Lateral epicondylitis

Question 1

Epicondylitis

Answer 1

Chronic symptomatic inflammation of the forearm tendons at the elbow

Question 2

Mechanism of injury

Answer 2

Overuse in the elbow - causes microtears in the tendons attaching to the epicondyles of the elbow following repetitive injury

Tendon adapts - formation of granulation tissue, fibrosis and eventually tendinosis

Question 3

Peak onset

Answer 3

Between 35-54 years old

Question 4

Lateral epicondylitis

Answer 4

Tennis elbow

Common extensor tendon

Question 5

Medial epicondylitis

Answer 5

Golfer’s elbow

Common flexor tendon

Question 6

Risk Factors

Answer 6

Tennis or Golf

Occupation

Question 7

Clinical features of lateral epicondylitis

Answer 7

Lateral pain affecting the elbow and radiating down the forearm.

Worsens over weeks to months

Often affecting the dominant arm.

On examination:
- tenderness on palpation over lateral epicondyle and common extensor tendon

• Due to the pain, there may be a reduced grip strength, despite a full range of movements at the wrist and the elbow.

Question 8

Special Tests for Lateral Epicondylitis

Answer 8

Cozen’s Test – The patient’s elbow is held flexed to 90 degrees, with one examiner’s hand held over the lateral epicondyle, whilst the other hand holds the patient’s hand in a radially deviated position with the forearm pronated. The patient is then asked to extend their wrist against resistance

Mill’s Test – The patient’s lateral epicondyle is palpated by the examiner, whilst also pronating the patient’s forearm, flexing the wrist, and extending the elbow

Question 9

Investigations

Answer 9

Clinical

Ultrasound or MRI imaging - confirm the diagnosis or to detect any structural abnormality

Question 10

Conservative management

Answer 10

• Modify activities - reduce repetitive actions
• Simple analgesics alongside topical NSAIDs
• Corticosteroid injections- repeated every 3-6 months.
• Physiotherapy
• Orthoses (a wrist or elbow brace)

Question 11

Surgical Treatment

Answer 11

• Open or arthroscopic debridement of tendinosis
• and/or release or repair of any damaged tendon insertions
• If the tendon has more than 50% damage, tendon transfer may be required to ensure function is retained

Question 12

When is surgery indicated

Answer 12

If the symptoms are not controlled through conservative measures.