10. Diseases of the muscles and their insertions from overexertion

Myositis (myosa)

Definition

• Aseptic inflammation of muscle tissue!

Etiology

• Straining
• Repetitive monotonous movements
• Agricultural workers, diggers etc

Symptoms

• Extensor muscle groups are more involved as they are phylogenetically younger!
• Pain provoked by muscle activity
• Painful nodules or indurations along muscle may be palpated

Treatment

• Immobilisation of affected muscle
• In a plaster splint for at least one week
• Physical therapy
• Revulsive gels
• NSAIDs

Epicondylitis (lateral/medial epicondylitis)

Definition

• Aseptic inflammation or damage to the area of epicondyle (part of humerus where ligaments and tendons are attached)
• Can be either lateral (tennis elbow) or medial (golfers elbow):
• Lateral is in tennis players, shooters, archers
• Medial is in golfers

Etiology

• In people who work with forced (against resistance) extension of wrist in pronation, extension and abduction of arm in relation to forearm
• Workers at risk are diggers, press operators, stone cutters, miners, athletes, brick layers

Pathogenesis

• Most common in tendon of M. extensor carpi radialis brevis at ~ 2cm below lateral epicondyle of humerus
• Long standing epicondylitis results in a degenerative state instead of inflammatory processes
• Tennis elbow- aseptic inflammation and degeneration of lateral epicondyle
• Extensor carpi radialis brevis
• Extensor digitorum communis and digiti minimi
• Extensor carpi ulnaris
• Golfer elbow- aseptic inflammation and degeneration of the medial epicondyle
• Pronator teres
• Flexor carpi radialis

Clinical manifestations

• Pain & point tenderness on outer/inner part of elbow about 1-2cm down from bony area
• Grows stronger in pronation and extension!
• Weakness & pain in wrist when gripping
• Difficulty in open doors or shaking hands
• Morning elbow joint stiffness

Diagnosis

• Cozen’s Test- for lateral epicondylitis when wrist extension with extended elbow causes pain
• Chair Test- when lifting chair with adducted shoulder, extended elbow & pronated wrist causes pain
• Maudsley’s Test- pain during resisted extension of middle finger
• Thomas test- pain if the patient tries to extend the wrist with their hand in a fist (against examiner’s resistance)
• Velscha test- pain at site of attachment of insertions when patient extends and pronates the forearm
• MRI: fluid in origin of extensor carpi radialis brevis
• X-Ray: calcification at ligament insertion & over epicondyle (in chronic cases)

Treatment

• Immobilisation in a plaster splint for about 10 days
• Rest and stopping the activity that produces the symptoms.
• Ice packs (to reduce inflammation)
• Strengthening and stretching exercises
• Anti-inflammatory medicines (such as ibuprofen or naproxen)
• Hohmann’s operation- insertions of extensors are seperated via incision and transferred distally (2xm)