Lateral epicondylitis, also known as “Tennis Elbow”, is the most common overuse syndrome in the elbow. It is a tendinopathy injury involving the extensor muscles of the forearm. These muscles originate on the lateral epicondylar region of the distal humerus.
It should be remembered that only 5% of people suffering from tennis elbow relate the injury to tennis!
It occurs often in repetitive upper extremity activities such as computer use, heavy lifting, forceful forearm pronation and supination, and repetitive vibration. Despite the name you will also commonly see this chronic condition in other sports such as squash, badminton, baseball, swimming and field throwing events. People with repetitive one-sides movements in their jobs such as electricians, carpenters, gardeners also commonly present with this condition.
The elbow joint is made up of three bones: the humerus, the radius and ulna. At the distal end of the humerus there are two epicondyles, one lateral (on the outside) and one medial (on the inside).
The area of maximal tenderness is usually an area just distal to the origin of the extensor muscles of the forearm at the lateral epicondyle.
The most prominent symptom of epicondylitis lateralis is pain, this pain can be produced by palpation on the extensor muscles origin on the lateral epicondyle. The pain can radiate upwards along the upper arm and downwards along the outside of the forearm and in rare cases even to the third and fourth fingers.
Patient often present with pain on wrist extension, a weakness in their grip strength or difficulty carrying objects in their hand, especially with the elbow extended. This weakness is due to finger extensor and supinator weakness.
You can perform Mill’s test to confirm your diagnosis as seen in this video by PhysioTutors.
Symptoms last, on average, from 2 weeks to 2 years. 89% of the patients recover within 1 year without any treatment except perhaps avoidance of the painful movements.
Treatment is simple and the same as most ligament / muscle injuries. It is a self limiting condition and will get better without treatment, however, the following advise should be given:
- Rest – avoid the activity that caused the pain especially
- Ice – regular cold compress to aid in swelling reduction
- Pain relief, especially NSAIDS
- GP follow if pain ongoing and may be referred for physio
- Onset of pain 24-72hours after provocative activity involving wrist extension
- Pain may radiate down forearm as far as the wrist and hand
- Difficulty with lift and grip (Pain+/- weakness)
- Pain and point tenderness over lateral epicondyle and/or 1-2cm distal to epicondyle
- Pain and weakness on resisted wrist extension
- Weakness on grip strength
- Pain and/or decreased movement on passive elbow extension, wrist flexion and ulnar deviation and pronation