Lateral Epicondylitis Clinical Presentation

  • Author: Bryant James Walrod, MD; Chief Editor: Sherwin SW Ho, MD   more...
 
Updated: Oct 25, 2011
 

History

  • The typical age of those affected is 40 to 50 years.
  • Patients most typically report an insidious onset, but they will often relate a history of overuse without specific trauma.
  • Symptom onset generally occurs 24-72 hours after repeated wrist extension activity.
  • Delayed symptoms are probably due to microscopic tears in the tendon.
  • The patient complains of pain over the lateral elbow that worsens with activity and improves with rest. The patient will also often describe aggravating conditions such as a backhand stroke in tennis or the overuse of a screwdriver.
  • Pain may radiate down the posterior aspect of the forearm.
  • The patient can often pinpoint pain 1.5 cm distal to the origin of the ECRB.
  • Pain can vary from being mild (eg, with aggravating activities like tennis or the repeated use of a hand tool), or it can be such severe pain that simple activities like picking up and holding a coffee cup (ie, "coffee cup sign") will act as a trigger for the pain.
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Physical

  • Inspection: Very rarely does one notice swelling or ecchymosis.
  • Palpation: Maximal tenderness is elicited 1-2 cm distal to the origin of the ECRB at the lateral epicondyle.
  • Pain is increased with resisted wrist extension, with the wrist radially deviated and pronated and the elbow extended
  • Pain may also increase when the patient attempts to lift the back of a chair with the elbow extended and the wrist maximally pronated.
  • Resisted extension of the middle finger is also painful secondary to stress placed on the ECRB tendon, as it is preferentially stressed in this position when it must contract synergistically to anchor the third metacarpal, such that extension can take place at the digits.[4]
  • Increased pain is noted with resisted supination and hand shaking.
  • Always examine ROM of the shoulder, elbow, and wrist on the affected side.
  • Examine ROM and test for crepitus at the radiohumeral joint of the affected limb to evaluate for radiohumeral bursitis, osteochondritis of the capitellum, or PIN entrapment.
  • If decreased ROM if noted on physical examination, consider obtaining an x-ray to further evaluate the joint.
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Causes

  • Poor general conditioning leads to fatigue of the core and shoulder muscles, which puts an overemphasis on the extensor muscles of the forearm.
  • Improper training (eg, poor positioning when striking a tennis ball)
  • Improper technique (eg, hitting a tennis ball late on the backhand)
  • Poor or improper equipment (eg, a grip that is too big or a racquet that is strung too tightly)
  • Scapular dyskinesis will lead to a compensatory increased load placed on the ipsilateral wrist extensors.
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Contributor Information and Disclosures
Author

Bryant James Walrod, MD  Clinical Assistant Professor, Department of Family and Preventive Medicine, Medical College of Wisconsin

Disclosure: Nothing to disclose.

Coauthor(s)

Craig C Young, MD  Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Director of Primary Care Sports Medicine Fellowship, Medical College of Wisconsin

Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Specialty Editor Board

Andrew D Perron, MD  Residency Director, Department of Emergency Medicine, Maine Medical Center

Andrew D Perron, MD is a member of the following medical societies: American College of Emergency Physicians, American College of Sports Medicine, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Jon B Whitehurst, MD  Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital

Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America

Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD  Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago

Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, and Herodicus Society

Disclosure: Breg, Inc. Consulting fee Consulting; Biomet, Inc. Consulting fee Consulting; GMV, Inc. Arthroscopy Simulator Evaluation and teaching; Smith and Nephew Grant/research funds Fellowship funding; DJ Ortho Grant/research funds Course funding; Athletico Physical Therapy Grant/research funds Course, research funding

References

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  25. 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].

 
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