

However, by themselves, these activities do not lead to the development of epicondylitis. The disease occurs as a result of constant monotonous flexion and extension of the elbow joint when exercising a load on the arm.

The humerus has two epicondylus, medial (internal) and lateral (external). Therefore, there is lateral epicondylitis and medial.

Muscle tendons are attached to the medial epicondyle, which are responsible for inward rotation (pronation) of the hand and forearm, flexion of the fingers and hand in the wrist joint. The extensor muscles are attached to the lateral, which allow you to rotate the hand and forearm outward.

The development process and causes of brachial epicondylitis are not fully understood. Some experts believe that the causes of it are damage to the tendons as a result of their friction against the bone. Others believe that the disease is preceded by an inflammatory process in the periosteum of the epicondylus.

There is also a theory that epicondylitis of the shoulder and elbow joint develops due to osteochondrosis. This theory is confirmed by the fact that in the treatment of osteochondrosis, pain in the elbow decreases.

Most often, lateral epicondylitis of the dominant hand develops. In this case, aching pains when trying to active physical movements, flexion or extension of the elbow and hand. Passive movements do not cause discomfort. The pain occurs when the extensor muscles are felt and radiates to the outer part of the shoulder.

Medial epicondylitis is not diagnosed very often and is the result of repeated repetitive flexion movements. The pain is sharp, radiates to the inner surface of the forearm. It occurs during rotation of the forearm and during flexion movements.

Symptoms

Epicondylitis of the shoulder is acute, subacute, and chronic. Initially, the pain is accompanied by a sharp overstrain of the muscles, then it becomes constant and the muscles of the arms quickly get tired.

In the subacute stage with epicondylitis of the shoulder joint, the intensity of pain sensations decreases, at rest they pass. The chronic course is characterized by an alternation of relapses and remissions, which last from 3 months to six months.

The most obvious sign is a painful sensation of a whining character in the wrist and elbow joints, difficulty in active movements. Symptoms of pain become worse with the most common movements, such as shaking hands, trying to clench the hand into a fist, or extending the arm.

Types of epicondylitis

Lateral

Inflammation develops at the site of attachment of the bone to the lateral epicondyle. Lateral epicondylitis of the elbow joint is called "external", or "tennis player's elbow", as it is characteristic of players involved in this sport.

But this by no means means that only tennis players have an ailment. A factor in the development of the disease is the excessive tension of the muscles of the elbow joint in the place of their attachment to the epicondyle of the shoulder bone.

This disease often occurs in tennis players, but in ordinary people it can also manifest itself when performing monotonous strenuous work, for example, when chopping wood.

Interior

Internal epicondylitis is called golfer's elbow or medial. The disease occurs as a result of injuries, unsuccessful movements with a sharp extension of the arm, and the use of a number of hand tools.

Diagnostics

Before treating epicondylitis of the elbow joint, the doctor asks the patient about the complaints, examines the symptoms, examines the diseased joint. Sometimes X-rays are taken to rule out long-term injury. A number of tests are carried out.

Coffee cup test

The patient is asked to pick up a cup of liquid from the table. When he tries to do this, the painful symptoms intensify several times. This indicates lateral epicondylitis.

Thomson test

A sick person is offered to clench a hand, palm down, into a fist. Then quickly unfold it with your palm up.

Welt's test

It is necessary to raise the forearms to the level of the chin, start bending and unbending both arms at once.

During the tests of Welt and Thomson, the actions performed with the healthy and sick hands differ significantly in speed. In addition, severe pain symptoms are observed in the diseased limb.

Therapy

It is necessary to treat lateral and medial epicondylitis in combination.

It all depends on the stage of development of the disease, the cause, changes in tendons and muscles in the area of the hand and elbow, the level of disruption of the joint.

The treatment helps relieve pain symptoms, unload muscles, and eliminates inflammation. Apply drug therapy, treatment folk remedies... In order to unload muscles, use:

Gentle mode and bandage

Treatment involves temporary abandonment of professional activities that led to the development of epicondylitis. Also, in order to immobilize the joint, a special bandage is used.

It allows you to immobilize a diseased limb, relieve severe pain. Professional athletes wear a bandage regularly to prevent overloading of the joint.

A brace is a special device that is attached to the upper part of the forearm. It prevents sore muscles from contracting and thus relieves them of stress. An orthopedic band is worn only during wakefulness; it is removed during sleep.

The principle of its use is simple. The bandage firmly fixes the elbow joint, preventing excessive range of motion. His choice must be approached thoroughly, it is better that the bandage is selected by an orthopedist, taking into account the anatomical features of the joint.

Gymnastics

It helps to restore the motor functions of the elbow joint. Gymnastics involves performing simple movements that stimulate the muscles to work. Exercises are performed to stretch the tendons with maximum abduction of the hand.

Hand trainers are used to help you do three-dimensional exercises. Classes begin to perform with simulators of maximum rigidity. Exercises are selected in such a way that the muscles are not overstrained.

Eliminate pain

To relieve pain, tablets are prescribed: analgin, ketanov, renalgin. Local treatment is also carried out, injections of glucocorticoids are used, such as Diprospan, Betamethasone.

Anti-inflammatory drugs are prescribed in the form of tablets or ointments, which include Indomethacin, Diclofenac, Ibuprofen. Compresses with Dimexide are used.

For anesthesia, improvement of local tissue trophism, blockages are made at the attachment point of the hand and fingers with lidocaine or novocaine in combination with hydrocortisone.

It will be enough 4 blockades with an interval of two days. Injections of B vitamins are prescribed.

Physiotherapy

Physiotherapeutic treatment is carried out:

magnetotherapy;
phonophoresis;
cryotherapy;
mud therapy;
paraffin therapy;
Bernard currents;
electrophoresis with anti-inflammatory drugs (with acetylcholine, potassium iodide, novocaine);
shock wave therapy.

These procedures improve metabolic processes in tendon and muscle tissues, restore blood microcirculation in muscle tissues, and eliminate pain and inflammation.

The painful area is cooled. Cold accumulators or chloroethyl irrigation are used. You can use ice cubes wrapped in a towel. The procedure is carried out once a day.

Massage is performed every day for 15 minutes. Knead the points where the muscle seals are located. The course is 12 days. The massage should not give the patient unpleasant sensations.

If all of the above procedures do not bring positive dynamics and the expected result, the disease progresses, then surgical treatment is used.

Operational impact

It includes the following techniques:

tendoperiostomy;
dissection of the tendon of the short extensor of the hand;
arthroscopy;
lengthening of the tendon of the short extensor of the hand.

Prophylaxis

In order for epicondylitis of the shoulder and elbow joint not to become chronic, a number of rules should be followed:

before physical activity, you should warm up the muscles;
correctly distribute physical activity, without overstraining the muscles;
before heavy physical exertion, the elbow joints are fixed by putting on a bandage;
when carrying out monotonous monotonous movements, you must constantly take breaks.

Treatment with folk remedies

Comfrey ointment

For cooking, you will need to take the leaves and roots of the plant (1: 1). Heat up vegetable oil and honey, combine them in a deep container. The volume of this mixture should be equal to the volume of the plant material taken.

Comfrey is gradually added to a bowl of honey and butter, stirring constantly. As a result, you should get a homogeneous mixture in the form of an ointment. It is impregnated with tissue and wrapped around the affected joint. Fasten with an elastic bandage and warm with a woolen scarf. The compress is kept on the joint for a day, then replaced with a new one.

To restore damaged ligaments, treatment with such folk remedies as a mixture of comfrey and interior fat will help. A glass of bacon is mixed with half a glass of comfrey root. A compress is made to the affected joint for 2 hours until the pain sensations disappear completely.

