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Vol. 6. Núm. 2.
Páginas 79-88 (Junio 2005)
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Vol. 6. Núm. 2.
Páginas 79-88 (Junio 2005)
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Epicondilitis
Visitas
17038
Rosa María Hortal Alonsoa, Marina Salido Olivaresb, Pilar Navarro Alonsob, Gloria Candelas Rodríguezc
a Sección de Reumatología. Hospital Universitario Dr. Peset. Valencia. España
b Departamento de Reumatología. Clínica SAS. Madrid. España
c Servicio de Reumatología. Hospital Clínico. Madrid. España
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Resumen

La epicondilitis es la enfermedad del codo más frecuente. Se trata de una tendinosis crónica producida en la mayoría de los casos por el sobreuso de los músculos extensores del antebrazo, relacionado principalmente con la actividad laboral o deportiva. Tiene un claro perfil ocupacional al igual que otras tendinopatías crónicas del miembro superior con las que puede aparecer asociada. Produce dolor en la cara lateral del codo irradiado al antebrazo, sensación de pérdida de fuerza en la mano y, con frecuencia, discapacidad. La duración de la sintomatología es prolongada, generalmente de 6 a 9 meses, si bien puede superar el año. El diagnóstico es eminentemente clínico; las exploraciones complementarias sólo son necesarias en casos de duda, para valorar enfermedad asociada o para planificar la cirugía cuando esté indicada. El tratamiento es siempre conservador, precisa de una terapia combinada con antiinflamatorios no esteroideos, ejercicios de fisioterapia, modificaciones posturalesergonómicas y banda preventiva de epicondilitis; en las más sintomáticas también infiltraciones locales con corticoides y/o rehabilitación. El tratamiento quirúrgico sólo está indicado cuando, tras 1 año de tratamiento conservador adecuado, persiste dolor que interfiere con las actividades cotidianas. Es una causa relativamente frecuente de incapacidad laboral transitoria por lo que conlleva importantes costes económicos.

Palabras clave:
Epicondilitis
Codo de tenista
Tratamiento conservador
Abstract

The epicondylitis is a common disease at the elbow. It is a chronic tendinosis originated in most of the cases by the repetitive injury of the extensor muscles of the forearm, related with work activity or sport. It has a clear occupational profile as other upper extremity chronic tendinopathies and it can appear associated with them simultaneously. It produces pain at the lateral aspect of the elbow irradiated down the forearm, sensation of weakness in the hand, and frequently disability. The duration of the sintomatology is prolonged, generally require from 6 to 9 months to resolve, although it can overcome a year. The diagnosis is eminently clinical; adjunct studies are only necessary in cases of doubt, to assess asociated entities or to plan the surgery when it is suitable. The treatment is always conservative, precise of a therapy combined with NSAIDs, physiotherapy exercises, activity and ergonomic modifications and preventive brace; in the most symptomatic cases also local corticosteroid injections and/or rehabilitation are required. The surgical treatment is indicated when after a year with optimum conservative management, pain that interferes with the daily activities persists. It is a relatively frequent cause of transitory work disability for what bears important economic costs.

Key words:
Epicondylitis
Tennis elbow
Conservative treatment
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Bibliografía
[1.]
J.M. Harrington, J.T. Carter, L. Birrell, D. Gompertz.
Surveillance case definitions for work related upper limb pain syndrome.
Occup Environ Med, 55 (1998), pp. 264-271
[2.]
H.P. Major.
Lawn-tennis elbow [letter].
BMJ, 2 (1883), pp. 557
[3.]
R.P. Nirschl.
Elbow tendinosis/tennis elbow.
Clin Sports Med, 11 (1992), pp. 851-870
[4.]
G.T. Gabel.
Acute and chronic tendinopathies at the elbow.
Curr Opin Rheumatol, 11 (1999), pp. 138-143
[5.]
B.P. Bernard.
Musculoskeletal disorders and workplace factors: a critical review of epidemiologic evidence for workrelated musculoskeletal disorders of the neck, upper extremity, and low back.
National Institute of Occupational Safety and Health, (1997),
[6.]
