Humeral Epicondylitis

　　Epicondylitis is mainly caused by repetitive and cumulative injuries at the attachment site of the flexor muscles of the forearm on the epicondyle of the humerus, similar to the pathogenesis of tennis elbow. As it is common among golfers, students, and miners, it is also known as golf elbow, student elbow, and miner's elbow.

　　It often occurs when the wrist is extended and the forearm is semi-propranol, receiving an external force from the elbow, causing the tense flexor muscle group to be suddenly over-stretched, resulting in injury at the attachment of the flexor muscle tendon to the epicondyle of the humerus, or when repeatedly using force to flex the wrist, fingers, or pronate the forearm, the flexor muscles and pronator teres are repeatedly tense and contracted, causing the attachment site of the epicondyle of the humerus to be subjected to long-term tension, leading to fatigue injury. Acute injury is common in the former, and chronic injury is more common in the latter.

　　Epicondylitis usually does not cause complications, but if it is not treated in a timely manner, it can lead to other diseases over a long period of time. The main possible complications include the following:

　　1. Deep fasciitis of the superficial muscles of the forearm;

　　2. Degenerative changes in the annular ligament of the radius;

　　3. Overgrowth of the synovial bursa of the radius or synovial folds.

　　The main symptom of epicondylitis is pain on the inside of the elbow joint. It develops slowly without a history of acute injury. However, fatigue can trigger pain. Common triggers include doing heavy laundry, lifting heavy objects, etc. The pain is persistent and can be described as sharp, aching, or fatigue pain. The pain can radiate to the inside of the forearm. In severe cases, there is a decrease in grip strength, and pain is particularly severe when wringing a towel, which is one of the characteristics of the disease.

　　During the examination, there is no local redness and swelling, and the joint function is not limited. There is localized tenderness over the epicondyle. A careful examination can reveal a sensitive trigger point stretch test of the extensor tendons: straighten the elbow, make a fist, and bend the wrist. Then, pronate the forearm; if this causes severe pain on the inside of the elbow, it is positive. Due to myofascial pain, pain is usually severe during this test. X-ray examination can rule out diseases such as infection, injury, tuberculosis, and tumors. Diagnosis should differentiate from cervical spondylosis. Cervical spondylotic radiculopathy can present with pain on the inside of the upper limb, which is a radicular pain, and there may be sensory disturbances in the hand and forearm. There is no localized tenderness. Sometimes, epicondylitis can be misdiagnosed as cervical spondylotic radiculopathy, which can delay treatment.

　　For those with mild epicondylitis, it can usually heal on its own with increased attention to daily care, after a few days or several months; if it recurs, causes persistent pain, weakness, or even drops objects suddenly from your hand, it is necessary to seek medical attention as soon as possible. In daily life, one should pay attention to the following:

　　1. When playing golf, choose a golf club with light weight, good elasticity, and high quality to reduce the burden on your arms.

　　2. When shopping for groceries, try to use a shopping cart instead of a basket; when pouring water, wringing clothes, or carrying heavy objects, pay attention to the position of your wrists and avoid bending them backwards.

　　3. When mopping the floor, bend your legs slightly and use the strength of your waist and legs to move your shoulders and arms, not just your arm strength to push.

　　4. If there are symptoms, it is advisable to reduce the workload as much as possible to prevent the condition from worsening.

　　Epicondylitis of the medial humeral epicondyle can generally be diagnosed based on the medical history and clinical manifestations. If further diagnosis is needed, the examiner can ask the patient to sit on a chair, place the forearm on the table with the palm facing up, and actively flex the wrist and clench the fist. The examiner will resist, which will trigger pain in the medial epicondyle and flexor tendons. Generally, no other auxiliary examination methods are needed. In special cases, X-ray examination can also be performed, which should be based on the specific diagnosis of the doctor.

　　Epicondylitis of the medial humeral epicondyle is often caused by the sudden passive overstretching of the tense flexor muscle group when the wrist is extended and the forearm is semi-pronated, due to the external varus force of the elbow. Treatment is mainly conservative, and at the same time, attention should be paid to the following points in diet:

　　1. Eat more foods rich in trace elements. Animal liver, seafood, soybeans, sunflower seeds, mushrooms contain more zinc. Animal liver, eggs, beans, green vegetables, flour contain more iron. Oats, turnips, egg yolks, cheese contain more manganese.

　　2. Eat more fresh vegetables and fruits to ensure adequate vitamin intake.

　　3. Eat less greasy and fried foods.

　　4. Avoid smoking, alcohol, and spicy刺激性 foods.

　　5. Drink tea less often, as tea contains a high amount of tannins, which can affect the absorption of calcium, iron, and protein.

　　Epicondylitis of the medial humeral epicondyle is often considered a self-limiting disease. If treatment is needed, conservative treatment methods are generally recommended. The following are four conservative treatment methods for this disease:

　　General Treatment

　　Rest, local hot compress, or external application of safflower oil, etc. For severe symptoms and acute onset, the affected limb can be suspended with a triangular bandage, and the wrist is immobilized for 1-2 weeks.

　　Medication

　　Mainly non-steroidal anti-inflammatory drugs, such as 25mg diclofenac, 3 times a day.

　　Pain Point Blockade

　　An injection of 1% lidocaine, 0.5mg vitamin B12, and a mixture of 3-4mg Dexamethasone in 2-3ml at the most pronounced tenderness of the lateral epicondyle of the humerus, once a week, with 3 times as one course.

　　Physical Therapy

　　Laser, superlaser, and other treatments can be performed at the tender point.