Page 132 - ASOP ROT Study Guide

C. MINOR ADULT DISORDERS

9. INTRODUCTION
In many ways the term "minor" does some injustice to the conditions discussed below. It is important
to appreciate that, although these conditions are common, they are often of sufficient severity to cause
considerable inconvenience and discomfort to the sufferer and they may have important social and
economic consequences. They are "minor" in the sense that many are self limiting in their natural
history, and many have non-surgical solutions. They all need great care in assessment and in
management as it is possible to worsen the condition by casual or inaccurate management.

10. ENTHESOPATHIES

The enthesis is the term given to the short fibrous origin of a muscle and so an "enthesopathy"
refers to an inflammation of a muscle origin.

Common sites of enthesopathies include:
♦ The common origin of the flexor muscles of the forearm - Golfer's elbow
♦ The common origin of the extensor muscles of the forearm - Tennis elbow
A person suffering from tennis or golfer's elbow complains of quite severe discomfort on using the
affected muscle.

Lateral epicondyle: http://orthoinfo.aaos.org/topic.cfm?topic=a00068

Medial epicondyle:
http://www.nationalsportsmed.com/images/m1/el
bow.jpg

It is possible that many entheses may be inflamed at one time giving rise to many aches and pains.
These general conditions are encountered principally by the rheumatologist and the causes remain
obscure. The common enthesopathies around the elbow may arise spontaneously although they are
commonly associated with repetitive movements or overuse. The prognosis is generally favorable,
especially if there is a clear cause, and rest will result in a spontaneous recovery.
Occasionally the condition may become chronic, or be severe enough to warrant intervention.
Recovery may be speeded up with a course of anti-inflammatory agents. Local steroid injections into
the point of maximum tenderness also can be of value. Care must be taken to ensure that the steroid
is injected into the enthesis with no leakage into the subcutaneous fat or skin, as this results in the pain
being exacerbated and the patient is left with an unsightly dimple.
A very small number of patients require surgery. This consists of scraping the origin of the muscle from
the bone and permitting it to slide distally thus "decompressing" the area. If possible patients should be
encouraged to wait as, in the long term, spontaneous recovery is highly likely.