Epicondylitis of the humerus Epicondylitis of the humerus, also known as tennis elbow, is a common condition in orthopedics. It is mostly seen in men aged 35-50 years. The disease is also common in middle-aged and elderly people. The essence of the disease is a chronic injury to the extensor digitorum supercilii tendon of the humerus. There is a direct relationship between the onset of the disease and excessive wrist weight holding or activity. However, the disease can be triggered by cold in middle-aged and elderly people, without necessarily having an obvious history of injury. 1. Pathogenesis The lateral epicondyle of the distal humerus is the attachment point of the finger and wrist muscles. Excessive hand force and wrist movement can damage the muscle attachment point and cause myofasciitis of the extensor digitorum generalis tendon. There is a tiny vascular nerve bundle at this site that occurs deep from the muscle and tendon, crosses the myofascial or tendon membrane, and finally crosses the deep fascia and enters the subcutaneous tissue. Myofasciitis of the muscle attachment will cause strangulation of this neurovascular bundle and is the main factor causing pain. Tearing of the tendon and fascia can be caused when the muscle attachment point of the lateral humeral epicondyle is subjected to greater violence, which is also a cause of pain. Fibroplasia and adhesions can form after the injury. Fibrous adhesions can in turn irritate the lateral collateral and circumferential ligaments of the lateral elbow joint. The injury can reflexively cause synovitis of the humerocutaneous joint. Thus, the degree of injury may vary between patients with humeral epicondylitis, and the tissue involved may be extensive. The onset of humeral epicondylitis is occupationally related. It is not only seen in tennis players, but also in housewives, carpenters, construction workers, and other occupations that require repetitive hand and wrist strain. The onset of the disease in middle-aged and elderly people may not have a clear history of injury. 2. Clinical manifestations The main symptom is pain in the lateral aspect of the elbow joint. The onset is slow and there is no history of acute injury. However, pain can be triggered by exertion. For example, a lot of laundry and heavy lifting are common causes of humeral epicondylitis in middle-aged and elderly people. The pain is persistent, stabbing, aching or fatigue pain. The pain may radiate to the lateral side of the forearm. Severe loss of grip strength, especially when wringing towels, is one of the characteristics of the disease. On examination, there is no localized redness or swelling, and joint function is not limited. There is limited pressure pain in the lateral epicondyle of the humerus. Careful examination may reveal sensitive pressure points. Extensor tendon pull test: elbow is straightened, fist is clenched and wrist is flexed. The forearm is then rotated forward, and those who can induce severe pain in the lateral elbow are considered positive. In traumatic humeral condylitis, pain is evident when this test is done because of myofasciitis. X-ray examination can exclude diseases such as infection, injury, tuberculosis and tumor. The diagnosis should be distinguished from cervical spondylosis. Neurogenic cervical spondylosis may manifest pain in the lateral aspect of the facial upper limbs as radiating pain with areas of sensory disturbance in the hand and forearm. There is no restrictive pressure pain. Sometimes, epicondylitis of the humerus can be misdiagnosed as neurogenic cervical spondylosis, which inevitably delays treatment. 3. Treatment Most patients can be cured by conservative treatment. Physiotherapy and acupuncture have certain efficacy. The effect of painful point closure of tretinoin is better, but we should pay attention to the selection of injection points, and only accurate injection can achieve good results. Due to the different patients, the degree of tissue damage, the scope of the same, a few patients with the above methods of treatment is not obvious, at this time, surgery can be smelting treatment. The purpose of surgery is to release the fibrous adhesions of the humeral epicondyle and to ligate the vascular nerve bundle penetrating from the myofascia. It is also important for the patient to cooperate with the surgeon. During the treatment process, the hand and wrist should be rested to reduce the tension on the tendon and fascia at the muscle attachment point of the humeral epicondyle, which helps to maintain the therapeutic effect. 4.Prevention The onset of humeral epicondylitis is related to chronic injury and is often caused by strain in middle-aged and elderly people. Therefore, labor intensity should not be too high. Do not walk with heavy objects for a long time. Do not do too much laundry at one time to prevent strain on the muscle fascia of the humeral epicondyle. Pay attention to physical exercise, active movement of the upper limb joints to enhance muscle strength, which can help prevent the occurrence of this disease.