Blue clay

It is used after acute inflammation has been removed. Take clay and hot water in equal proportions, mix and spread on cheesecloth folded in half.

Applied to the affected joint and secured. Insulate, leave for half an hour. You can do three of these compresses a day. Clay warms up a sore joint and relaxes tense muscles.

Sleeping green tea treatment

After drinking the tea, collect what is left in the teapot and freeze it. Then wipe the sore joint with the resulting ice in a circular motion.

This method treats external epicondylitis well. Rub herbal ice the affected joint needs about a minute, but you can repeat the procedure several times a day.

The above ointments and compresses are easy to make at home, but it is worth remembering that treatment with folk remedies may be unsafe, so you should consult your doctor.

There is a definite similarity between shoulder (ulnar) and knee epicondylitis. Epicondylitis of the knee joint is called "jumper's or runner's knee" and develops in a similar way.

That is, it is caused by damage to the joint capsules, ligaments, as well as lumbar osteochondrosis. The treatment for both diseases is also very similar.

Epicondylitis is a chronic degenerative disease and therefore cannot be completely cured.

However, if you use all of the above treatment methods, take care of the elbow joint, wear a bandage, do gymnastics, use folk remedies, you can achieve stable remission, forget about the feeling of discomfort, without changing your usual life and professional activities.

What is shoulder epicondylitis?

Video about epicondylitis of the elbow joint from the program "Health": The solution to the first problem in the treatment of epicondylitis is carried out by using traditional and surgical methods.

Construction workers (plasterers, painters, bricklayers);

Since the disease itself belongs to a chronic pathology, the treatment process will be long. First of all, it is required to create rest for the sore hand, to limit movements that cause acute pain. You can purchase special elbow pads or fix the joint with an eight-band bandage. In case of chronic course, it is recommended to apply an elastic bandage during the day, and remove it in the evening. You should not lift weights, otherwise all therapeutic measures will be useless.

Do not ignore the warm-up before the power load;

Types of shoulder epicondylitis

Treatment of the disease is carried out on an outpatient basis, for this you need to contact a traumatologist or orthopedist. The main objectives of therapy are:

Sudden movement that could result in injury.

When the first signs of the disease appear, you should immediately contact an experienced specialist, and not try to treat the damaged forearm on your own. This is very important because epicondylitis has symptoms similar to those of other diseases. It can be easily confused with shoulder arthritis, arthritis and osteoarthritis of the shoulder joint, and bursitis of the bursa supracondylar.

The prognosis is generally favorable, with the observance of the correct regime of work, physical activity and rest, you can achieve a stable remission.

Causes of shoulder epicondylitis

Athletes (kettlebell lifters, weightlifters, wrestlers, boxers) and others.

It is better to conduct classes in the gym under the supervision of a trainer;

Pain relief:

The disease can be diagnosed using dynamometry or thermography methods. X-ray studies are also used, however, in the early stages, it is far from always possible to identify signs of pathology. Finding foci of compaction in the epicondyle is possible only with a long-standing disease.

Symptoms of shoulder epicondylitis

The presence of concomitant diseases.

- This is a degenerative-inflammatory tissue damage in the area of the shoulder joint: the epicondyles and the tendons attached to them.

Diagnostics

With regular sports, daily massage sessions are required;

Treatment of shoulder epicondylitis

Depending on the cause that caused the development of the disease, the following forms can be distinguished:

Treatment of shoulder epicondylitis involves the use of conservative and surgical methods.

Medical treatment includes:

The humerus bones have at their ends the so-called condyles - bony thickenings, on the surface of which there are other protrusions - epicondyles, which serve for the attachment of muscles.

Ultrasound has a good analgesic effect in the treatment of epicondylitis of the elbow joint, but it is even better to use phonophoresis (the so-called ultrasound with hydrocortisone).

Epicondylitis is of two types.

Epicondylitis

Take complex vitamins regularly;

When contacting a doctor immediately after an injury, cold must be applied to the damaged area;

Traumatic - occurs due to the presence of microtraumas of tendons and muscles in athletes and people engaged in heavy physical labor. A factor that can provoke the development of traumatic epicondylitis is the presence of deforming arthrosis.

Epicondylitis of the shoulder is a disease resulting from overstrain and microdamage of the muscles that attach to the epicondyle of the humerus.

Use of NSAIDs for external use (ointments and gels): Diclofenac, Voltaren, Indomethacin, Nurofen;

Among athletes, tennis and golfers are most prone to this disease. No wonder lateral epicondylitis is also called "tennis elbow", and medial - "golfer's elbow".

The main cause of epicondylitis is chronic overstrain of the muscles of the forearm, in most cases - in the course of professional activity.

ayzdorov.ru

Symptoms and treatment of shoulder epicondylitis

Bernard currents, ozokerite and paraffin applications are also widely used.

Lateral epicondylitis

- degenerative-dystrophic process in the places of muscle attachment to the epicondyle of the humerus.

Cure all chronic foci of infection.

Signs of the disease

You can also fix the affected arm with an elastic neoprene bandage, which also performs a warming function and performs micromassage.

Epicondylitis is a very common condition in the working arm. A general decrease in the load, which is observed due to a high level of industrial mechanization, and at the same time an increase in the proportion of small movements carried out by the muscles of the forearms leads to the onset of the development of muscle overstrain.

Blockade with corticosteroid drugs (hydrocortisone or methylprednisolone), which are injected directly into the area of inflammation;

Among other diseases, epicondylitis is often accompanied by cervical and thoracic osteochondrosis, periarthritis of the shoulder scapula, osteoporosis.

Shoulder epicondylitis accounts for 21% of occupational hand diseases.

Diagnostics and treatment

What is the difference between external and medial elbow epicondylitis? The prognosis of the disease is always favorable, it does not threaten the patient's life, and with the appointment of adequate treatment, remission can be achieved, which will last for a long time if the rules of prevention are followed.
With prolonged intractable pain, a blockade with glucocorticosteroids can be used;

The severity of symptoms and signs of epicondylitis depends on the stage of development of the inflammatory process and destructive changes in the joint. Experts point out:

VashaSpina.ru

Epicondylitis of the knee: causes, symptoms, treatment

Epicondylitis can be external and internal. The first occurs many times more often.

B vitamins injections.

The reasons for the development of the disease

The peak incidence is in the 40-60 age range. External epicondylitis occurs 10 times more often than internal epicondylitis. Also, this type of epicondylitis affects mainly men, while medial epicondylitis is diagnosed mainly in women.

There are two main types of epicondylitis:

Over the entire period of treatment for epicondylitis of the elbow joint, 4 blocks are performed (an interval of a couple of days). When the plaster splint is removed, use warming compresses with petroleum jelly, camphor alcohol, or ordinary vodka compresses.
Medial epicondylitis
Medical treatment for epicondylitis is aimed at relieving pain and inflammation. Ointments containing ibuprofen or diclofenac are recommended; nanoplasts are also used.
The answer to the question: "How to treat epicondylitis of the elbow joint?" can be obtained from an orthopedic surgeon or surgeon. Pain localized to the elbow can also be a sign of arthritis, myositis, or arthrosis. Therefore, it is better to go for a consultation and determine what kind of pathology you have. Often, patients themselves postpone the treatment process until the process becomes chronic, when recovery takes place with great effort.
Restoration of blood supply to the affected area;

The acute stage of the disease, characterized by the presence of acute or burning pain, which has a different duration and duration, painful sensations intensify when moving in the joint and can radiate (spread) along the muscle fibers, while the focus of pain is clearly defined;

If conservative methods do not work, a surgical operation is indicated - fasciomyotomy.

