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