Epicondylitis

Epicondylitis refers to inflammation at the point where the tendons of the forearm insert into the epicondyles at the elbow. It is a specific type of repetitive strain injury.

There is a medial epicondyle and a lateral epicondyle on the distal end of the humerus, either side of the elbow joint. 

The tendons of the muscles that insert into the:

  • Medial epicondyle act to flex the wrist 
  • Lateral epicondyle act to extend the wrist

 

Epicondylitis is the result of repetitive use and injury to the tendons at the point of insertion. Symptoms gradually worsen over weeks to months. It most commonly affects patients in middle age.

 

Lateral Epicondylitis

Lateral epicondylitis is often called tennis elbow. 

Lateral epicondylitis causes pain and tenderness at the lateral epicondyle (outer elbow). The pain often radiates down the forearm. It can lead to weakness in grip strength.

Mill’s test involves stretching the extensor muscles of the forearm while palpating the lateral epicondyle. The elbow is extended, the forearm supinated, and the wrist and fingers are extended. The examiner holds the patient’s elbow with pressure on the lateral epicondyle. If this causes pain, the test is positive, indicating lateral epicondylitis. 

Cozen’s test starts with the elbow extended, forearm pronated, wrist deviated in the direction of the radius and hand in a fist. The examiner holds the patient’s elbow with pressure on the lateral epicondyle. The examiner applies resistance to the back of the hand while the patient extends the wrist. If this causes pain, the test is positive, indicating lateral epicondylitis.

 

Medial Epicondylitis

Medial epicondylitis is often called golfer’s elbow. 

Medial epicondylitis causes pain and tenderness at the medial epicondyle (inner elbow). The pain often radiates down the forearm. It can lead to weakness in grip strength.

A golfer’s elbow test involves stretching the flexor muscles of the forearm while palpating the medial epicondyle. The elbow is extended, forearm supinated and wrist and fingers are extended. The examiner holds the patient’s elbow with pressure on the medial epicondyle. If this causes pain, the test is positive, indicating medial epicondylitis. 

 

Management

Epicondylitis is a clinical diagnosis based on the signs and symptoms.

In most patients, epicondylitis is self-limiting and resolves with time. However, symptoms can take several years to resolve. 

Management options for epicondylitis include:

  • Rest
  • Adapting activities
  • Analgesia (e.g., NSAIDs)
  • Physiotherapy
  • Orthotics, such as elbow braces or straps
  • Steroid injections
  • Platelet-rich plasma (PRP) injections
  • Extracorporeal shockwave therapy

 

Rarely, surgery may be required to debride, release or repair damaged tendons.

 

Last updated August 2021
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