Summary
Definition
History and exam
Key diagnostic factors
- 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)
Other diagnostic factors
- amplitude de movimentos normal no cotovelo
- sensibilidade normal
- sinal de Tinel negativo
- extensão fraca do punho (epicondilite lateral)
- edema
Risk factors
- 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
Diagnostic tests
1st tests to order
- nenhum exame inicial (diagnóstico clínico)
Tests to consider
- 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
Treatment algorithm
apresentação inicial
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
Contributors
Authors
Adam C. Watts, BSc, MBBS, FRCS (Tr and Ortho)
Consultant Hand and Upper Limb Surgeon
Wrightington Hospital
Appley Bridge
Wigan
UK
Disclosures
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
Disclosures
PMR declares that he has no competing interests.
Acknowledgements
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.
Peer reviewers
Frank G. Alberta, MD, FAAOS
Associate Professor of Orthopaedic Surgery
Hackensack Meridian School of Medicine
Nutley
NJ
Disclosures
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.
References
Key articles
American College of Radiology. Practice parameter for the performance and interpretation of magnetic resonance imaging (MRI) of the elbow. 2021 [internet publication].Full text
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. Abstract
National Institute for Health and Care Excellence. Autologous blood injection for tendinopathy. Jan 2013 [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Síndrome do túnel radial
- Plica radiocapitelar
- Osteoartrite
More DifferentialsGuidelines
- ACR Appropriateness Criteria: acute elbow and forearm pain
- Lateral epicondyle tendinopathy (LET) toolkit
More GuidelinesPatient information
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