The most susceptible to the development of this disease are people who constantly rotate their forearm and at the same time often bend and unbend the elbow. These are workers in such professions as: blacksmith, bricklayer, ironer, painter-plasterer, locksmith, hand-milking milkmaid, cutter and so on. Among the patients there are also seamstresses, draftsmen, typists.
A wide range of physiotherapy procedures can also be used:

Epicondylitis symptoms

Common symptoms of the disease:

External (lateral), in which the tendons extending from the external epicondyle of the humerus are affected;
To improve regional blood circulation in the affected area, UHF therapy, electrophoresis with acetylcholine, novocaine or potassium iodide is used.
Known as golfer's elbow. However, this does not mean that only golfers can suffer from this ailment. However, golf is a common cause of medial epicondylitis. In addition, other repetitive movements lead to epicondylitis. These include throws, sports activities, the use of different types of hand tools, and the consequences of injuries.

Prevention of the development of muscle atrophy and restoration of the functional characteristics of the joint and the full range of motion in it:
Painful sensations in the subacute stage appear during the load on the joint or shortly after it;
Epicondylitis of the knee joint is a degenerative inflammatory process that develops in the epicondyle, to which the muscles that support the joint are attached, and is characterized by the gradual destruction of these attachments. Late treatment leads to the development of inflammation in the structures and tissues surrounding the joints. The disease is more common in men over the age of 40.

How the doctor makes this diagnosis

Epicondylitis usually develops on the right limb, since most have it in a working limb.

Epicondylitis treatment

Shock wave therapy;

Spontaneous pain in the elbow joint, intense and burning during exacerbations, dull and aching in the chronic course of the disease;
Internal (medial), when the site of attachment of muscle tendons to the internal epicondyle of the humerus is affected.
In addition, medications such as nikoshpan and aspirin are prescribed to treat medial epicondylitis of the elbow.
In other words, any activity in which the muscles of the forearm are actively used can cause medial epicondylitis.
If these methods are ineffective, shock wave therapy is used. This is a relatively new technique, when high power ultrasound is applied to the affected joint.
External develops with inflammation of the muscles on the outside of the elbow, most often this pathology is present in professional tennis players.
Massage;
Chronic epicondylitis of the knee is characterized by an undulating course with periodic remissions and exacerbations.
The prevalence of this disease has not been fully understood, since people suffering from epicondylitis often try to be treated with traditional medicine, contacting a doctor only if the condition worsens or there is no improvement. And even when contacting a traumatologist, the correct diagnosis is not always made, since the clinical manifestations of epicondylitis are similar to many joint diseases.
The first symptoms of the disease are pain in the area of the epicondyle of the humerus, aching, pulling or stabbing. At the initial stage, pain can occur only directly during work. Over time, they become permanent, and with rotation and flexion / extension of the forearm, they become stronger. At the slightest touch of the epicondyle, the pain becomes so pronounced that patients have to limit the movements of the injured limb, wrap the elbow joint with bandages, thus trying to protect it.

Magnetotherapy;

Strengthening of pain syndrome during loading on the elbow joint and muscles of the forearm;

Prevention and prognosis

To change the trophism of tissues at the site of tendon attachment, blockade with bidistilled water is used. Although such blockages have a good effect, it should be said that the very process of drug administration is quite painful. In the case of a chronic course of the disease, injections of vitamins such as B1, B2, B12 are prescribed.
Treatment of epicondylitis is complex, based on the duration of the disease, the level of dysfunction of the joint, as well as changes in the tendons and muscles in the area of the hand and forearm.
It should be noted that epicondylitis is a rather insidious disease. Medical measures are able to stop pain in a short time, but when returning to previous physical activity, all symptoms can resume. It will take a long time for the affected areas to fully recover.
Internal epicondylitis occurs with inflammation of the muscle tendons located on the medial side of the elbow joint.
Gymnastics;

ArtrozamNet.ru

How to treat elbow epicondylitis

What is epicondylitis?

Phonophoresis and electrophoresis;

Gradual loss of muscle strength in the arm.
The main cause of epicondylitis

Symptoms

The main objectives of the treatment of epicondylitis of the elbow joint can be formulated in a certain way:

What is the treatment for lateral epicondylitis of the elbow joint?

Physiotherapy: phonophoresis, cryotherapy, shock wave therapy, diadynamic therapy, pulse magnetotherapy.

How is shoulder epicondylitis treated?

Since the main reason for the development of knee epicondylitis is professional sports, experts distinguish several types of development of the process, which are somewhat different from each other:

Experts consider professional sports to be the main reason for the development of knee joint lesions, in addition to this, the following factors can contribute to the development of the disease:

Bernard's currents; With epicondylitis of the shoulder, joint pain appears only with independent active movements and muscle tension. Passive movements (extension and flexion), when the doctor himself performs them with the patient's hand, are painless. This is the difference between this disease and arthritis or arthrosis.

Shoulder joint

Surgical methods for the treatment of medial epicondylitis of the elbow joint are used with unsuccessful conservative treatment for 3-4 months.

Eliminate pain at the site of the lesion;

Internal epicondylitis is an inflammation of those muscles that provide extension and flexion of the hand (in other words, the inner part).

The main complaint that patients present is a sharp pain in the elbow joint. Pain sensations can spread up and down the outer or inner side of the arm, reaching the middle of the forearm.

tvoisustavi.ru

Elbow epicondylitis: treating inflammation

Stereotypical repetitive movements in the joint, which are performed by people engaged in some work or visiting the fitness room;

Causes of epicondylitis of the elbow joint

Rotational movements with a bent forearm are easy and painless for the patient, but when the arm is fully extended, they are difficult because of the severe pain that occurs.

Paraffin applications;
With lateral epicondylitis, the pain increases with wrist extension and supination (turning the forearm outward, palm up). With medial epicondylitis, the pain increases with flexion and pronation of the forearm (turning the hand palm down).
Is the regular trauma of the tendons with light, but systematic stress. The constant continuous work of muscles and tendons causes ruptures of individual tendon fibers, in the place of which scar tissue is subsequently formed. This gradually leads to degenerative changes in the joint area, against which the inflammatory process begins to develop.

Types of epicondylitis

To restore or improve regional blood circulation;

It should be noted that the development of external epicondylitis occurs most often. This disease is considered one of the most common in the area of the musculoskeletal system.As a rule, pain occurs when the forearm is extended and rotated outward. A characteristic feature of epicondylitis is the absence of pain during passive hand movements (without the participation of the patient's muscular apparatus). This allows you to distinguish epicondylitis from other diseases of the elbow joint - arthritis and arthrosis.

Joint injuries - shock, sprain, fall, tearing of ligaments when trying to lift or move a heavy load;

Elbow epicondylitis treatment

Cryotherapy, etc.

The diagnosis is made on the basis of complaints and external examination. Radiography in epicondylitis is informative only in the case of a long chronic course, when structural changes become noticeable in the affected joint: a decrease in bone density (osteoporosis), pathological outgrowths (osteophytes).
The risk factors that trigger the disease include:
After such an operation, it takes some time to recover, carry out the appropriate procedures and perform special exercises for epicondylitis of the elbow joint.
Restore full range of motion in the elbow joint;

It is possible to prevent the development of epicondylitis by following some simple recommendations:

The most common (practically in one third of all professional athletes-runners) the development of "runner's knee" pain is the result of compression of the nerves that innervate the patella.

Chronic increased stress on the knees;

Welsh's symptom is the appearance of severe pain in the epicondyle zone with simultaneous extension of the forearms, which are in a bent position at the level of the chin.

Experts have different opinions about massage. Some of them believe that massage for epicondylitis is useless and even harmful.

MRI and biochemical blood tests are performed when it is necessary to differentiate epicondylitis from other diseases or injuries (fracture, tunnel syndrome, or SGS).

The specifics of professional activities;

In the case of a chronic course of this disease with frequent exacerbations and unsuccessful treatment, patients must change the nature of their work.

