Lateral epicondylitis

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What this article covers

• Overview

  Overuse tendinosis, not tendinitis: lateral epicondylitis (tennis elbow) is a form of elbow tendinopathy, specifically chronic degenerative tendinosis of the common extensor tendon origin at the…

• Epidemiology

  Common cause of elbow pain in adults: epicondylitis, together with medial epicondylitis, accounts for most cases of pathology at the elbow seen in general practice.

• Risk factors

  Repetitive wrist extension and forearm supination: activities requiring sustained or repeated wrist extension against resistance, such as backhand racquet strokes, are the dominant mechanical risk factor.

• Pathophysiology

  Tendinosis, not inflammation: repetitive microtrauma to the ECRB origin produces vascular hyperplasia, fibroblast hypertrophy, and disorganized collagen deposition rather than a classic inflammatory…

• Clinical features

  Lateral elbow pain with tenderness at the epicondyle, reproduced by resisted wrist extension, establishes the diagnosis: pain and tenderness are located over the lateral epicondyle at the ECRB origin…

• Differential diagnosis

  Radial tunnel syndrome: entrapment of the posterior interosseous branch of the radial nerve should be considered when lateral elbow pain initially diagnosed as tennis elbow fails to respond to…

• Diagnosis

  Lateral epicondylitis is a clinical diagnosis confirmed by reproducible tenderness at the lateral epicondyle with pain on resisted wrist extension (and resisted third-digit extension): no laboratory…

• Management

  First, modify or avoid the pain-inducing activity (backhand strokes, repetitive gripping, sustained keyboard positioning) as the foundation of treatment, since ongoing loading of the tendon prevents healing.

• Complications

  Chronic refractory tendinosis: a subset of patients fail conservative measures and develop persistent pain lasting beyond 6 months, the threshold at which surgery is considered.

• Prognosis

  Generally favorable with conservative care: most patients improve with activity modification, NSAIDs, bracing, and physical therapy over weeks to a few months.

• Prevention

  Modify technique and equipment for racquet-sport athletes: correcting backhand stroke mechanics and using a larger-grip, lower-string-tension racquet reduces repetitive loading of the ECRB origin.