Lateral Epicondylitis Flashcards
What is epicondylitis?
A chronic symptomatic inflammation of the forearm tendons at the insertion at the elbow.
It is an overuse syndrome due to microtears in the tendons attaching to the epicondyles.
Epidemiology of epicondylitis.
Males and females equally with a peak of onset between 35-54 yo.
There are two types lateral (Tennis elbow) and medial (Golfer’s elbow) and lateral is more common.
Pathophysiology of medial and lateral epicondylitis.
Medial and lateral epicondyles are small bony tuberosities on the distal end of the humerus.
Common extensor tendon - Lateral epicondyle
Common flexor - medial epicondyle
Repetitive over use of the tendons can cause microtears in the tendon at origin. This leads to multiple tears and formation of granulation tissue, fibrosis and then tendinosis.
RF for lateral
Occupations and hobbies requiring excessive use of extensive forearm muscles, such as tennis.
Clinical features of lateral.
Pain affecting elbow at the point of origin
Pain radiates down the forearm and typically worses over weeks to months.
Examination findings of lateral.
Local tenderness on palpation over or distal to the lateral epicondyle and common extensor tendon.
Due to pain there might be reduced grip strength as well
There should be full range of movements at wrist and elbow.
Special tests for lateral.
Cozen’s test
Mill’s test
Explain Cozen’s test.
Patient’s elbow is held flexed to 90 degrees.
Examiner’s hand held over lateral epicondyle and other hand is holding the patient’s hand in a radially deviated position with forearm pronated.
Patient is then asked to extend their wrist against resistance.
+ve = Pain
Explain Mill’s test
Patient’s lateral epicondyle is palpated by the examiner.
Pronation of patient’s forearm + flexion of wrist and extension of elbow should be done wile palpating.
+ve = Pain
Dx of lateral
Cervical radiculopathy
Elbow OA
Radial carpal tunnel syndrome
Ix of lateral
Diagnosis is clinical
USS or MRI can be used to confirm if there is suspicion of structural abnormality.
Management of lateral.
Modify activities + single analgesic like topical NSAIDs.
If symptoms persist -> corticosteroid injections repeated every 3-6 months
Physio and orthoses might be indicated for longer-term symptom relief.
Indications for surgical referral and treatment.
Symptoms are not controlled through conservative measures
Surgical treatment of lateral
Open or arhtroscopic debridement of tendinosis and/or release or repair of any damaged tendon insertions.
If there is more than 50% damage tendon transfer may be required.
Complications of lateral
Usually self-limiting and improves in 80-90% of people in 1-2 years.
