Orthopedics - Oleksa A.P. 2006

Occupational musculoskeletal disorders
Epicondylitis of the humerus

Humeral epicondylitis is one of the most common occupational disorders affecting the working arm. It arises from overuse and microtrauma to the Muscles Attached to the epicondyles of the humerus. Clinically, it manifests as chronic aseptic periostitis and tendomyofascia in the region of the lateral or medial epicondyle of the humerus.

Lateral humeral epicondylitis is of the greatest practical significance, occurring 10 to 12 times more frequently than medial epicondylitis. It develops in individuals whose work involves prolonged and strenuous pronation and supination of the forearm, combined with frequent flexion and extension of the arm at the elbow joint (such as fettlers, die-cutters, locksmiths, assembly workers, stonemasons, painters, dairymaids, and machine operators).

Pathogenesis. The condition is rooted in microtrauma to the periosteum of the epicondyle caused by strenuous overuse of the muscles originating from the lateral or medial humeral epicondyle. This leads to aseptic reactive inflammation, followed by metaplastic changes in both the periosteum of the epicondyle itself and the adjacent fascia, ligaments, and muscles. Local circulatory disturbances in the epicondylar area resulting from trauma also play a role in The Development of inflammation.

Pathological anatomy. It is widely held that Muscle strain leads to the accumulation of Metabolic waste products, causing colloid Swelling and stiffness, which ultimately triggers aseptic inflammation.

Diagnosis. Establishing a diagnosis requires not only a detailed history of working conditions, onset, and disease progression, but also a precise understanding of clinical manifestations. The primary symptom is tenderness upon Palpation of the lateral and medial humeral epicondyles, sharp pain in the epicondyle during resisted wrist extension (Thomsen's test), and a significant decrease in dynamometric measurements on the affected side.

Treatment. Given the pathogenetic nature of epicondylitis, the primary objective is to relieve muscle tension and irritation in the epicondylar region. To achieve this, the upper extremity is immobilized with a plaster splint extending from the fingertips to the middle or even upper third of the arm, effectively neutralizing the function of the muscles that attach to the epicondyle. Patients are prescribed thermal therapy, UHF therapy, analgesics, and anti-inflammatory drugs.

In clinical practice, local injections of Kenalog-40 (1 ml) diluted in a 0.5% novocaine solution (3-4 ml) with an antibiotic directly into the point of maximum tenderness have proven highly effective. If treatment is initiated promptly, a single Kenalog injection is usually sufficient; however, in delayed presentations, the injection may need to be repeated two to three times at 5 to 7-day intervals.

Good therapeutic outcomes are achieved in almost all cases; nevertheless, if the causative occupational hazards are not eliminated, epicondylitis recurrences may occur.

In some cases of chronic progression and frequent relapses, surgery is indicated. The surgical Procedure involves excision of the subtendinous bursa and drilling the epicondyle with a Kirschner wire in five to six places.

Disability assessment. In the Cytology/cytology/16.html">Early stages of the condition, patients are temporarily incapacitated. Upon successful medical treatment, the patient is temporarily reassigned to lighter work duties, with compensation provided via a sick leave certificate.

In cases of recurrence, occupational reassignment is necessary. If this is not feasible, the patient is referred to the medical and social expert commission (MSEC).