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.

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