Resumen
Definición
Anamnesis y examen
Principales factores de diagnóstico
- history of repetitive recreational or occupational activity
- past medical history of epicondylitis
- smoking
- elbow pain during or following flexion and extension
- exacerbation of pain with repetitive movement or occupational activity
- decreased grip strength
- pain at the lateral aspect of the elbow (lateral epicondylitis)
- tenderness over the common extensor tendon (lateral epicondylitis)
- positive extensor carpi radialis brevis stretch (lateral epicondylitis)
- pain during resisted wrist and digit extension (lateral epicondylitis)
- pain at the medial aspect of the elbow (medial epicondylitis)
- tenderness approximately 5 mm distal and lateral to the medial epicondyle (medial epicondylitis)
- increased pain with resisted forearm pronation or wrist flexion (medial epicondylitis)
Otros factores de diagnóstico
- normal range of movement at elbow
- normal sensation
- Tinel sign negative
- weak wrist extension (lateral epicondylitis)
- swelling
Factores de riesgo
- increasing age (>40 years)
- past medical history of epicondylitis
- repetitive activities
- poor mechanics during activities
- improper equipment
- inadequate physical conditioning
- smoking
- obesity
- symptoms occurring on the same side as hand dominance
- female sex
Pruebas diagnósticas
Primeras pruebas diagnósticas para solicitar
- no initial tests (clinical diagnosis)
Pruebas diagnósticas que deben considerarse
- elbow x-ray
- computed tomographic scan of the elbow
- MRI of the elbow
- MRI of the cervical spine
- electromyogram and nerve conduction studies
- ultrasound of the elbow
Algoritmo de tratamiento
initial presentation
no response to initial treatment at 6 weeks
lateral epicondylitis refractory to treatment 6-12 months after initial presentation
medial epicondylitis refractory to treatment 6-12 months after initial presentation
Colaboradores
Autores
Adam C. Watts, BSc, MBBS, FRCS (Tr and Ortho)
Consultant Hand and Upper Limb Surgeon
Wrightington Hospital
Appley Bridge
Wigan
UK
Divulgaciones
ACW has received payment for education from Medartis and Wright Medical. His institution has received funding for research from Chemedica, ZimmerBiomet, Wright Medical, Stryker and Lima.
Paul M. Robinson, FRCS (Tr&Orth), BMedSci, MBChB (Hons)
Consultant Trauma and Orthopaedic Surgeon
Peterborough City Hospital
North West Anglia NHS Foundation Trust
Peterborough
UK
Divulgaciones
PMR declares that he has no competing interests.
Agradecimientos
Dr Adam C. Watts and Dr Paul M. Robinson would like to gratefully acknowledge Dr Len Funk, Dr Iain Macleod, Dr Daniel J. Soloman, and Dr Hugo B. Sanchez, previous contributors to this topic. LF, IM, DJS, and HBS declare that they have no competing interests.
Revisores por pares
Frank G. Alberta, MD, FAAOS
Associate Professor of Orthopaedic Surgery
Hackensack Meridian School of Medicine
Nutley
NJ
Divulgaciones
FGA declares that he has no competing interests.
Agradecimiento de los revisores por pares
Los temas de BMJ Best Practice se actualizan de forma continua de acuerdo con los desarrollos en la evidencia y en las guías. Los revisores por pares listados aquí han revisado el contenido al menos una vez durante la historia del tema.
Divulgaciones
Las afiliaciones y divulgaciones de los revisores por pares se refieren al momento de la revisión.
Referencias
Artículos principales
American College of Radiology. Practice parameter for the performance and interpretation of magnetic resonance imaging (MRI) of the elbow. 2021 [internet publication].Texto completo
American College of Radiology. ACR appropriateness criteria: acute elbow and forearm pain. 2024 [internet publication].Texto completo
Raman J, MacDermid JC, Grewal R. Effectiveness of different methods of resistance exercises in lateral epicondylosis - a systematic review. J Hand Ther. 2012 Jan-Mar;25(1):5-25. Resumen
National Institute for Health and Care Excellence. Autologous blood injection for tendinopathy. Jan 2013 [internet publication].Texto completo
Artículos de referencia
Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
Diferenciales
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Más DiferencialesGuías de práctica clínica
- ACR Appropriateness Criteria: acute elbow and forearm pain
- Lateral epicondyle tendinopathy (LET) toolkit
Más Guías de práctica clínicaFolletos para el paciente
Tennis elbow
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