Lateral Epicondylitis

Background

Lateral epicondylitis, also known as tennis elbow, is a condition that causes pain on the outside of the elbow. This condition is often a result of forceful repetitive motion of the forearm extensors. In lateral epicondylitis, the common extensor tendon origin becomes inflamed or experiences microtears.

Causes

The extensor carpi radialis brevis (ECRB) is an extensor tendon that extends the wrist and originates at the lateral epicondyle, tennis elbow usually involves changes in this tendon. This tendon undergoes degenerative changes called tendinosis and exhibits microtears located at the site of attachment to the lateral epicondyle at the elbow.

Symptoms

Pain associated with this condition often initiates near the lateral epicondyle and gradually radiates along the forearm. This pain can have a burning quality and can be present during activities as well as sleep. Patients with this condition may suffer from a loss of grip strength due to pain.

Diagnosis

The physical examination is particularly important. A thorough elbow examination is performed to rule out other potential causes of pain in this area such as a radial nerve compression, arthritis, and ligamentous injury to the elbow. Imaging such as x rays, ultrasound, MRI are occasionally used, depending on the case.

Treatment

Conservative management and activity modification are sometimes enough to improve symptoms. Conservative measures include splinting, physical therapy, and NSAIDs. Steroid injections are often performed but have been shown to not provide lasting relief and can lead to thinning of the skin and soft tissues which can exacerbate the issue. Physical therapy is the treatment of choice. If this fails, the next step is a procedure called dry needling which is performed in the office. Surgical treatment is reserved for patients that continue to have pain despite the above measures.