Physical Medicine and Rehabilitation for Lateral Epicondylitis Clinical Presentation
- Author: Consuelo T Lorenzo, MD; Chief Editor: Stephen Kishner, MD, MHA more...
The patient usually describes a gradual onset of lateral elbow pain, which is characterized as follows:
- The aching pain generally increases with activity. The patient may describe symptoms occurring during simple activities of daily living (ADL), such as picking up a cup of coffee or a gallon of milk.
- Pain may be present at night.
- Symptoms are typically unilateral.
Most commonly, the examination reveals localized tenderness to palpation just distal and anterior to the lateral epicondyle. Other symptoms include the following :
- Pain increases with resisted wrist extension, especially with the elbow in extension.
- The patient may have a weakened grip on the affected side.
- Elbow range of motion (ROM) is typically normal.
- In chronic, refractory cases, be sure to fully assess shoulder integrity and scapular stability. Weakness or instability of the scapular stabilizers may perpetuate lateral epicondylitis by leading to overuse of the wrist extensors.
See the list below:
- Lateral epicondylitis is an overuse syndrome generally caused by repetitive use of the wrist extensors or sustained power gripping.
- Lateral epicondylitis can be associated with an imbalance secondary to muscle weakness and soft-tissue inflexibility.
Sheon RP. Repetitive strain injury. 1. An overview of the problem and the patients. The Goff Group. Postgrad Med. 1997 Oct. 102(4):53-6, 62, 68. [Medline].
Sheon RP. Repetitive strain injury. 2. Diagnostic and treatment tips on six common problems. The Goff Group. Postgrad Med. 1997 Oct. 102(4):72-8, 81, 85 passim. [Medline].
Nadler S, Nadler JM. Cumulative trauma disorders. DeLisa JA, Gans BM, eds. Rehabilitation Medicine: Principles and Practice. 3rd ed. Philadelphia, Pa: Lippincott-Raven; 1998. 1661-76.
Khan KM, Cook JL, Taunton JE. Overuse tendinosis, not tendinitis. Phys Sportsmed. 2000. 28:38-48.
O'Connor FG, Howard TM, Fieseler CM. Managing overuse injuries. A systematic approach. Phys Sportsmed. 1997. 25:88-113.
Yassi A. Repetitive strain injuries. Lancet. 1997 Mar 29. 349(9056):943-7. [Medline].
Downs DG. Nonspecific work-related upper extremity disorders. Am Fam Physician. 1997 Mar. 55(4):1296-302. [Medline].
Torp-Pedersen TE, Torp-Pedersen ST, Qvistgaard E, et al. Effect of glucocorticosteroid injections in tennis elbow verified on colour Doppler ultrasound: evidence of inflammation. Br J Sports Med. 2008 Mar 4. [Medline].
Laban MM, Pai R. Lateral Epicondylitis of the Elbow Use of Magnetic Resonance Imaging in Predicting Clinical Recovery. Am J Phys Med Rehabil. 2013 Jul 27. [Medline].
Altan L, Kanat E. Conservative treatment of lateral epicondylitis: comparison of two different orthotic devices. Clin Rheumatol. 2008 Mar 26. [Medline].
Hoogvliet P, Randsdorp MS, Dingemanse R, Koes BW, Huisstede BM. Does effectiveness of exercise therapy and mobilisation techniques offer guidance for the treatment of lateral and medial epicondylitis? A systematic review. Br J Sports Med. 2013 May 24. [Medline].
Olaussen M, Holmedal O, Mdala I, Brage S, Lindbaek M. Corticosteroid or placebo injection combined with deep transverse friction massage, Mills manipulation, stretching and eccentric exercise for acute lateral epicondylitis: a randomised, controlled trial. BMC Musculoskelet Disord. 2015 May 20. 16:122. [Medline].
Bisset L, Beller E, Jull G, et al. Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. BMJ. 2006 Nov 4. 333(7575):939. [Medline]. [Full Text].
Bisset L, Paungmali A, Vicenzino B, et al. A systematic review and meta-analysis of clinical trials on physical interventions for lateral epicondylalgia. Br J Sports Med. 2005 Jul. 39(7):411-22; discussion 411-22. [Medline].
Jafarian FS, Demneh ES, Tyson SF. The immediate effect of orthotic management on grip strength of patients with lateral epicondylosis. J Orthop Sports Phys Ther. 2009 Jun. 39(6):484-9. [Medline].