Prevent forearm muscle atrophy.

Agricultural workers (milkmaids, tractor drivers, handymen);

Causes and symptoms of elbow epicondylitis

Follow the rules for performing physical exercises;

Inconsistent functioning of the muscles that ensure the work of the knee joint;

sustavy-svyazki.ru

Our joints are in constant motion. Due to this, they live: it is known that the friction of the articular surfaces against each other provides nutrition to the cartilage. If something is wrong with the joint, it becomes noticeable very quickly. Joint pain is a very common problem, according to statistics, this is the first reason in the world in terms of the frequency of seeking help and the main reason for using analgesics. So doctors very often have to puzzle over: what exactly caused the "failure" of this or that joint?

The joint is not a very complex structure, but nevertheless there are plenty of reasons for the occurrence of pain in it: the articular surface can be damaged, soft tissue around, muscles or bones may ache. The joint capsule, which doctors call bursa, can also become inflamed and cause suffering. The bag surrounds the joint, isolates it from the surrounding tissues and creates a cavity in which intra-articular fluid circulates - a lubricant that ensures smooth sliding of surfaces against each other. Inflammation of this anatomical formation is called bursitis.

Bursitis is most typical for large, loaded joints with a large range of motion - shoulder, knee, elbow. For each of the joints, its own range of situations is known that provokes the development of bursitis. In ICD-10, bursitis is assigned the code 70-71.

The elbow joint is in great demand in humans. This is due to the active use of the upper limbs in Everyday life, work. The elbow joint is the second after the shoulder joint in terms of the volume of the load performed (when it comes to the upper limb).

Causes

It is natural to assume that olecranon bursitis will occur more often in those people whose joint is more overloaded. Indeed, this type of disease is more common in people of certain professions or certain occupations. These include:

professional athletes (most often - tennis players, boxers, gymnasts, judokas, wrestlers, javelin throwers and weightlifters, as well as representatives of various schools of martial arts);
people whose professional activity associated with increased stress on the elbow joint: operators of pneumatic hammers, locksmiths, gardeners, steelworkers. In the past, this disease very often affected bakers (the need to put bread in the oven on a shovel with a long lever handle that loads the elbow joint), students and clerks (manually rewriting large volumes of text). Now, when computer typing has practically supplanted manual typing, this problem can occur among PC operators, programmers. As a rule, in such a case, the wrist joints, which are also subject to severe stress, are simultaneously affected;
among other segments of the population, joint diseases are most often found in people of older age groups. Elbow bursitis is no exception: the frequency of referrals for this condition increases significantly after 50 years.

Most common reasons development of bursitis of the elbow joint (Table 1)

Cause	Clinical example
Acute injuries of the joint and periarticular bursa	Intra-articular fractures, blows to the elbow joint (especially with the occurrence of hematoma)
Recurrent injuries and sprains of the joint and periarticular bursa	Professional sports, work with increased stress on the joint
Metabolic disorders	Gout
Autoimmune diseases	Rheumatoid arthritis, ulcerative colitis, Crohn's disease, systemic lupus erythematosus, scleroderma, psoriasis
Joint infections	Tuberculosis, rheumatism, gonorrhea, secondary post-traumatic arthritis, sepsis
Other arthrosis and arthritis	Poisoning, hypothermia, age-related changes in the joints, deforming arthrosis

The complexity of the structure of the elbow joint is that it is a design that can be described as "three in one". At their core, these are three different joints, enclosed in a single capsule:

shoulder joint - between the humerus and ulna;
brachioradial joint - between the humerus and the radius;
radioulnar joint - between the radius and ulna.

Thanks to such a device in the joint, such movements are possible that provide the highest mobility of the lower parts of the upper limb: the forearm and hand.

The capsule of the elbow joint consists of two layers, or sheets, as doctors say. The inner layer provides moisture for the joint, the outer layer gives the capsule strength. The capsule covers all three joints, forming a semblance of a closed pouch.

Also of importance is the fact that in the joint cavity the capsule forms folds, partitions, as a result of which it has a complex multi-chamber structure. For example, the anterior and posterior parts of the articular cavity communicate with each other only through a narrow opening-gap between the radius and ulna. This feature is important when carrying out a puncture of the joint: for the complete removal of fluid or blood from it, it is necessary to carry out punctures in two places - in front and behind.

The capsule and ligaments in the elbow joint are very developed: for example, the most powerful of the ligaments, the internal one, can withstand a tensile load of up to 230 kg, others have a tensile strength of up to 130-160 kg.

Of all the joints, the ulnar has perhaps the highest reactivity in response to even minor injury. The reason for this is the peculiarities of its blood supply and innervation. The fact is that the main artery of the joint creates as many as three developed vascular networks in its capsules: two in the inner layer and one in the outer layer. In the folds of the articular bag, the vessels can generally form loops. Such a structure was conceived by nature for a better outflow of blood from the joint, which normally happens. But with the slightest injury to the joint capsule, its capacity for blood flow decreases - and the joint swells very quickly.

In addition, the mass of nerve endings is embedded in all layers of the articular bag. The pain that accompanies any injury or inflammation is perceived by the body as a signal of danger, and the muscles surrounding the elbow joint immediately spasm - immobilization of the elbow occurs. In this case, the spasm is pronounced and also counteracts the outflow of blood - edema develops in a very short period of time.

Symptoms

To be precise, there are not one, but three bags in the elbow joint. And although in essence they still form a single integral structure, from an anatomical and clinical point of view, it is better to consider them separately. These include:

subcutaneous bag: envelops the joint along the perimeter;
radial: covers the heads of the radius and ulna;
interosseous ulnar: located over all three bones of the joint.

Depending on which bag the inflammation begins with, bursitis of the elbow joint can manifest with various symptoms. But subsequently, as a rule, the pathological process spreads to all three bursae, and the differences in the initial clinic are simply erased.

With bursitis, there may be following symptoms and syndromes:

Swelling usually occurs earlier than other symptoms and is the patient's greatest concern. With microtrauma, autoimmune diseases edema begins gradually and can be the only manifestation of bursitis for a long time. If untreated, it progresses: the joint increases in size, movements in it are disturbed, and other signs of the disease appear.
Bursitis is characterized by a bent, forced position of the hand. On the outside of the joint, its capsule protrudes. In the area of the olecranon - the most protruding part of the joint - a significantly enlarged articular bag is determined, resembling a plum in size (in the unbent state of the limb).
Redness of the skin is not always observed and indicates not only a violation of the outflow of intra-articular fluid, but also an active current inflammation - microbial, autoimmune.
Pain always accompanies inflammation, therefore, with bursitis in various forms - from a feeling of discomfort to a pronounced pain syndrome, leading to the impossibility of movement in the elbow. The intensity of the pain directly depends on the severity of the inflammation;
General symptoms of inflammation - fever, intoxication - are not very common for isolated bursitis, unless the joint capsule is infected.

All these manifestations are characteristic not only of bursitis and can occur in other rheumatological and traumatological diseases - arthritis, epicondylitis, fractures and sprains, etc. Therefore, for the correct diagnosis of bursitis, it is of great importance additional methods research, as well as a correctly collected anamnesis.

The final understanding of the essence of the process helps to draw up the classification used in clinical practice... Bursitis (code 70-71 according to ICD-10) differ from each other in the following ways:

by the nature of the exudate: serous, purulent, hemorrhagic;
by the type of course: acute, subacute, recurrent and chronic.

