Castro Domínguez Francisco

Lateral epicondylitis, commonly known as "tennis elbow," is a painful condition that affects the elbow region. Despite its name, this condition is not limited to tennis players, as it can affect anyone who makes repetitive movements of the arm and wrist.

The diagnosis of lateral epicondylitis is based primarily on the patient's medical history and physical examination. Below are the key aspects of the diagnosis:

The doctor will begin by obtaining a detailed medical history of the patient. This will include questions about the nature and duration of the pain, activities that trigger or aggravate symptoms, and any history of previous elbow injuries.

During the physical exam, the doctor will evaluate the elbow for signs of epicondylitis. One of the characteristic findings is tenderness and pain on palpation of the lateral epicondyle of the elbow, the bony prominence on the outer side of the elbow.

Specific resistance tests may be performed to evaluate the strength and function of the affected muscles and tendons. The resisted wrist extension test, in which the patient attempts to extend the wrist against the physician's resistance, often causes pain characteristic of lateral epicondylitis.

Mobility tests may be performed to evaluate the range of motion of the elbow and wrist. This helps determine if joint function is compromised.

The doctor may also perform additional tests, such as X-rays or MRIs, to rule out other conditions that may cause similar symptoms, such as fractures, arthritis, or nerve problems.

Lateral epicondylitis can present different phenotypes or patterns of presentation, and can be classified based on its severity and chronicity:

• Acute Epicondylitis: In acute cases, symptoms usually appear suddenly and are associated with a traumatic injury or a sudden increase in activity involving the wrist and forearm. The pain is intense and can significantly limit function.
• Chronic Epicondylitis: In chronic cases, symptoms may have been present for weeks or months. The pain tends to be more constant, but may be less intense than in the acute phase. Limitation of function and muscle weakness may be more pronounced in chronic cases.
• Recurrent Epicondylitis: Some people experience recurring episodes of lateral epicondylitis, in which symptoms improve but then worsen again due to repetitive activity or lack of proper medical care.
• Bilateral Epicondylitis: Sometimes, epicondylitis can affect both elbows simultaneously or at different times. This is usually related to work or sports activities that involve bilateral repetitive movements.

Treatment:

Treatment of lateral epicondylitis is based on the severity of the condition and its impact on the patient's quality of life.

Conservative Management:

• Rest: Resting the arm and avoiding activities that trigger symptoms is essential in the initial stages.
• Physical Therapy: Strengthening and stretching exercises supervised by a physical therapist can help improve strength and flexibility in the affected area.
• Massage therapy and myofascial release techniques: These therapies can help reduce muscle tension and improve blood flow to the affected area.
• Immobilization: In some cases, the use of a splint or bandage may be recommended to limit elbow mobility and reduce stress on the tendons.

Medicines:

Nonsteroidal anti-inflammatory drugs (NSAIDs)can relieve pain and reduce inflammation in mild to moderate cases.

In some cases, corticosteroid injections may be given directly into the epicondyle to reduce inflammation and pain.

Advanced Therapies:

• Shock wave therapy: This therapy uses high-energy sound waves to stimulate healing of affected tissues.
• Platelet-rich plasma (PRP) therapy: It has been used to promote the regeneration of affected tissues.
• Surgery: In severe cases or cases that do not respond to conservative treatment, surgery may be considered to remove damaged tissue and repair the tendons. This option is generally reserved for cases that are chronic or do not improve with other approaches.