Knutsen EJ, Calfee RP, Chen RE, Goldfarb CA, Park KW, Osei DA. Factors Associated With Failure of Nonoperative Treatment in Lateral Epicondylitis. Am J Sports Med. 2015 Jun 29. [Medline].
Rosenbaum R. Disputed radial tunnel syndrome. Muscle Nerve. 1999 Jul. 22(7):960-7. [Medline].
Baker CL Jr, Baker CL 3rd. Long-term follow-up of arthroscopic treatment of lateral epicondylitis. Am J Sports Med. 2008 Feb. 36(2):254-60. [Medline].
Dunn JH, Kim JJ, Davis L, et al. Ten- to 14-year follow-up of the Nirschl surgical technique for lateral epicondylitis. Am J Sports Med. 2008 Feb. 36(2):261-6. [Medline].
Genovese MC. Joint and soft-tissue injection. A useful adjuvant to systemic and local treatment. Postgrad Med. 1998 Feb. 103(2):125-34. [Medline].
Rifat SF, Moeller JL. Site-specific techniques of joint injection. Useful additions to your treatment repertoire. Postgrad Med. 2001 Mar. 109(3):123-6, 129-30, 135-6. [Medline].
Tonks JH, Pai SK, Murali SR. Steroid injection therapy is the best conservative treatment for lateral epicondylitis: a prospective randomised controlled trial. Int J Clin Pract. 2007 Feb. 61(2):240-6. [Medline].
Lewis M, Hay EM, Paterson SM, et al. Local steroid injections for tennis elbow: does the pain get worse before it gets better?: Results from a randomized controlled trial. Clin J Pain. 2005 Jul-Aug. 21(4):330-4. [Medline].
Roberts WO. Lateral epicondylitis injection. Phys Sportsmed. 2000. 28:93-4.
Küçüksen S, Yilmaz H, Salli A, Ugurlu H. Muscle Energy Technique Versus Corticosteroid Injection for Management of Chronic Lateral Epicondylitis: Randomized Controlled Trial With 1-Year Follow-up. Arch Phys Med Rehabil. 2013 Jun 22. [Medline].
Carayannopoulos A, Borg-Stein J, Sokolof J, Meleger A, Rosenberg D. Prolotherapy versus corticosteroid injections for the treatment of lateral epicondylosis: a randomized controlled trial. PM R. 2011 Aug. 3(8):706-15. [Medline].
Gosens T, Peerbooms JC, van Laar W, den Oudsten BL. Ongoing Positive Effect of Platelet-Rich Plasma Versus Corticosteroid Injection in Lateral Epicondylitis: A Double-Blind Randomized Controlled Trial With 2-year Follow-up. Am J Sports Med. 2011 Jun. 39(6):1200-8. [Medline].
Hayton MJ, Santini AJ, Hughes PJ, et al. Botulinum toxin injection in the treatment of tennis elbow. A double-blind, randomized, controlled, pilot study. J Bone Joint Surg Am. 2005 Mar. 87(3):503-7. [Medline].
Wong SM, Hui AC, Tong PY, et al. Treatment of lateral epicondylitis with botulinum toxin: a randomized, double-blind, placebo-controlled trial. Ann Intern Med. 2005 Dec 6. 143(11):793-7. [Medline]. [Full Text].
Placzek R, Drescher W, Deuretzbacher G, et al. Treatment of chronic radial epicondylitis with botulinum toxin A. A double-blind, placebo-controlled, randomized multicenter study. J Bone Joint Surg Am. 2007 Feb. 89(2):255-60. [Medline].
Haake M, König IR, Decker T, et al. Extracorporeal shock wave therapy in the treatment of lateral epicondylitis: a randomized multicenter trial. J Bone Joint Surg Am. 2002 Nov. 84-A(11):1982-91. [Medline].
Pettrone FA, McCall BR. Extracorporeal shock wave therapy without local anesthesia for chronic lateral epicondylitis. J Bone Joint Surg Am. 2005 Jun. 87(6):1297-304. [Medline].
Dingemanse R, Randsdorp M, Koes BW, Huisstede BM. Evidence for the effectiveness of electrophysical modalities for treatment of medial and lateral epicondylitis: a systematic review. Br J Sports Med. 2013 Jan 18. [Medline].
Ilieva EM, Minchev RM, Petrova NS. Radial shock wave therapy in patients with lateral epicondylitis. Folia Med (Plovdiv). 2012 Jul-Sep. 54(3):35-41. [Medline].