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
- Gradual onset pain/tenderness over the lateral epicondyle of the humerus, radiating into the extensor aspect of the forearm
- 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
- Gradual onset pain/tenderness over the medial epicondyle, radiating into the flexor aspect of the forearm
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.