What is the most common cause of right elbow pain in a hairdresser?

Lateral Epicondylosis (Tennis Elbow)

The most common cause of right elbow pain in a hairdresser is lateral epicondylosis (tennis elbow), a degenerative tendinopathy of the common extensor tendon origin at the lateral epicondyle, caused by repetitive wrist extension and forearm movements inherent to hairdressing work. 1, 2

Why Hairdressers Develop This Condition

• Lateral epicondylosis is 7 to 10 times more common than medial epicondylosis and affects the dominant arm 75% of the time, making the right elbow the typical site in right-handed hairdressers 1, 2
• Occupations requiring repetitive wrist flexion and extension are primary risk factors, and hairdressing involves constant scissor work, blow-drying with sustained wrist positioning, and repetitive gripping motions 1, 2
• The condition peaks after age 40 and affects men and women equally, fitting the typical demographic of experienced hairdressers 1
• Repetitive wrist extension against resistance combined with forearm pronation and supination creates microtrauma at the lateral epicondyle where the extensor muscles originate 2

Clinical Presentation to Confirm

• Pain localized to the lateral epicondyle that worsens with activities requiring wrist extension and gripping 3
• Weakened grip strength and pain with shaking hands or opening doors are characteristic warning signs 2, 3
• Tenderness on palpation directly over the lateral epicondyle with pain reproduced by resisted wrist extension 1

Important Diagnostic Considerations

• This is a degenerative tendinosis, not an inflammatory "tendonitis"—the pathology involves incomplete healing with microtearing rather than active inflammation 1, 4
• Initial imaging should be plain radiographs of the elbow, which may show soft tissue calcification or exclude other pathology, though they are often normal in epicondylosis 1
• MRI or ultrasound are reserved for cases where diagnosis is unclear, surgery is contemplated, or symptoms fail conservative treatment, as they can demonstrate the extent of tendon degeneration and exclude other causes 1

Treatment Approach

• Most patients (approximately 80%) fully recover within 3 to 6 months with conservative treatment 1
• Initial management consists of relative rest from aggravating activities, ice application, and eccentric strengthening exercises 1
• NSAIDs provide acute pain relief but cannot be recommended over other analgesics for long-term management 1
• Corticosteroid injections are more effective than NSAIDs in the acute phase but do not change long-term outcomes, so use them cautiously 1
• Activity modification is critical—hairdressers should modify gripping technique, avoid sustained wrist extension positions, and incorporate rest breaks between repetitive movements 2
• Surgery is reserved for debilitating pain persisting despite at least 6 months of well-managed conservative treatment 5, 6

Common Pitfalls to Avoid

• Do not mislabel this as "tendonitis" and overtreate with anti-inflammatory medications—the pathology is degenerative, not inflammatory 1, 4
• Avoid relying solely on corticosteroid injections, as they provide short-term relief but don't improve long-term outcomes and may weaken the tendon 1
• Don't order advanced imaging (MRI/ultrasound) initially unless the diagnosis is uncertain or other pathology is suspected—radiographs are the appropriate first imaging study 1