From the Guidelines
Mild spurring of the lateral epicondyle is more indicative of a chronic degenerative process rather than active inflammation, as most patients with overuse tendinopathies have chronic symptoms suggesting a degenerative condition 1. When evaluating patients with lateral epicondyle spurring, it is essential to consider the historical features, anatomy, and physical examination maneuvers to make an accurate diagnosis. The presence of spurring on imaging does not necessarily correlate with active inflammation, but rather with chronic stress, repetitive microtrauma, or degenerative changes at the tendon attachment site. Key points to consider in the diagnosis and management of lateral epicondyle spurring include:
- The natural history of overuse tendinopathies, which involves gradually increasing load-related localized pain coinciding with increased activity 1
- The importance of thorough inspection, range-of-motion testing, palpation for tenderness, and examination maneuvers that simulate tendon loading and reproduce pain 1
- The use of imaging modalities such as plain radiography, ultrasonography, and magnetic resonance imaging to help clarify the diagnosis when necessary 1
- The treatment options, which may include relative rest, icing, eccentric strengthening exercises, and analgesics, with surgery reserved for patients who have failed conservative therapy 1 It is crucial to correlate imaging findings of spurring with clinical symptoms to determine the appropriate management, as patients with lateral epicondyle spurring may be asymptomatic or experience pain with certain movements.
From the Research
Lateral Epicondylitis and Mild Spurring of the Lateral Epicondyle
- Lateral epicondylitis, also known as tennis elbow, is a common condition characterized by pain and inflammation on the outer part of the elbow 2, 3, 4, 5.
- The condition is often associated with overuse or repetitive strain on the extensor tendons of the forearm, particularly the extensor carpi radialis brevis tendon 2, 3, 4.
- Mild spurring of the lateral epicondyle may be observed in some cases, but the presence of spurring does not necessarily indicate inflammation 2.
- Histological analysis of tissue samples from patients with lateral epicondylitis has failed to show significant inflammatory processes, suggesting that the condition may be more related to degenerative changes than inflammation 2.
Diagnosis and Treatment
- The diagnosis of lateral epicondylitis is typically made clinically through history and physical examination, with a focus on symptoms such as lateral elbow pain, pain with wrist extension, and weakened grip strength 3.
- Treatment options for lateral epicondylitis include nonoperative measures such as activity modification, physical therapy, and injections, as well as surgical release of the extensor carpi radialis brevis tendon in some cases 3, 4.
- There is no direct evidence to suggest that mild spurring of the lateral epicondyle is a reliable indicator of lateral epicondylitis or inflammation, and diagnosis should be based on a comprehensive clinical evaluation 6, 2, 3, 4, 5.