Medijalni epikondilitis je upala skupine mišića koji vrše fleksiju i pronaciju, a polaze s medijalnog epikondila lakta. Dijagnoza se postavlja testovima provokacije. Liječenje se temelji na mirovanju, ledenim oblozima te nakon toga vježbama i postupnim povratkom u aktivnost.
Medijalni epikondilitis je uzrokovan bilo kojom aktivnošću kod koje dolazi do djelovanja valgus sile na lakat ili koja uključuje snažno flektiranje volarnih mišića podlaktice, kao što je to tijekom bacanja u bejzbolu, igranju golfa lošom tehnikom, serviranju teniske loptice (osobito uz top spin kad je reket prejako zategnut ili preslabo držan ili kad su loptice teške) te pri bacanju koplja. Nesportske aktivnosti koje mogu uzrokovati medijalni epikondilitis su zidanje, udaranje čekićem i kucanje.
Simptomi i znakovi
Simptomi i znakovi medijalnog epikondilitisa
Bol se pojavljuje u flektorno pronatorskim tetivama (povezanim s medijalnim epikondilom) i u medijalnom epikondilu, uz flektirani ili pronirani zglavak, uz otpor.
Dijagnoza
Dijagnoza medijalnog epikondilitisa
Za potvrđivanje dijagnoze, liječnik posjedne bolesnika na stolac, uz podlakticu položenu na stol i supiniranu šaku. Pacijent pokuša podići šaku savijajući ručni zglob, dok ga liječnik u tome sprječava. Bol u području medijalnog epikondila i u izvorištu tetiva fleksora potvrđuje dijagnozu. (Vidi također Kako pregledati lakat.)
Liječenje
Liječenje medijalnog epikondilitisa
Liječenje je simptomatsko i slično liječenju lateralnog epikondilitisa. Pacijenti bi trebali izbjegavati bilo kakvu aktivnosti koja uzrokuje bol. U početku se primjenjuje mirovanje, led, NSAR i istezanje, ponekad uz injekciju kortikosteroida u bolno područje oko tetive. Kad se bol povuče, izvode se nježne vježbe ekstenzora i fleksora podlaktice uz otpor, nakon čega slijede ekscentrične i koncentrične vježbe uz otpor. Općenito, operacija se razmatra tek nakon najmanje 9 do 12 mjeseci od neuspjelog konzervativnog liječenja. Kirurški postupci za liječenje medijalnog epikondilitisa obuhvaćaju odstranjenje ožiljnog tkiva i pričvršćivanje oštećenih tkiva.
Vježbe za ublažavanje simptoma medijalnog epikondilitisaResisted Finger Abduction and Extension with Putty
1. Flatten putty on table.
2. Flex (curl) fingers and place on putty.
3. Extend and abduct (spread) fingers.
4. Perform 3 sets of 10 repetitions, 1 time a day.
5. Special Instructions
a. Start with least resistance putty (ie, yellow).
b. Can also perform exercise using rubber band for resistance around fingers.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
Resisted Hand and Finger Gripping with Towel
1. Grasp and gently squeeze towel roll with both hands.
2. Twist towel in alternating directions.
3. Perform 3 sets of 10 repetitions, 1 time a day.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
Resisted Wrist Extension with Weight
1. Place forearm on table with the hand palm down, off the edge of the table.
2. Move wrist up into extension.
3. Slowly flex wrist down to starting position.
4. Perform 3 sets of 10 repetitions, 1 time a day.
5. Special Instructions
a. Focus on lowering (eccentric) phase with a count of 4 to flex wrist down to starting position and a count of 2 up for wrist extension.
b. Start with least resistance (ie, a soup can) or simply against gravity.
c. Can also perform exercise with band resistance.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
Resisted Wrist Flexion with Weight
1. Place forearm on table with the hand palm up, off the edge of the table.
2. Curl wrist up into flexion.
3. Slowly lower and extend wrist to starting position.
4. Perform 3 sets of 10 repetitions, 1 time a day.
5. Special Instructions
a. Focus on lowering (eccentric) phase with a count of 4 to extend wrist down to starting position and a count of 2 up for wrist flexion.
b. Start with light resistance (ie, a soup can) or simply against gravity.
c. Can also perform exercise with band resistance.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
Wrist Flexor Stretch
1. Position involved hand palm up.
2. Grasp fingers on involved hand with the other hand.
3. Keep elbow straight on involved arm.
4. Pull hand and fingers gently into extension.
5. Hold exercise for 30 sec.
6. Perform 1 set of 4 repetitions, 3 times a day.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
Wrist Extensor Stretch
1. Begin with the elbow straight.
2. With the uninvolved hand, grasp thumb side of hand and bend wrist downward into wrist flexion.
3. To increase the stretch, bend wrist toward small finger and pull, curling fingers into more flexion.
4. Hold each exercise for 30 sec.
5. Perform 1 set of 4 repetitions, 3 times a day.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.