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Epicondilite

Última revisión: 22 Aug 2025
Última actualización: 11 Mar 2025

Resumen

定义

病史和体格检查

关键诊断因素

  • presença de fatores de risco
  • dor no cotovelo durante ou após a flexão e extensão
  • exacerbação da dor com movimento ou atividade ocupacional repetitivos
  • redução da força de preensão
  • dor na região lateral do cotovelo (epicondilite lateral)
  • dor à palpação sobre o tendão extensor comum (epicondilite lateral)
  • estiramento positivo do extensor radial curto do carpo (epicondilite lateral)
  • dor durante a extensão do punho e dedos contra resistência (epicondilite lateral)
  • dor na região medial do cotovelo (epicondilite medial)
  • dor à palpação aproximadamente 5 mm distal e lateral ao epicôndilo medial (epicondilite medial)
  • dor elevada com flexão do punho ou pronação do antebraço contra resistência (epicondilite medial)
完整详情

其他诊断因素

  • amplitude de movimentos normal no cotovelo
  • sensibilidade normal
  • sinal de Tinel negativo
  • extensão fraca do punho (epicondilite lateral)
  • edema
完整详情

危险因素

  • aumento da idade (>40 anos)
  • história médica de epicondilite
  • atividades repetitivas
  • mecânica incorreta durante as atividades
  • equipamentos inadequados
  • condicionamento físico inadequado
  • tabagismo
  • obesidade
  • sintomas ocorrendo no mesmo lado que a mão dominante
  • sexo feminino
完整详情

诊断性检查

首要检查

  • nenhum exame inicial (diagnóstico clínico)
完整详情

需考虑的检查

  • radiografia do cotovelo
  • tomografia computadorizada (TC) do cotovelo
  • RNM do cotovelo
  • ressonância nuclear magnética (RNM) da coluna cervical
  • estudos de eletromiografia e condução nervosa
  • ultrassonografia do cotovelo
完整详情

治疗流程

急症处理

apresentação inicial

持续性治疗

nenhuma resposta ao tratamento inicial em 6 semanas

epicondilite lateral refratária ao tratamento 6 a 12 meses após a apresentação inicial

epicondilite medial refratária ao tratamento 6 a 12 meses após a apresentação inicial

撰稿人

作者

Adam C. Watts, BSc, MBBS, FRCS (Tr and Ortho)

Consultant Hand and Upper Limb Surgeon

Wrightington Hospital

Appley Bridge

Wigan

UK

利益声明

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

利益声明

PMR declares that he has no competing interests.

鸣谢

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.

同行评议者

Frank G. Alberta, MD, FAAOS

Associate Professor of Orthopaedic Surgery

Hackensack Meridian School of Medicine

Nutley

NJ

利益声明

FGA declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

参考文献

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

关键文献

American College of Radiology. Practice parameter for the performance and interpretation of magnetic resonance imaging (MRI) of the elbow. 2021 [internet publication].全文

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. 摘要

National Institute for Health and Care Excellence. Autologous blood injection for tendinopathy. Jan 2013 [internet publication].全文

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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