Lateral epicondylitis
Lateral epicondylitis, or tennis elbow, is overuse tendinosis of the extensor carpi radialis brevis origin diagnosed clinically by lateral epicondyle tenderness reproduced with resisted wrist extension, managed first with activity modification and NSAIDs, then bracing and physical therapy, reserving corticosteroid injection and surgery for refractory disease.
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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.
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- Medial epicondylitis
Medial epicondylitis, or golfer's elbow, is overuse tendinosis of the common flexor-pronator origin diagnosed clinically by medial epicondyle tenderness reproduced with resisted wrist flexion and forearm pronation, managed first with activity modification and NSAIDs before bracing, injection, or surgery.
- 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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Cervical nerve root compression from disk herniation or degenerative spondylosis causes neck pain with dermatomal arm pain, paresthesia, weakness, and reduced reflexes, diagnosed clinically with the Spurling test and treated conservatively with NSAIDs and exercise before imaging or surgery.