Elbow tendinopathy
Elbow tendinopathy (tennis or golfer's elbow) is an overuse degenerative tendinosis at the lateral or medial epicondyle diagnosed clinically by localized tenderness reproduced with resisted wrist motion. Management is a staged sequence of activity modification, NSAIDs, eccentric exercise, and, only for refractory cases, peritendinous injection or surgery.
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What this article covers
- Overview
Overuse tendinosis at the epicondyle: elbow tendinopathy is a degenerative (not primarily inflammatory) injury of the tendon origin at the elbow, most commonly lateral epicondylitis (tennis elbow…
- Epidemiology
Common overuse condition: epicondylitis is one of the most frequent soft-tissue causes of elbow symptoms in primary care and sports medicine, and lateral epicondylitis (tennis elbow) is more common than medial epicondylitis (golfer's elbow).
- Risk factors
Repetitive wrist extension (lateral): repeated wrist extension and forearm supination from computer/keyboard use, carpentry, plumbing, and racquet sports with poor backhand technique.
- Pathophysiology
Angiofibroblastic tendinosis, not tendinitis: repetitive microtrauma at the tendon origin outpaces reparative capacity, producing disorganized collagen, fibroblast and vascular hyperplasia, and an…
- Clinical features
Localized epicondylar tenderness reproduced by resisted motion is the diagnostic finding: point tenderness directly over the lateral (or medial) epicondyle, reproduced or worsened by resisted wrist…
- Differential diagnosis
Ulnar collateral ligament injury: medial elbow pain in a throwing athlete with a history of valgus stress; discriminator is instability/pain reproduced on valgus stress testing, which is absent in isolated medial epicondylitis.
- Diagnosis
Clinical diagnosis confirmed by tenderness reproduced with resisted motion: the diagnosis is made clinically, without a formal scoring system, when point tenderness over the affected epicondyle is…
- Management
First step, activity modification: reduce or modify the specific repetitive activity driving symptoms (grip size and stroke mechanics for racquet sports, ergonomic keyboard positioning for computer use); this alone improves many mild cases.
- Complications
Chronic pain and grip weakness: untreated or repeatedly re-injured tendinopathy can progress to persistent pain and functional grip weakness limiting occupational and recreational activity.
- Prognosis
Favorable natural history in the great majority: 80-95% of patients with lateral or medial epicondylitis improve with conservative management alone within 1 to 2 years, most substantially within the first several months.
- Prevention
Ergonomic and technique modification before symptoms occur: for at-risk workers and athletes, optimize keyboard/mouse height and racquet grip circumference and correct stroke mechanics (avoid a flexed-wrist backhand) as primary prevention.
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