Tennis Elbow (Lateral Epicondylitis) and Golfers Elbow

Background/Epidemiology

• Epicondylitis of the elbow is extremely common
  • Tennis elbow (lateral epicondylitis) occurs in 4-7/1000 patients and is the most elbow problem in the general population
  • Golfers elbow (medial epicondylitis) is less common (5/10,000)
• Most commonly affects the dominant arm (usually unilateral).  Men:women 1:1.  Average age 40-50.

Aetiology/Causes

• Repetitive minor/unrecognised trauma of the forearm extensor (lateral) muscles or flexor (medial) muscles
  • Often patients with manual work occupations e.g. plumbers, joiners etc (tennis and golf are infrequent causes)
• Microtears of the extensor/flexor tendons cause inflammation, fibrosis and granulation.

Presentation

• Tennis (lateral)
  • Gradual onset pain/tenderness over the lateral epicondyle of the humerus, radiating into the extensor aspect of the forearm
    • Often worse on resisted extension (/full flexion) of the wrist (i.e. stretching the extensors) and/or middle fingerand activity such as opening jars
• Golfers (medial)
  • Gradual onset pain/tenderness over the medial epicondyle, radiating into the flexor aspect of the forearm
    • Often worse on resisted flexion (/full extension) of the wrist (i.e. stretching the flexors)
  • There may also be associated ulnar neuropathy
    • Decreased sensation and/or tingling of the 4th/5th fingers and ulnar border of the hand

It may require a full elbow examination, although pain/tenderness described above is usually the only abnormality

Investigations

• Clinical diagnosis, usually none required
• However, it is important that epicondylitis is differentiated from pain coming from the cervical spine (which may require imaging)

Management

• Analgesia (paracetamol and NSAIDs) with physiotherapy/exercises are the mainstay of treatments
• Other options include surgery although this is only used as a last resort.