Lateral Epicondylitis Flashcards
What is epicondylitis
chronic symptomatic inflammation of the forearm tendons at the elbow.
Lateral and medial refer to the side of the tendons affected
What is the epidemiology of the condition
Affects males and females equally
35-54 years
what are the two types of epicondylitis
Lateral - tennis elbow
Medial - golfers
Lateral is more common
Which set of muscles have a origin at the lateral epicondyle
Common extensor muscles
What is the pathophysiology of epicondylitis
Repetitive overuse of the tendons can cause microtears in the tendon at their origin; the tendon adapts to the multiple tears, leading to the formation of granulation tissue, fibrosis and eventually tendinosis.
What are the risk factors for this condition
Occupations and Hobbies associated with excessive use of the extensive forearm muscles ( eg - tennis )
what are the clinical features
Pain - radiating down the forearm
Worsens over weeks to months
Locals tenderness
May be a reduced grip strength
What are the specialised tests for lateral epicondylitis
Cozens test
Mills test
what is cozens test
elbow held flexed at 90 degrees. Hand over the lateral epicondyle and hold patients hand in pronated and radially deviated position. Ask patient to extend thier wrist against resistance
what is the mills 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
what is the differential diagnosis
Cervical radiculopathy
Elbow OA
Radial carpal tunnel syndrome
What are the investigations
Typically clinical
Can do a USS or MRI to detect any structural abnormality
What is the non-surgical management of lateral epicondylitis
Reduce repetitive actions
Simple analgesics
Topical NSAIDS
Corticosteroid injections - can be repeated every 3 to 6 months
Physiotherapy
what is the surgical management of this Condition
Open or arthroscopic debridement of tendinosis and/or release or repair of any damaged tendon insertions may be required. If the tendon has more than 50% damage, tendon transfer may be required to ensure function is retained.
Which tendons in medial epicondylitis affected the most
pronator teres and flexor carpi radialis are the most commonly affected tendons.