Y. Ono, R. Nakamura, M. Shimaoka, S. Hiruta, Y. Hattori, G. Ichihara, et al.
Epicondylitis among cooks in nursery schools.
Occup Environ Med, 55 (1998), pp. 172-179
[7.]
B.R. Ritz.
Humeral epicondylitis among gas and waterworks employees.
Scand J Work Environ Health, 21 (1995), pp. 478-486
[8.]
A. Malmivaara, E. Viikari-Juntura, M. Huuskonen, K. Aho, P. Kivi, S. Koskimies, et al.
Rheumatoid factor and HLA antigens in wrist tenosynovitis and humeral epicondylitis.
Scand J Rheumatol, 24 (1995), pp. 154-156
[9.]
E.P. Roetert, H. Brody, C.J. Dillman, J.L. Groppel, J.M. Schultheis.
The biomechanics of tennis elbow. An integrated approach.
Clin Sports Med, 14 (1995), pp. 47-57
[10.]
J.C. Le Huec, T. Schaeverbeke, D. Chauveaux, J. Rivel, J. Dehais, A. Le Rebeller.
Epicondylitis after treatment with fluoroquinolone antibiotics.
J Bone Joint Surg Br, 77 (1995), pp. 293-295
[11.]
B.S. Kraushaar, R.P. Nirschl.
Tendinosis of the elbow (tennis elbow). Clinical features and findings of histological, inmunohistochemical, and electron microscopy studies.
J Bone Joint Surg, 81A (1999), pp. 259-278
[12.]
M.C. Ashe, T. McCauley, K.M. Khan.
Tendinopathies in the Upper Extremity: a paradigm shift.
J Hand Ther, 17 (2004), pp. 329-334
[13.]
J.H. Cyriax.
The pathology and treatment of tennis elbow.
J Bone Joint Surg, 18 (1936), pp. 921-940
[14.]
I. Goldie.
Epicondylitis lateralis humeri (epicondylagia or tennis elbow). A pathologic study.
Acta Chir Scand, 339 (1964), pp. 1-119
[15.]
R.P. Nirschl.
Muscle and tendon trauma: tennis elbow.
The elbow and its disorders, 1st ed., pp. 537-552
[16.]
R.P. Nirschl, E.S. Ashman.
Tennis elbow tendinosis (epicondylitis).
Instr Course Lect, 53 (2004), pp. 587-598
[17.]
W. Regan, L.E. Wold, R. Coonrad, B.F. Morrey.
Microscopic histopathology of chronic refractory lateral epicondylitis.
Am J Sports Med, 20 (1992), pp. 746-749
[18.]
S.R. Fairbank, R.J. Corelett.
The role of the extensor digitorum communis muscle in lateral epicondylitis.
J Hand Surg Br, 27 (2002), pp. 405-409
[19.]
R.P. Nirschl.
Mesenchymal syndrome.
Va Med Mon (1918), 96 (1969), pp. 659-662
[20.]
R.M. Hortal, M. Salido, P. Navarro, L. Abasolo, G. Candelas.
Epicondilitis: características clínicas y discapacidad en una serie de 120 pacientes.
Rev Esp Reumatol, 31 (2004), pp. 310
[21.]
S.A. Antuna, S.W. O’Driscoll.
Snapping plicae associated with radiocapitellar chondromalacia.
Arthroscopy, 17 (2001), pp. 491-495
[22.]
G.T. Gabel, B.F. Morrey.
Tennis elbow.
Instr Course Lect, 47 (1998), pp. 165-172
[23.]
G. Piligian, R. Herbert, M. Hearns, J. Dropkin, P. Landsbergis, M. Cherniack.
Evaluation and management of chronic workrelated musculoskeletal disorders of the distal upper extremity.
Am J Ind Med, 37 (2000), pp. 75-93
[24.]
J. Pomerance.
Radiographic analysis of lateral epicondylitis.
J Shoulder Elbow Surg, 11 (2002), pp. 156-157
[25.]
M. Castaño.
Epicondilitis: hallazgos ecográficos.
Rev Esp Reumatol, 30 (2003), pp. 213
[26.]
