Epicondylitis
Epicondylitis is a painful condition which occurs at the elbow, where muscles which permit the wrist and fingers to move, meet the bone. When this painful condition occurs on the outside it is called tennis elbow (lateral epicondylitis). When it occurs on the inside of the elbow bend, it is called golfer’s elbow (medial epicondylitis). Tennis elbow is a fairly common disease in the general population, and in some studies high occurrence has been observed in some occupational groups with hand-intensive tasks (table 1); it is more common than medial epicondylitis.
Table 1. Incidence of epicondylitis in various populations.
|
Study population |
Rate per 100 person-years |
Reference |
|
5,000 workers of diverse trades |
1.5 |
Manz and Rausch 1965 |
|
15,000 subjects of a normal population |
<1.0 |
Allander 1974 |
|
7,600 workers of diverse trades |
0.6 |
Kivi 1982 |
|
102 male meatcutters |
6.4 |
Kurppa et al. 1991 |
|
107 female sausage makers |
11.3 |
Kurppa et al. 1991 |
|
118 female packers |
7.0 |
Kurppa et al. 1991 |
|
141 men in non-strenuous jobs |
0.9 |
Kurppa et al. 1991 |
|
197 women in non-strenuous jobs |
1.1 |
Kurppa et al. 1991 |
Epicondylitis is thought to be caused by repetitive and forceful exertions of the wrist and fingers; controlled studies have, however, given contradictory results concerning the role of hand- intensive tasks in the development of the disease. Trauma can also play a role, and the proportion of cases occurring after trauma has ranged from 0 to 26% in different studies. Epicondylitis usually occurs in people aged 40 years and older. The disease is rare under the age of 30. Little is known of other individual risk factors. A common view about the pathology is that there is a tear at the insertion of the muscles. Symptoms of epicondylitis include pain, especially during exertion of the hand and wrist, and gripping with the elbow extended may be extremely painful.
There are various concepts of the pathogenesis of epicondylitis. The duration of epicondylitis is usually from some weeks to some months, after which there is usually complete recovery. Among workers with hand-intensive tasks the length of sick-leave due to epicondylitis has usually been about or slightly over two weeks.
Olecranon Bursitis
Olecranon bursitis is an inflammation of a liquid-filled sac on the dorsal side of the elbow (olecranon bursa). It may be caused by repeated mechanical trauma (traumatic or “student’s” bursitis). It may also be due to infection or associated with gout. There is local swelling and wavelike motion on palpation due to accumulation of fluid in the bursa. When there is raised skin temperature, an infectious process (septic bursitis) is suggested.
Osteoarthrosis
Osteoarthrosis or degenerative disease that results from a breakdown of cartilage in the elbow is rarely observed in people under the age of 60. However, an excess prevalence of osteoarthrosis has been found among some occupational groups whose work includes intensive use of hand tools or other heavy manual work, such as coal miners and road construction workers. Valid studies with no excessive risk in such occupations have also been reported, however. Elbow arthrosis has also been associated with vibration, but it is believed that osteoarthrosis of the elbow is not specific to vibration.
The symptoms include local pain, first during movement and later also during rest, and limitation of the range of motion. In the presence of loose bodies in the joint, locking of the joint may occur. Loss of the ability to extend the joint completely is especially disabling. Abnormalities seen on x rays include the growth of new bone tissue at the sites where ligaments and tendons meet the bone. Sometimes loose pieces of cartilage or bone can be seen. Damage to the joint cartilage may result in destruction of the underlying bone tissue and deformation of joint surfaces.
The prevention and treatment of elbow osteoarthrosis emphasize optimizing work load by improving tools and work methods to decrease the mechanical loads imposed on the upper limb, and minimizing exposure to vibration. Active and passive movement therapy may be used in order to minimize restrictions in the range of motion.