Sometimes clinical data alone are not enough to make a diagnosis of elbow bursitis. More information about the affected joint needs to be collected. In such cases, the following diagnostic procedures can be used (at the discretion of the doctor):

X-ray examination

It is the gold standard in orthopedics, rheumatology and traumatology, which allows you to assess the structure, contours of bones, the presence or absence of fractures. On the roentgenogram, it is impossible to see soft structures - muscles, ligaments, skin, but with bursitis, this method is extremely important, since it allows you to see the absence of another, gross pathology, and thereby make the correct diagnosis.

In professional athletes, the X-ray will show changes in the bones that have been formed for a long time in response to increased stress: thickening of the bone, closure of growth zones ahead of time. In the places of attachment of the ligament to the bone, many spines (osteophytes) can be found, and in the joint cavity there are intra-articular bodies, in everyday life referred to as "articular mice".

Most characteristic feature An "athlete's joint" is the detection of a spur on the inside of the joint. This spur can reach large sizes and sometimes even break. In this case, bursitis of the elbow joint takes a very long time, is difficult to treat and requires surgical intervention.

If bursitis has arisen against the background of a rheumatological disease, then it is always accompanied by damage to the cartilaginous tissue. On the roentgenogram, this is manifested by the jaggedness of the articular surface (usuration).

If the symptoms of the disease are caused not by bursitis, but by a fracture, then the latter is easily determined on an x-ray image.

X-ray contrast study

Allows you to see foreign bodies in the joint cavity that are invisible on a conventional X-ray. The method is an X-ray after the injection of a special contrast agent into the joint with or without air. The resulting image also allows you to obtain information about the condition of the articular surfaces, to determine the optimal place for a joint puncture (if necessary), to trace the contours of the ligaments and joint capsules.

Radionuclide method

The study is widely used in traumatology and rheumatology, allowing high accuracy to identify tumors, assess mineral metabolism and the degree of maturity of bone outgrowths - thorns. Chronic and recurrent bursitis of the elbow joint is the most frequent indication for radionuclide diagnostics, it allows you to establish the cause of such a long course of this disease and choose the right treatment tactics. But in connection with the emergence of simpler and no less informative methods, the indications for the use of this study are currently narrowed.

Joint ultrasound

Ultrasonography is one of the most important non-traumatic research methods that allows you to see the contents of the joint capsule and assess the condition of the soft tissues located around the joint. This is precisely its main importance, since ultrasound very poorly "shows" the state of the cartilaginous and bone surfaces.

Currently, five approaches are known, from which a joint examination can be performed. In addition, there are five pathological conditions that can be detected during ultrasound. These include:

thickening of the tendon;
inflammation of the tendon (tendonitis);
thickening of the tendon sheath (paratenonitis);
intermuscular hematomas;
ulnar bursitis.

Thus, the role of ultrasound of the joints increases significantly when it is necessary to carry out a differentiated diagnosis between these conditions. This is a very urgent task for sports medicine, as well as in the treatment of occupational diseases of the joints.

Computed and magnetic resonance imaging

In some cases, patients have recurrent swelling and restriction of movement in the elbow joint, discomfort or pain in it, but it is not possible to identify the cause of these symptoms using specific methods. In such situations, CT or MRI is indicated. These methods are not equivalent: computed tomography allows you to track the state of hard tissues - bones, cartilage, and magnetic resonance imaging - soft: cartilage, bursae and ligaments.

CT and MRI can help solve the most difficult diagnostic situations. The need for their use usually arises in the chronic or recurrent course of the disease, and also allows you to identify the consequences of bursitis of the elbow joint.

The method is unique in its own way: on the one hand, it allows you to qualitatively examine the joint cavity, and on the other hand, to immediately carry out medical manipulations, if in the process of research they become necessary. In essence, arthroscopy is a surgical operation.

Indications for arthroscopy:

joint pain after minor injury;
symptoms of recurrent bursitis;
limitation of movement in the joint;
bursitis of unknown etiology.

Contraindications to arthroscopy:

the presence of a general or local infection;
deforming arthrosis of the III or IV degree;
significant narrowing of the joint space, revealed on the roentgenogram;
severe contractures of the elbow joint;
a significant decrease in the volume of the articular cavity.

The technique of arthroscopy is as follows: after preliminary marking (see figure), local anesthesia of the puncture area is performed, and then the puncture itself. In connection with the above anatomical features to conduct a full examination of the elbow joint cavity, it is necessary to enter it from three different approaches. An examination of the articular surfaces and the articular bag is carried out, after which the pathology that caused the bursitis is determined, and the second part of the procedure is carried out - to the therapeutic actions. Arthroscopy allows you to do the following:

flushing of the joint cavity and removal from it foreign bodies;
arthrolysis (separation of adhesions in the articulation cavity and articular bag);
removal of osteophytes (growths);
removal of part of the articular bag;
removal of foci of necrosis.

Differential diagnosis of certain diseases of the elbow joint

There are a number of diseases that are very similar to elbow bursitis - arthritis, epicondylitis, and arthrosis.

Arthritis is an inflammation of the cartilaginous surface of a joint. It is also a consequence of many reasons - infectious, autoimmune, traumatic. Bursitis to one degree or another always accompanies any arthritis, since inflammation from the head of the joint very quickly spreads to the periarticular bursa.
Epicondylitis is an inflammation that occurs where tendons attach to bones. The causes of epicondylitis are prolonged repetitive stress on the muscles of the forearm (working at a computer, professional sports, music, etc.), trauma. With epicondylitis, inflammation of the bursa located around the ligament also always develops.
Arthrosis - changes in the joint associated with long-term malnutrition of the cartilage. Osteoarthritis is also accompanied by pain, swelling and sometimes inflammation of the periarticular sac.

Despite the general clinical similarity, all these conditions have fundamental differences in treatment tactics. The table shows a number of signs that make it possible to differentiate diseases from each other.

Sign	Bursitis	Arthritis	Epicondylitis	Arthrosis
Causal disease		Trauma, systemic disease	Occupational hazards, sports	Age, chronic trauma.
The nature of the flow	Acute or chronic with clear exacerbations	Spicy	Chronic	Chronic
Pain	Moderate or weak, rarely strong (with the development of complications)	Strong or moderate, rarely weak	Weak to moderate	Weak to moderate
Edema	Leading symptom, very pronounced	Expressed	Not expressed	Not expressed
Redness, increased local temperature		Expressed	Missing	Missing
Fever, intoxication	Rarely, only in the presence of complications	Moderate or strong	Missing	Missing
Joint movements	Reduced	Dramatically reduced	Slow	Reduced
The rate at which symptoms develop	Moderate to high	High	Slow	From several months to several years

Elbow bursitis is treated in different ways, depending on the cause of its occurrence. However, there is general principles providing assistance with this pathology:

Joint immobilization. The elbow joint is fixed with a bandage or orthosis, which provides peace to the organ, reduces discomfort arising from movement, and helps to resolve edema.
As emergency care for acute bursitis, a cold compress can be used. For chronic bursitis, compresses with honey, aloe, burdock, St. John's wort or yarrow are used. In folk medicine, compresses are used from fresh vegetables- cucumber, potatoes, cabbage leaves.
Anti-inflammatory drugs are called NSAIDs. Basic group for the treatment of bursitis and all rheumatological diseases. In principle, they can be used in three dosage forms: topically, inside and intramuscularly / intravenously.

Local anti-inflammatory drugs are used in the absence of accumulation of a large amount of fluid in the joint, mild pain syndrome. Dosage form- gel or ointment (Diclofenac, Dolobene, Indomethacin, Voltaren).

In the acute stage, ointments that enhance blood flow to the joint are contraindicated - Vishnevsky's ointment, Finalgon, Fastum gel, etc., since they significantly increase edema.

NSAIDs in tablets are used for any severity of bursitis. If you need to get a quick effect or there are stomach diseases in which tablets are contraindicated, ampouled drugs are prescribed. There are a great many drugs from this group, but those that have a predominantly anti-inflammatory effect have the greatest effect. These include:

Analgin;
Indomethacin;
Diclofenac;
Ibuprofen;
Ketoprofen;
Mefenamic acid;
Nimesulide.

