eMedicine Specialties > Physical Medicine and Rehabilitation > Upper Limb Musculoskeletal Conditions

Lateral Epicondylitis

Author: Consuelo T Lorenzo, MD, Consulting Staff, Department of Physical Medicine and Rehabilitation, Alegent Health Care, Immanuel Rehabilitation Center
Contributor Information and Disclosures

Updated: Jul 24, 2009

Introduction

Background

Lateral epicondylitis, or tennis elbow, is the most common overuse injury of the elbow and is observed up to 10 times more frequently than medial epicondylitis. Lateral epicondylitis is usually precipitated by repetitive contraction of the wrist extensors and is characterized by aching pain that is worsened with activity. Early conservative management is the key to symptom resolution, which eventually allows return to vocational and avocational activities without restriction.1,2,3

Related eMedicine topics:
 Elbow and Forearm Overuse Injuries
Lateral Epicondylitis [Orthopedic Surgery]
Lateral Epicondylitis [Sports Medicine]
Overuse Injury
Tendonitis

Related Medscape topics:
CME/CE Guidelines Issued for Overuse Injuries in Child and Adolescent Athletes
Resource Center Exercise and Sports Medicine

Pathophysiology

Lateral epicondylitis is a result of inflammation, or enthesitis, at the muscular origin of the extensor carpi radialis brevis (ECRB). This inflammation leads to microtears of the tendon, with subsequent fibrosis and, ultimately, tissue failure. Less commonly, the attachments of the extensor carpi radialis longus (ECRL), extensor digitorum communis (EDC), or extensor carpi ulnaris (ECU) are involved.4,5,6

Sex

The condition affects men and women with equal frequency.

Age

Lateral epicondylitis most often occurs between the third and fifth decades of life.

Clinical

History

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.

Physical

Most commonly, the examination reveals localized tenderness to palpation just distal and anterior to the lateral epicondyle. Other symptoms include the following7 :

  • 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.

Causes

  • Lateral epicondylitis is an overuse syndrome generally caused by repetitive use of the wrist extensors or sustained power gripping.8
  • Lateral epicondylitis can be associated with an imbalance secondary to muscle weakness and soft-tissue inflexibility.

More on Lateral Epicondylitis

Overview: Lateral Epicondylitis
Differential Diagnoses & Workup: Lateral Epicondylitis
Treatment & Medication: Lateral Epicondylitis
Follow-up: Lateral Epicondylitis
References
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References

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  2. Sheon RP. Repetitive strain injury. 2. Diagnostic and treatment tips on six common problems. The Goff Group. Postgrad Med. Oct 1997;102(4):72-8, 81, 85 passim. [Medline].

  3. Nadler S, Nadler JM. Cumulative trauma disorders. In: DeLisa JA, Gans BM, eds. Rehabilitation Medicine: Principles and Practice. 3rd ed. Philadelphia, Pa: Lippincott-Raven; 1998:1661-76.

  4. Khan KM, Cook JL, Taunton JE. Overuse tendinosis, not tendinitis. Phys Sportsmed. 2000;28:38-48.

  5. O'Connor FG, Howard TM, Fieseler CM. Managing overuse injuries. A systematic approach. Phys Sportsmed. 1997;25:88-113.

  6. Yassi A. Repetitive strain injuries. Lancet. Mar 29 1997;349(9056):943-7. [Medline].

  7. Chumbley EM, O'Connor FG, Nirschl RP. Evaluation of overuse elbow injuries. Am Fam Physician. Feb 1 2000;61(3):691-700. [Medline]. [Full Text].

  8. Downs DG. Nonspecific work-related upper extremity disorders. Am Fam Physician. Mar 1997;55(4):1296-302. [Medline].

  9. 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. Mar 4 2008;[Medline].

  10. Altan L, Kanat E. Conservative treatment of lateral epicondylitis: comparison of two different orthotic devices. Clin Rheumatol. Mar 26 2008;[Medline].

  11. [Best Evidence] 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. Nov 4 2006;333(7575):939. [Medline]. [Full Text].

  12. 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. Jul 2005;39(7):411-22; discussion 411-22. [Medline].

  13. [Best Evidence] 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. Jun 2009;39(6):484-9. [Medline].

  14. Rosenbaum R. Disputed radial tunnel syndrome. Muscle Nerve. Jul 1999;22(7):960-7. [Medline].

  15. Baker CL Jr, Baker CL 3rd. Long-term follow-up of arthroscopic treatment of lateral epicondylitis. Am J Sports Med. Feb 2008;36(2):254-60. [Medline].

  16. 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. Feb 2008;36(2):261-6. [Medline].

  17. Genovese MC. Joint and soft-tissue injection. A useful adjuvant to systemic and local treatment. Postgrad Med. Feb 1998;103(2):125-34. [Medline].

  18. Rifat SF, Moeller JL. Site-specific techniques of joint injection. Useful additions to your treatment repertoire. Postgrad Med. Mar 2001;109(3):123-6, 129-30, 135-6. [Medline].

  19. 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. Feb 2007;61(2):240-6. [Medline].

  20. 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. Jul-Aug 2005;21(4):330-4. [Medline].

  21. Roberts WO. Lateral epicondylitis injection. Phys Sportsmed. 2000;28:93-4.

  22. [Best Evidence] 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. Mar 2005;87(3):503-7. [Medline].

  23. [Best Evidence] 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. Dec 6 2005;143(11):793-7. [Medline]. [Full Text].

  24. [Best Evidence] 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. Feb 2007;89(2):255-60. [Medline].

  25. 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. Nov 2002;84-A(11):1982-91. [Medline].

  26. Pettrone FA, McCall BR. Extracorporeal shock wave therapy without local anesthesia for chronic lateral epicondylitis. J Bone Joint Surg Am. Jun 2005;87(6):1297-304. [Medline].

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Further Reading

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Keywords

tennis elbow, lateral elbow tendinitis, lateral elbow tendonitis, elbow overuse syndrome

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Contributor Information and Disclosures

Author

Consuelo T Lorenzo, MD, Consulting Staff, Department of Physical Medicine and Rehabilitation, Alegent Health Care, Immanuel Rehabilitation Center
Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation
Disclosure: Nothing to disclose.

Medical Editor

Daniel D Scott, MD, MA, Associate Professor, Department of Physical Medicine and Rehabilitation, University of Colorado at Denver and Health Sciences Center
Daniel D Scott, MD, MA is a member of the following medical societies: Alpha Omega Alpha, American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Paraplegia Society, Association of Academic Physiatrists, National Multiple Sclerosis Society, and Physiatric Association of Spine, Sports and Occupational Rehabilitation
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Patrick M Foye, MD, FAAPMR, FAAEM, Associate Professor of Physical Medicine and Rehabilitation, Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, Director of Coccyx Pain Service (Tailbone Pain Service: www.TailboneDoctor.com), University of Medicine and Dentistry of New Jersey, New Jersey Medical School
Patrick M Foye, MD, FAAPMR, FAAEM is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists, and International Spine Intervention Society
Disclosure: Nothing to disclose.

CME Editor

Kelly L Allen, MD, Regional Medical Director, IMX-Medical Management Services
Disclosure: Nothing to disclose.

Chief Editor

Rene Cailliet, MD, Professor-Chairman Emeritus, Department of Rehabilitation Medicine, University of Southern California School of Medicine; Former Director, Department of Rehabilitation Medicine, Santa Monica Hospital Medical Center
Rene Cailliet, MD is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American Pain Society, Association of American Medical Colleges, International Association for the Study of Pain, and Pan American Medical Association
Disclosure: Nothing to disclose.

 
 
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