Epicondylitis: Causes from Both Repetitive Movement and Trauma
Epicondylitis can result from both repetitive movements and acute trauma or injury, with repetitive microtrauma being the more common etiology in most clinical cases. 1
Pathophysiology and Mechanisms
Repetitive Movement Causes
- Epicondylitis most commonly develops from repetitive overuse with resultant microtearing and progressive degeneration due to an immature reparative response 2
- Affects the common extensor tendon laterally ("tennis elbow") or the common flexor tendon medially ("golfer's elbow") 1
- Estimated to occur in 1-3% of the general population 1
- Most common in individuals aged 40-60 years 3
Traumatic/Injury Causes
- Acute injury resulting in inflammation (true epicondylitis) can occur from large valgus forces with medial distraction and lateral compression 4
- Direct trauma to the epicondyle can trigger the inflammatory process
- Single traumatic events can initiate the pathologic process that later manifests as chronic epicondylitis
Risk Factors
Occupational Risk Factors
- Forceful activities
- High force combined with high repetition
- Awkward postures during work 3
- Occupations requiring repetitive wrist and forearm movements
Sports-Related Risk Factors
- Sports with overhead or repetitive arm actions 4
- Specific activities:
- Tennis and golf (hence the common terms)
- Weightlifting
- Wrestling
- Soccer
- Baseball
- Gymnastics 1
Diagnostic Considerations
Clinical Presentation
- Pain at the lateral or medial epicondyle
- Pain associated with gripping and resisted wrist extension/flexion
- Symptoms may develop gradually (repetitive strain) or suddenly (trauma)
Imaging
- Radiographs are beneficial as initial imaging for chronic elbow pain 1
- MRI is useful for evaluating the extent of disease when conservative treatment fails 2
- Ultrasound can also be used to assess tendon integrity and inflammation
Treatment Approach
Conservative Management (First-Line)
Initial phase:
- Rest and activity modification
- Ice application
- NSAIDs for pain control
- Possible corticosteroid injection 5
Rehabilitation phase:
- Range-of-motion exercises
- Progressive strengthening exercises
- Counterforce bracing
- Technique enhancement and equipment modification if sports/occupation-related 5
Surgical Intervention
- Indicated for debilitating pain that persists despite well-managed conservative treatment for at least 6 months
- Involves excision of pathologic portion of tendon, repair of resulting defect, and reattachment to epicondyle 5
Prognosis
- Poorer prognosis reported for:
- Individuals with high level of physical strain at work
- Non-neutral wrist postures during work activity
- Condition affecting the dominant elbow 3
Prevention Strategies
- Improved joint strength
- Biomechanically sound sport/work technique
- Use of appropriate equipment
- Workload modification, especially in manually strenuous jobs 4, 3
Common Pitfalls to Avoid
- Delayed diagnosis or misdiagnosis (confusing with other elbow pathologies)
- Inadequate rest during initial treatment phase
- Premature return to aggravating activities
- Overuse of corticosteroid injections
- Failure to address underlying biomechanical issues
Understanding that epicondylitis can result from both repetitive movements and acute trauma is essential for proper diagnosis and treatment planning, with the approach tailored based on the specific mechanism of injury.