Paracetamol, coxibs, dexketoprofen, ketorolac, aspirin, ksefokam are significantly inferior to them in effectiveness. Any NSAID cannot be used for a long time.

Antibiotics are contraindicated in most cases for bursitis.

An exception is purulent bursitis, in which the joint fluid becomes infected with bacteria. Acute purulent bursitis is manifested by the following symptoms:

severe swelling and soreness;
fever, high body temperature;
signs of lymphadenitis in the elbow and axillary regions;
obtaining pus with a puncture of the joint.

In this case, antibiotics from the group of penicillins or cephalosporins are used, less often - drugs from other groups ("Ampicillin", "Amoxiclav", "Augmentin", "Vilprafen", "Sumamed", "Ceftriaxone", "Ceftazidim", "Cefoperazone", " Cefepim "and others).

Physiotherapy procedures on the joint area are indicated both in the acute phase and in the period of remission of bursitis. In the second case, mud therapy, massage, physiotherapy exercises, acupuncture are used. With an exacerbation of the process, it is possible to use magnetotherapy, UHF. There is evidence of the effectiveness of hirudotherapy (treatment with leeches) in acute and chronic bursitis. Warm compress is the simplest type of physiotherapy, it can be used for chronic bursitis. Such a compress can also be delivered at home.
Puncture of the joint is carried out in case of severe edema that interferes with movement, the absence of a positive effect from basic therapy, and in the diagnosis of purulent bursitis. This technique, despite its simplicity, is very effective and quickly eliminates excess fluid in the joint. After the puncture, drainage can be left in the joint, which ensures a slow outflow of inflammatory contents.
Surgical treatment (operation) and arthroscopy are performed when it is impossible to cure bursitis conservatively in patients with recurrent or chronic bursitis. In addition to removing foreign bodies, it is possible to surgically remove part of the articular membrane, resect bone growths in order to get rid of the cause that supports the violation of the circulation of intra-articular fluid.

What specialist treats bursitis

In the event of a sports injury, assistance is provided by a sports doctor, and in his absence - by a traumatologist. The surgeon deals with complicated forms of bursitis, namely, purulent ones. In large cities, for the treatment of complicated forms of infectious diseases of the joints, there are specialized departments- purulent orthopedics, tuberculosis of bones and joints, etc. If bursitis has arisen against the background of rheumatological diseases, it should be treated by a rheumatologist. An ambulance doctor should take urgent measures in case of severe pain syndrome. It is necessary to treat complicated bursitis only in a hospital.
Summing up, we can say that bursitis of the elbow joint is a heterogeneous concept. Sometimes bursitis is an independent disease, sometimes it can be just one of the symptoms of another disease. A clear understanding of the mechanisms of origin of bursitis is the main condition for its successful treatment. Given the variety of reasons that cause it, carrying out a full diagnostic search for bursitis is the prerogative of an orthopedic surgeon or rheumatologist.

Sources:

Rheumatology. National leadership. Moscow: 2013
Mironov S.P. Injury to the elbow joint when playing sports. Moscow: 2000

Hemarthrosis of the knee joint: what is it, knee treatment

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Hemarthrosis is a disease manifested by hemorrhage into the inner cavity of the joint capsule. This condition can occur as a result of traumatic exposure or if the patient has poor blood clotting.

Hemarthrosis of the knee joint most often develops due to injury. As a result of the hemorrhage that has occurred, the pressure of the articular fluid inside the joint increases.

Due to the complexity of the structure of the knee, elbow and ankle joints, the blood accumulation does not dissolve quickly. Such a pathology requires medical intervention and special therapy.

Causes and Symptoms of Trauma-Induced Hemarthrosis

Description of hemarthrosis of the knee, elbow and ankle joint is included in international directory classification of diseases. It brings together all the diagnostic information. In ICD 10, hemarthrosis has the code M25.0.

Codes are necessary for storing information data and for the convenience of their processing. The diagnostic and clinical terminology used in the Russian version of the medical handbook is consistent with domestic practice.

Hemarthrosis of the knee, elbow or ankle joint can develop as a result of various injuries:

If the articular bones are dislocated or fractured, bleeding may occur.
Hemarthrosis in the area of the knee joint and its symptoms can occur due to a sprain or rupture of the ligaments.
Injury to the vessels of soft tissues can provoke bleeding and blood accumulation in the joint and capsule.
Damage to the meniscus or joint capsule can cause hemarthrosis.

The symptoms of the disease are more pronounced in children. Therefore, immediately after the injury, the child should be shown to a doctor. Traumatic hemarthrosis of the knee, elbow or ankle joint is characterized by the presence of a certain clinical picture:

Blood in the joint appears as a result of a sudden rupture of blood vessels, and begins to flow into the cavity of the injured joint, which provokes its rapid swelling.
Pain in the joint and a decrease in its mobility are caused by an increase in the size of the joint capsule. She begins to put pressure on the surrounding tissue.
After the onset of bleeding, diarthrosis quickly swells, which is especially noticeable on the sides.
If the bleeding does not stop, the tumor begins to appear in the front. The articulation contours are smoothed out.
When a large vessel ruptures, cyanosis of the skin is observed. If the rupture occurs in small and medium-sized vessels, the skin acquires a purple hue, local hyperemia is noted.
In a patient with diarthrosis, weakness is felt, during his palpation, the pain intensifies.

Symptoms of post-traumatic hemarthrosis of the ankle, knee and elbow joint develop in 1.5-2 hours.

Important! To prevent hemarthrosis, people should, if possible, try to avoid traumatic situations, wear fixing bandages, and treat chronic diseases in a timely manner.

Treatment of hemarthrosis of the knee joint

To prescribe adequate treatment, the doctor must be sure of the correctness of the diagnosis. To do this, appoint:

X-ray.
Knee ultrasound.

In order to exclude infectious inflammation, arthritis and to determine the signs of hemarthrosis, a puncture of the cavity of the articular bag is performed. The presence in the blood test indicates the presence of hemarthrosis of the ankle, knee or any other joint.

Note! Chronic hemarthrosis of the knee joint is a very dangerous disease. Untimely treatment of pathology threatens the patient with multiple complications.

Treatment of the disease consists in removing blood exudate from the articular cavity. After that, the capsule is washed with saline and medications are injected into the cavity to eliminate bleeding, inflammation and pain.

Hemarthrosis in the primary stage is fairly easy to treat. The treatment procedure is carried out under local anesthesia, in the following order:

Liquid and blood are removed from the inner cavity of the knee joint with a syringe with a thin needle.
The articular capsule is washed with saline, then the medicine is injected into it.
A sterile tight bandage is applied to diarthrosis.

This procedure can be performed several times.

Removing blood from the knee after injury

With the puncture method, hemarthrosis of the knee joint can be cured in three weeks. If the hemorrhage into the articular cavity is repeated, degenerative changes occur. Therefore, it is much more difficult to cure secondary hemarthrosis. If the disease reappears, another method is chosen for the operation:

First, the joint is tightened with a bandage. This measure is necessary to create positive pressure.
Next, the main volume of the liquid is aspirated.
At the next stage, a flushing agent is introduced, which is then removed through a new puncture and with another needle.
The medicine is injected through the first puncture.
The treatment ends with the application of a fixation bandage that immobilizes the joint.

When using this technology, the risk of recurrent bleeding is significantly reduced, so the disease can be cured in one procedure. With mild bleeding, the joint fluid dissolves on its own and does not require surgery. In such a situation, the symptoms of hemarthrosis of the knee or ankle joint can be eliminated with folk remedies.

