From the Guidelines
Lateral Epicondylitis Definition
Lateral epicondylitis, also known as "tennis elbow," is a condition characterized by pain and inflammation on the outside of the elbow, where the muscles and tendons of the forearm attach to the lateral epicondyle of the humerus.
Key Characteristics
- It is caused by tendinosis of the common extensor tendon laterally 1
- Symptoms include pain, swelling, restricted range of motion, stiffness, and numbness or tingling 1
- It is estimated to occur in 1% to 3% of the population and is associated with lost workdays and a significant economic burden 1
- Both occupational and recreational activities can contribute to the development of lateral epicondylitis 1
Diagnosis and Management
- Imaging plays an important role in the assessment of chronic elbow pain, with radiographs being beneficial as the initial imaging modality 1
- Electromyography can assist in the workup related to nerve symptoms 1
- Management includes conservative measures such as rest, activity modification, analgesia, physical therapy, and corticosteroid injections, with surgery indicated for more severe or refractory cases 1
From the Research
Definition and Causes of Lateral Epicondylitis
- Lateral epicondylitis (LE) is a chronic aseptic inflammatory condition caused by repetitive microtrauma and excessive overload of the extensor carpi radialis brevis muscle 2.
- It is also known as "tennis elbow" and is a common cause of elbow pain in the general population, especially in individuals who participate in repetitive forceful movements involving the wrist and forearm 3.
- The pathogenesis of LE is believed to start from an overload event leading to a microtear in or near the origin of the extensor carpi radialis brevis, which is subsequently prone to additional injury and structural weakness over time 3.
Symptoms and Diagnosis
- LE typically presents as lateral elbow pain, pain with wrist extension, and weakened grip strength 4.
- The diagnosis is made clinically through history and physical examination, and a thorough understanding of the differential diagnosis is imperative to prevent unnecessary testing and therapies 4.
- Maudsley's and Cozen's clinical tests have a high sensitivity in diagnosing lateral epicondylitis 5.
Prevalence and Risk Factors
- LE affects approximately 1-3% of the population 2, 6 and is frequently seen in racquet sports and sports associated with functional overload of the elbow, such as tennis, squash, gymnastics, acrobatics, fitness, and weight lifting 2.
- It is also common in professions requiring frequent repetitive movements in the elbow and wrists, such as typewriters, artists, musicians, electricians, mechanics, and other professions 2.
- Women in the fourth and fifth decades of life who participate in repetitive forceful movements involving the wrist and forearm are also at risk 3.
Treatment and Management
- The treatment of LE often begins with a wide variety of nonoperative modalities, including rest, nonsteroidal anti-inflammatory drugs, bracing, and physical therapy 3.
- Electrophysiotherapy and physical therapy have been shown to be effective in improving pain and function in patients with LE 6.
- Injections may put patients at higher risk for adverse effects compared to other conservative treatments 6.
- Surgery is indicated if conservative measures fail, and common methods of release may be performed via percutaneous, arthroscopic, or open approaches 4.