Physical Medicine and Rehabilitation for Lateral Epicondylitis

Updated: Dec 20, 2017
  • Author: John W Hawkins, DO; Chief Editor: Stephen Kishner, MD, MHA  more...
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Overview

Background

Lateral epicondylitis, or tennis elbow, is the most common overuse injury of the elbow. It has an annual incidence of 3% in the general population [1]  and is responsible for 10 million visits to physicians every year in the United States. [2] Lateral epicondylitis is usually precipitated by repetitive contraction of the wrist extensors and is characterized by aching pain that is worsened with activity. It is most commonly attributed to pathology of the extensor carpi radialis brevis tendon. [3]

Early conservative management is the key to symptom resolution, which eventually allows return to vocational and avocational activities without restriction. Patients with symptoms that persist beyond 6 months may have a prolonged course that ultimately may require surgical intervention. [4, 5, 6, 7, 8, 9]

Related Medscape Drugs & Diseases topics:

Elbow and Forearm Overuse Injuries

Lateral Epicondylitis Surgery [Orthopedic Surgery]

Lateral Epicondylitis [Sports Medicine]

Overuse Injury

Tendonitis

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Pathophysiology

The etiology of chronic tendinopathy has been debated in the literature. Tendons are hypovascular, with some suggesting that they receive one third the blood flow of muscles. [10] Thus, once tendons are injured, healing times can be prolonged.

Most clinicians agree that 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. [11, 12, 13]

 

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Epidemiology

Frequency

Lateral epicondylitis is seen in up to 50% of tennis players. [14]

Sex

The condition affects men and women with equal frequency.

Age

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

 

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