You can use absorbent compresses (arnica and wormwood herbs, clay), take anti-inflammatory infusions (nettle, yarrow), pain relieving honey ointments. After an injury, the limbs must be completely at rest, the leg or arm must be in an elevated state.

Cold should be applied to the area of the injured joint for two days. The load on the diseased joint must be limited.

Danger of hemophilic hemarthrosis

If the cause of hemarthrosis of the joint is hemophilia, the pathology can be latent for a long time. Cartilage tissue is destroyed by blood clots, it undergoes fibrotic changes that lead to inflammatory processes. Hemarthrosis gradually disrupts the work of the ligaments, which is the reason for the rapid loss of joint functionality.

Hemophilia can cause serious joint problems even with minor injuries. Hemarthrosis in patients with hemophilia can occur suddenly. In order to reduce blood loss, treatment of such patients should be started immediately.

Symptoms of the disease after its treatment do not disappear immediately, but gradually. Therefore, diarthrosis should be in a state of maximum rest.

Hemophilic hemarthrosis is treated only in a hospital setting. The risk of degenerative changes in cartilaginous tissues is the main danger of circulatory disorders arising from injuries. Osteoarthritis, the causes of which are associated with scar tissue on the surface of the joint, progresses very quickly.

If the correct treatment is not started on time, joint hemarthrosis can become chronic. Due to the constant presence of blood in the articular cavity, inflammation develops.

There is a high likelihood of developing bursitis, arthritis, or purulent synovitis. With neglect or chronic course of hemarthrosis, there may be a need for arthroplasty, replacement of the knee joint. The entire recovery period, the patient should be under medical supervision.

A caring attitude to your health will allow you to avoid post-traumatic complications and quickly restore the full functioning of the joint.

Relieves pain and swelling in joints with arthritis and arthrosis
Restores joints and tissues, is effective in osteochondrosis

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Chronic synovitis of the knee (knee joint): causes, classification, symptoms and treatment

A prolonged inflammatory process affecting the synovial membrane of the knee joint is defined as chronic synovitis of the knee or knee joint. The disease is characterized by the accumulation of fluid in the capsule, an increase in the volume of the joint. This brings discomfort to the patient, disrupts the motor function in the joint, and causes pain.

After the removal of acute symptoms, treatment of synovitis of the knee joint is carried out at home. To do this, follow the doctor's recommendations, reduce the load on the knee, perform exercises, and avoid injuries. The pathology often affects the joints of the knees. This is due to the constant increased stress on the large joints. Synovitis can also be diagnosed in a child. It is most often caused by trauma or a recent infectious disease.

ICD-10

According to the international classifier of diseases of pathology, the code M65 is assigned and is interpreted as synovitis and tenosynovitis. When attaching a bacterial agent, add the code B95, B96. The microbial code M65.9 is suitable for the classification of synovitis of unspecified etiology.

Causes

Chronic synovitis is often a consequence of other pathologies and has a wavy nature of the course, that is, the acute period is replaced by remission. The factors causing the disease are considered:

osteoarthritis;
juvenile arthritis;
consequence after injuries;
bruises;
dislocations;
infection;
hemophilia.

In addition, the reasons for the development of knee synovitis can be allergies, endocrine pathologies, violation metabolic processes in organism. Inflammation occurs due to the spread of pathogenic microorganisms with the flow of blood or lymph. The course of the disease is aggravated by degenerative changes in the cartilage tissue occurring in the knee joint.

Varieties

There is a classification of synovitis, depending on the causes that caused it and the clinical picture.

Infectious species. Quite a rare pathology. It is caused by the ingress of pathogenic microorganisms into the joint cavity. Infection occurs by the lymphatic, hemorrhagic or articular route. Surgical treatment by draining the joint capsule or removing it completely. V postoperative period the patient is prescribed drug therapy aimed at relieving the inflammatory process and destroying pathogenic microbes.
Aseptic. It develops without the participation of an infectious factor and is a consequence of internal inflammatory processes occurring in the musculoskeletal system. Often seen in the presence of chronic knee injuries. The risk group includes athletes and people whose profession is associated with constant stress on the knee joints. Chronic arthritis contributes to the development of this form of synovitis.
Allergic. This type of disease does not require the presence of bacteria and occurs against the background of an allergy caused by disruption of the endocrine glands. This is a rare disease, accompanied by skin rashes, changes in the structure of the synovial fluid. The main cause of pathological changes is considered to be autoimmune disorders, leading to the development of severe allergic reactions, a decrease in immunity.
Reactive form. This synovitis is a variety allergic form... It develops acutely with pronounced symptoms. It is impossible to ignore the violation, since it is accompanied by edema, hyperemia, impaired motor function of the joint. It is often a consequence of bursitis.
Moderate. The name of this form determines the severity of the clinical picture. In this case, the symptoms appear a few days after the onset of inflammation, changes in the knee joint are moderate, the pain is not severe. The danger of this form of the disease is that patients underestimate the complexity of the disease. Even with unexpressed symptoms, the inflammatory process occurs and subsequently causes complications. Therefore, no matter what the intensity of the pain, it is imperative to carry out treatment.
Post-traumatic. This type of synovitis is associated with trauma. It can be a blunt blow, dislocation, intra-articular violation of the integrity of the ligaments, meniscus, capsule, depressed fracture. There is an accumulation of synovial fluid in the bag and an increase in the volume of the joint. The pain is moderate, the skin is without redness. Joint discomfort is noted only during maximum flexion of the limb.
Minimal synovitis. This initial stage a disease characterized by minor destructive changes in the synovium. Pathologists are asymptomatic, for many years they do not make themselves felt. During this time, the synovial membrane thickens and articular fluid accumulates under it. The diagnosis is made according to the results of ultrasound, where an uneven structure of the shell is noted.
Secondary. It is a consequence of pathological processes occurring in the body. Develops against the background of: autoimmune disorders; chronic inflammatory processes; injuries. Often this type occurs with arthrosis and arthritis. The inflammatory process spreads throughout the body and affects the joints, as a result of which there is a change in the joint capsule and the structure of the synovial fluid.
Purulent. Pathology is rare and is caused by bacteria entering the synovial bag through microcracks due to compression or injury. Usually microorganisms enter the joint capsule through damaged skin. Chronic arthrosis can cause suppuration, which leads to a change in the composition of the synovial fluid.
Villous. The growth of the villi of the inner membrane of the synovial bag occurs. Fibrous fibers interfere with normal blood circulation and lymph movement in the area of the injured knee joint.
Recurrent. This is a chronic form of the disease, characterized by frequent repetitions of the inflammatory process. Chronic recurrent synovitis of the knee joint, treatment should be carried out under the supervision of a doctor, and if conservative methods do not give a positive effect, then an operation should be performed.
Suprapatellar. With such a pathology, damage is exposed top part knee joint, swelling forms over the knee pad, which leads to inflammation of the synovium.
Bilateral. Chronic inflammation of the synovial bag, which develops as a result of autoimmune disorders, when the synovial membrane is damaged by antibodies.
Exudative. This is a disease that develops as a result of injury or prolonged inflammation. In the cavity of the articular bag, an accumulation of exudate (fluid) of a different nature (serous, purulent, with an admixture of blood) occurs. The main treatment is surgery.
Hypertrophic. Chronic form synovitis, characterized by an increase and proliferation of the villi of the synovial membrane due to prolonged inflammation.
Transient. The pathological process is observed in children from 1.5 to 15 years old. It is characterized by an acute course. Pain appears in the morning, motor function is limited. The illness usually goes away within two weeks. Presumably, this type of synovitis is a consequence of the transferred viral diseases, long walking, injuries.

