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Updated: Dec 27 2021

Lateral Epicondylitis

Images elbow.jpg elbow2.jpg
  • Snapshot
    • A 42-year-old woman presents to her primary care physician with elbow pain. She reports that the pain began a few days ago and affects the lateral aspect of the left elbow. The pain improves with rest and is aggravated while playing tennis or holding a cup of coffee. On physical exam, there is tenderness upon palpation of the lateral epicondyle. Pain is elicited with resisted wrist extension while the elbow is fully extended.
  • Introduction
    • Clinical definition
      • an overuse syndrome that results in pain in the myotendinous junction between the wrist extensors and lateral epicondyle
        • also known as "tennis elbow"
  • Epidemiology
    • Incidence
      • more common in activities that result in repetitive wrist extension, such as
        • badminton
        • squash
        • tennis
    • Demographics
      • typically between 40-50 years of age
  • Etiology
    • Repetitive wrist extension activities which irritate the tendon
    • Pathoanatomy
      • the lateral epicondyle is the bony origin for the wrist extensors and involve the
        • extensor carpi radialis brevis muscle
          • most commonly involved
        • extensor digitorum communis muscle
      • repetitive wrist extension activities results in a angiofibroblastic tendinosis
  • Presentation
    • Symptoms
      • pain in the lateral epicondyle
        • worsened with wrist extension or forearm supination
        • pain onset is typically insidious
    • Physical exam
      • tenderness at the lateral epicondyle
      • pain upon resisted wrist extension
        • performed with the elbow extended
      • pain upon passive wrist flexion
        • performed with the elbow extended
  • Imaging
    • Radiography
      • performed in recalcitrant cases
  • Studies
    • Making the diagnosis
      • this is a clinical diagnosis
  • Differential
    • Medial epicondylitis
      • distinguishing factor
        • patients present with medial elbow pain
  • Treatment
    • Conservative
      • activity modification
        • indication
          • an initial intervention performed in all patients
      • counterforce bracing
        • indication
          • an initial intervention performed in all patients
      • physical therapy
        • indication
          • an initial intervention performed in all patients
    • Operative
      • orthopedic surgery
        • indication
          • in patients who have severe pain and/or impaired function for ≥ 6 months
          • patients who failed physical therapy for ≥ 6 months
          • patients preferring surgical intervention
  • Complications
    • None
  • Prognosis
    • In most patients, symptoms resolve within 12 months with conservative treatment
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