H.G. Potter, J.A. Hannafin, R.M. Morwessel, E.F. DiCarlo, S.J. O’Brien, D.W. Altchek.
Lateral epicondylitis: correlation of MR imaging, surgical, and histopathologic findings.
[27.]
M. Coel, C.Y. Yamada, J. Ko.
MR imaging of patients with lateral epicondylitis of the elbow (tennis elbow): importance of increased signal of the aconeus muscle.
AJR Am J Roentgenol, 161 (1993), pp. 1019-1021
[28.]
C.E. Martin, M.E. Schweitzer.
MR imaging of epicondylitis.
Skeletal Radiol, 27 (1998), pp. 133-138
[29.]
T.T. Pienimaki, T.K. Tarvainen, P.T. Siira, H. Vanharanta.
Progressive strengthening and stretching exercises and ultrasound for chronic lateral epicondylitis.
Physiotherapy, 82 (1996), pp. 522-530
[30.]
A.I. Froimson.
Treatment of tennis elbow with forearm support band.
J Bone Joint Surg, 53 (1971), pp. 183-184
[31.]
R.J. Enzenauer, D.M. Nordstrom.
Anterior interosseous nerve syndrome associated with forearm band treatment of lateral epicondylitis.
Orthopedics, 14 (1992), pp. 788-790
[32.]
J. Bennett.
Lateral and medial epicondylitis.
Hand Clin, 10 (1994), pp. 157-163
[33.]
H. Labelle, R. Guibert.
Efficacy of diclofenac in lateral epicondylitis of the elbow also treated with inmobilization.
Arch Fam Med, 6 (1997), pp. 257-262
[34.]
W.J. Assendelft, E.M. Hay, R. Abshead, L.M. Bouter.
Corticosteroid injections for lateral epicondylitis: a systematic overview.
Br J Gen Pract, 46 (1996), pp. 209-216
[35.]
N. Smidt, W.J. Assendelft, D.A. Van der Windt, E.M. Hay, R. Buchbinder, L. Bouter.
Corticosteroid injections for lateral epicondylitis: a systematic review.
Pain, 96 (2002), pp. 23-40
[36.]
R.N. Demirtas, C. Oner.
The treatment of lateral epicondylitis by iontophoresis of sodium salicylate and sodium diclofenac.
Clin Rehabil, 12 (1998), pp. 23-29
[37.]
National Institute of Health.
NIH Consensus Conference. Acupuncture.
JAMA, 280 (1998), pp. 1518-1524
[38.]
K.V. Trinh, S.D. Phillips, E. Ho, K. Damsma.
Acupuncture for the alleviation of lateral epicondyle pain: a systematic review.
Rheumatology, 43 (2004), pp. 1085-1090
[39.]
D. Trudel, J. Duley, I. Zastrow, E.W. Kerr, R. Davidson, J.C. MacDermid.
Rehabilitation for patients with lateral epicondylitis: a systematic review.
J Hand Ther, 17 (2004), pp. 243-266
[40.]
J.D. Rompe, C. Hope, K. Kullner.
Analgesic effect of extracorporeal shockwave therapy on chronic tennis elbow.
J Bone Joint Surg Br, 78 (1996), pp. 233-237
[41.]
M. Haake, I.R. Boddeker, T. Decker, M. Buch, M. Vogel, G. Labek, et al.
Side-effects of extracorporeal shock wave therapy in the treatment of tennis elbow.
Arch Orthop Trauma Surg, 122 (2002), pp. 222-228
[42.]
N. Smidt, A.W.M. Van der Windt, W.J.J. Assendelft, L.J.M. Deville, I.B. Korthals de Bos, L.M. Bouter.
Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: a randomised controlled trial.
[43.]
Occupational injuriesevaluation, management, prevention, pp. 333-345
[44.]
G.T. Gabel, C. Vissers.
Anatomic evaluation of the conjoint extensor tendon at the elbow.
American Academy of Orthopaedic Surgeons, (1999),
[45.]
J. Grifka, S. Boenke, J. Kramer.
Endoscopic therapy in epicondylitis radialis humeri.
Arthroscopy, 11 (1995), pp. 743-748
Copyright © 2005. Sociedad Española de Reumatología
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