Medial and lateral epicondylitis (golfer's elbow, tennis elbow) Flashcards
When is pain exacerbated in medial epicondylitis?
Pain is exacerbated with wrist flexion and pronation
Which activities are common causes of medial/lateral epicondylitis?
- Tennis
- Fencing
- Golf
- Rowing
- Baseball (pitching)
- Hammering
- Typing
- Meat-cutting
- Plumbing
- Painting
Where is tenderness located in medial epicondylitis?
Approximately 5 mm distal and anterior to the medial epicondyle
What are the differentials for epicondylitis?
- Olecranon bursitis
- Elbow arthritis
- Cervical nerve root entrapment
- Radial tunnel syndrome-
- this is due to compression of the posterior interosseous nerve, and tenderness is more distal and more anterior
- Medial ligament strain (golfer’s elbow)
- Radiation of pain from shoulder or wrist injuries
- Carpal tunnel syndrome
When should you refer to physio?
After 6 weeks - monitor patients every 6-8weeks for 6 months to assess progress
What nerve problem may coexist with medial epicondylitis?
Numbness / tingling in the 4th and 5th finger due to ulnar nerve involvement
What muscles originate at the lateral epicondyle?
Common wrist extensor muscles especially ECR - so lateral elbow tendinopathy is tested with resisted wrist extension
Who is affected by lateral epicondylitis?
Those whose work involves a lot of gripping and twisting of the forearm e.g.
- bricklayers
- mechanics
- tennis players
- construction workers
- assembly line workers
- users of vibratory tools
- typers
- players of the piano
- kayakers
What is the aetiology of lateral epicondylitis?
Repetitive overuse causes micro-tears near the origin of the common extensor tendon at the lateral epicondyle of the humerus, which initiates a degenerative process.
Other possibilities are that it is due to radial or posterior interosseous nerve entrapment.
What are the clinical features of lateral epicondylitis?
- Localized point tenderness on palpation over and/or distal to the lateral epicondyle and along the common extensor tendon
- Pain on resisted middle finger extension.
- Pain on resisted wrist extension.
- Reduced grip strength due to pain.
- Preserved full range of active and passive movement at the elbow and wrist joints.
- No XR changes
What is the management of lateral epicondylitis?
- Self-resolves but may last up to 2 years
- Rest arm for 6 weeks
- Heat or ice packs to help with pain
- Orthosis e.g. forearm strap or wrist/elbow brace
- Simple analgesia
If persists:
- Physiotherapy
- Local corticosteroid injections
- OT assessment at work
If persists past 6-12 months:
- Refer to orthopaedics - only if peristent, affecting work or there is uncertainty about diagnosis.
Surgery - rarely, if there is detachment of the common extensor origin from the later epicondyle.
What is the use of this strap?
Inelastic, non-articular, proximal forearm strap for lateral epicondylitis. Short-term use of this bracing technique for up to 12 weeks after injury has been shown to be beneficial.
What is the orthopaedics management of epicondylitis? What is a common complication?
ESWT - first line for those with recalcitrant disease or for those who with to avoid surgery.
Arthroscopic surgery which invovles debridement and excision of the undersurface of the affected muscle –> risk of decreased grip strength, risk of damage to ulnar nerve at the medial epicondyle.
What are common complaints of someone with lateral epicondylitis?
The person may describe difficulty with a range of common activities such as:
- raising a cup,
- shaking hands,
- shaving,
- lifting bags with an extended elbow.
What tests can be used OE in lateral epicondylitis?
Mills’ test:
- Straighten the patient’s arm and palpate the lateral epicondyle.
- Fully flex the wrist.
- Pronate the patient’s forearm.
- If this is painful, the test is positive.
Cozen’s test:
- Elbow in 90° of flexion, patient makes a fist and deviates wrist radially with forearm pronated.
- Resisted extension of the wrist.
- Pain in the area of lateral epicondyle is a positive result.
Briefly describe radial tunnel syndrome and its management.
Due to repetitive activities/acute trauma causing compression to the posterior interosseous branch of the radial nerve.
Patients will experience pain localised over the radial neck approximately 4 finger-breadths distal to the lateral epicondyle. This pain may be exacerbated by pronation of the forearm with the elbow extended, resisted supination, and extension of the long fingers.
Mx involves the usual, keeping elbow in extension at night using splints, exercise, lastly surgery.
