Revisión de epicondilitis:clínica, estudio y propuesta de protocolo de tratamiento

Abstract

Epicondylitis is characterized by pain localized in the insertion of the elbow`s epicondilar muscles, resulting from traumatic inflammation caused by repetitive pronationsupination`s movements. It is known that early conservative treatment is the key to resolution of symptoms. However, 5 to 10% of patients are not responsive to medical treatment. After reviewing the literature and based on the best available evidence, we have prepared treatment protocols for acute and chronic epicondylitis. In the acute epicondylitis approach, the algorithm provides, initially, correction of biomechanical conditions, changes in the patient`s daily activities, use of NSAIDs and Brace. If symptoms persist, corticosteroids infiltration is suggested, in addition to physical therapy and physiotherapy. In the chronic condition, an integral treatment is recommended, and includes the following: Confirmation of diagnosis and complementation of the medical history with a thorough assessment of pain (DN4 questionnaire); individualized analgesia considering personal risk factors, severity and characteristics of pain; management with local infiltrations; mental health assessment and management of a posible comorbid myofascial syndrome. If the condition does not improve, an advance management is proposed. Finally, suggestions for a successful job reinstatement are made.