Clinical picture

Symptoms of chronic synovitis form a syndrome characteristic of other joint diseases:

To know how to properly treat a disease, you need to carry out a distinctive diagnosis and exclude other diseases.

Diagnostics of the chronic synovitis

In order to determine the treatment, you need to make an accurate diagnosis. In addition to examining and palpating the damaged joint, the patient is offered to undergo diagnostic procedures.

This technique includes instrumental and laboratory studies.

The patient undergoes a puncture, with the help of which the exudate is taken from the affected knee. The procedure is painless and performed without anesthesia. The liquid is examined and the cause of the synovitis is determined by the nature of the impurities.
X-ray of the knee. X-ray shows darkened areas of the knee joint in the damaged area.
MRI and ultrasound are the most informative diagnostic methods that show the places of thickening of the synovial membrane, as well as the accumulation of fluid.

Other analyzes

The patient must be general analysis blood with the definition:

leukocytes;
stab;
neutrophils.

If there is a suspicion of blood poisoning, a bacterial culture is done.

Who to contact?

If symptoms of synovitis appear, you should consult an orthopedist. He will examine the patient, collect anamnesis and prescribe additional diagnostic methods. After receiving the research results, treatment is prescribed. If there are concomitant diseases, then a consultation of narrow specialists is appointed.

Chronic synovitis treatment

Therapeutic procedures are aimed at reducing inflammation, relieving puffiness, pain syndrome, as well as treating the underlying disease that provokes synovitis (if any). There are certain stages in the treatment of this disease.

Puncture of the joint is performed if exudate is collected in the capsule. The procedure does not require anesthesia. A thin needle is inserted into the joint cavity and fluid is removed from there. After that, an antibiotic is injected into the joint capsule. The agent is administered even if the infectious factor is absent. This is done as a preventive measure.

Joint immobilization. The manipulation is carried out to relieve the load on the joint and is performed by applying a tight bandage, knee pad or special knee cuts. It is not necessary to completely limit the mobility of the joint, since complete immobilization is harmful and leads to the development of contractures. The bandage is applied for no more than one week.

Medicines

To relieve inflammation, drugs of the NSAID group are prescribed. These are non-steroidal drugs that have a triple effect: they relieve inflammation, relieve pain, and have an antipyretic effect. They are widely used to treat pathologies of the musculoskeletal system. The drugs of choice are Diclofenac, Movalis, Naklofen. This drug group has a big disadvantage - they negatively affect the gastrointestinal tract. Therefore, they can be used in the form of injections or ointments (Voltaren).

Chronic inflammation leads to damage to the deep layers of the shell of the articular bag. With this pathology, anti-lytic enzymes are prescribed (Kontrikal, Gordox).

To improve blood circulation in the damaged joint, derivatives are prescribed nicotinic acid, Trental, ATF.

With a severe course of the disease, corticosteroids are injected directly into the joint capsule (Dexamethasone). If laboratory tests have confirmed the presence of an infectious factor, then antibiotic therapy is prescribed.

Lack of efficiency conservative treatment is the reason for surgical intervention.

Physical procedures

Physiotherapy for synovitis can reduce the inflammatory process, relieve pain, help reduce the amount of exudate, and restore the synovium. These procedures include:

These procedures help restore joint mobility and reduce pain and swelling.

Operation

If drug treatment does not help, then arthroscopy is performed (the inner surface of the capsule is treated with drugs). In case of severe deformation of the joint capsule, its complete or partial removal is carried out.

Other treatments

Physical education with synovitis is aimed at preventing recurrence of the disease. The complex is developed by an exercise therapy doctor and performed by patients at home. Exercises are done only after the removal of acute symptoms. The set of exercises is aimed at restoring joint mobility.

Ointments. Treatment of chronic synovitis of the knee joint at home is carried out with ointments Diclofenac, Voltaren, Indomethacin. You can make your own remedy from dry mustard, paraffin and salt. The ingredients are heated and made into an ointment.

Leeches. The method helps to relieve swelling, inflammation, increase general immunity, and prevent relapses.

Traditional methods. Treatment folk methods can not be carried out on its own., since the use of herbs can alleviate the symptoms, but will not cure completely. Therefore, one should resort to prescriptions from healers only after consulting a doctor. Positive feedback on comfrey-based ointment. For cooking, take in equal proportions the root of the plant and not salted fat, mix and the product is ready.

Treatment at home. At home, rubbing with ointments is carried out, application folk ways(compresses, decoctions, infusions), exercise, weight correction (for obesity).

Terms of treatment: there is no exact period of therapy. It all depends on the severity of the disease, the patient's condition, aggravating pathologies, the reasons that provoked the disease.

Treatment in children

Symptoms of synovitis in children are the same as in adults. Therefore, the treatment methods are similar.

It should be noted that many medicines are not suitable for babies, so the doctor selects drugs approved by pediatricians. Surgical treatment is carried out as a last resort.

Are they recruited into the army with such a diagnosis?

To be exempt from military service, it is necessary that knee-joint functioned poorly. If the pathology is chronic in nature, then the commission considers the issue of postponement for the treatment of the joint.

Prevention and prognosis

In order to prevent the development of the disease, you need to monitor your condition, do not ignore the first symptoms and carry out qualified treatment. In this case, the risk of complications is minimized as much as possible, and the prognosis will be favorable.

Doctor's opinion

Chronic synovitis is not dangerous disease but not correct treatment, ignoring medical recommendations, it can cause pathological changes in the joint, which will lead to limited mobility, disability.

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Therapeutic tactics depend on the duration of the disease, the severity of clinical symptoms and the causes of tendon overload. With fresh epicondylitis with a mild pain syndrome, it is sometimes sufficient to prescribe a protective mode, in which certain movements of the limb are excluded. If epicondylitis occurs as a result of occupational overload, the patient is issued a sick leave. If sports are the reason for the development of the disease, it is recommended to temporarily stop training. After the pain disappears, the load is gradually increased.
To prevent relapse, it is necessary to establish what caused the muscle overload. Patients are advised to pay attention to the technique of performing stereotyped movements, use other tools, regularly pause during work, review the training regimen. Sometimes the above measures are enough to eliminate the symptoms of the disease and prevent relapses. With inefficiency this method, as well as with an intense pain syndrome and a protracted course of epicondylitis, more active treatment is needed.
The arm is provided with complete rest by applying a splint and hanging the limb on a kerchief. After pain relief, the plaster cast is removed, patients are advised to use NSAIDs local action... NSAIDs in tablets are usually not prescribed because the risk of side effects (irritation of the stomach wall) outweighs the potential of anti-inflammatory therapy. With persistent sharp pains, blockade of the affected area is carried out with solutions of glucocorticosteroids.
The best option for epicondylitis is blockade with betamethasone, since this drug does not cause an increase in pain immediately after blockade and does not provoke degenerative changes in tissues at the injection site. Betamethasone can be replaced with methylprednisolone or hydrocortisone, however, in this case, the patient must be warned that the pain will intensify on the first day after the blockade, and only then relief will come. The use of triamcinolone for epicondylitis is contraindicated, since it medicine when administered subcutaneously, it can cause a violation of skin pigmentation and the formation of adhesions between the skin and underlying tissues (in this case, the surface of the condyle of the humerus).
The prognosis for epicondylitis of the elbow joint is favorable. Rest and the use of local NSAIDs can completely eliminate the pain syndrome in 2-3 weeks. With the introduction of glucocorticosteroid drugs, pain disappears within 2-3 days. In some cases, there is a persistent course with frequent exacerbations and low effectiveness of therapy. Usually the cause is congenital failure connective tissue... In such patients, joint hypermobility is revealed, and epicondylitis is often bilateral in nature. The best option in such cases is a constant gentle mode and an individual selection of tolerable loads (possibly with a change in specialty or refusal to go in for sports).