Lateral Epicondylitis (Tennis Elbow)
Also known as: Tennis elbow, Lateral epicondylitis, Lateral elbow tendinopathy, Lateral epicondyle tendinopathy, Extensor tendinopathy of the elbow, Common extensor tendon tendinopathy
Last updated: December 18, 2024
Lateral epicondylitis, or tennis elbow, causes pain and tenderness on the outer side of the elbow where forearm extensor muscles attach to bone. It can affect people who do not play tennis and is linked to overuse and repetitive stress, with degenerative tendon changes rather than acute inflammation. Pain may spread into the forearm and wrist and can worsen with gripping, twisting, or lifting. Many cases improve over 6–12 months with conservative treatment.
Key Facts
- •Lateral epicondylitis, known as tennis elbow, is a condition involving pain and tenderness on the outer side of the elbow where the forearm extensor muscles attach to the bone
- •Pain on the outer side of the elbow
- •Diagnosed through history, physical exam, and imaging
- •First-line treatment includes exercise, weight management, and activity modification
What It Is
Lateral epicondylitis, commonly known as tennis elbow, is a condition involving pain and tenderness on the outer side of the elbow where the forearm extensor muscles attach to the bone. Despite its name, it affects many people who do not play tennis. The condition results from overuse and repetitive stress, leading to degenerative changes in the tendon rather than acute inflammation.
Affected Anatomy
This condition affects several structures in and around the joint:
- •Lateral epicondyle of the humerus
- •Common extensor tendon origin
- •Extensor carpi radialis brevis (most commonly involved)
- •Other forearm extensor muscles including extensor digitorum
- •Annular ligament and lateral collateral ligament complex (in severe cases)
Common Symptoms
Symptoms can vary in intensity and may change over time. Common experiences include:
- •Pain on the outer side of the elbow
- •Pain that may radiate into the forearm and wrist
- •Pain worsened by gripping, twisting, or lifting activities
- •Weak grip strength
- •Pain when shaking hands or turning a doorknob
- •Tenderness when pressing on the lateral epicondyle
- •Pain with resisted wrist extension
- •Morning stiffness in the elbow
- •Symptoms typically develop gradually over weeks to months
Causes and Risk Factors
Multiple factors can contribute to the development of this condition:
Causes
- •Repetitive wrist extension and gripping activities
- •Overuse of the forearm extensor muscles
- •Degenerative changes in the tendon (tendinosis)
- •Microtearing of the extensor carpi radialis brevis tendon
- •Activities involving repetitive forearm motions
Risk Factors
- •Age between 30 and 50 years (most common)
- •Occupations involving repetitive hand and wrist motions (plumbers, painters, carpenters, cooks)
- •Racquet sports, especially with poor technique
- •Poor ergonomics during repetitive tasks
- •Smoking
- •Obesity
- •History of rotator cuff disease or carpal tunnel syndrome
How It's Diagnosed
Diagnosis typically involves a combination of clinical assessment and imaging studies:
- •Medical history focusing on activities, occupation, and symptom patterns
- •Physical examination of the elbow and forearm
- •Tenderness over the lateral epicondyle
- •Pain with resisted wrist or finger extension
- •Cozen test (pain with resisted wrist extension with elbow extended)
- •Mill test (pain with passive wrist flexion with elbow extended)
- •X-rays usually normal but may rule out other conditions
- •MRI or ultrasound may show tendon changes in uncertain cases
Treatment Options
Treatment approaches range from conservative measures to surgical interventions, often starting with the least invasive options:
Self-Care and Activity Modification
- •Rest and activity modification to avoid aggravating motions
- •Counterforce brace or tennis elbow strap
- •Wrist extensor stretches and exercises
- •Ergonomic modifications for work or sport activities
Physical Therapy and Exercise
- •Physical therapy focusing on stretching and eccentric strengthening
Medications
- •Ice application for pain relief
- •NSAIDs for short-term pain management
Injections and Office-Based Procedures
- •Corticosteroid injection (may provide short-term relief)
- •Platelet-rich plasma (PRP) injection (evidence evolving)
Surgery
- •Surgical debridement or release may be considered for refractory cases
Prognosis and Recovery
The course of this condition varies between individuals:
- •Most cases improve with conservative treatment over 6 to 12 months
- •Symptoms may fluctuate during recovery
- •Recurrence is possible if aggravating activities are resumed
- •Approximately 80-90% of patients improve without surgery
- •Surgical treatment typically provides good outcomes for refractory cases
Related Pages
- Lateral Epicondyle Surgery (Tennis Elbow Release)(Procedure)
- Medial Epicondylitis (Golfer's Elbow)(Condition)
- Corticosteroid Injection (Joint Injection)(Procedure)