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Lateral epicondylitis

What you have to know ...

Lateral epicondylitis is a diagnostic term that describes a common arm ailment. Pain and localized tenderness are found at the epicondyle of the distal humerus (an area on the bony point of the outer elbow). Lateral epicondylitis is also known as « tennis elbow ». This occurs in most from overuse. Although 95% of affected people are not tennis players. 10% to 50% of people who regularly play tennis will, at some time, experience symptoms characteristic of this disorder. In the majority of cases  medical and  physiotherapy treatments resolve this painful condition. In patients that do not respond to medical therapy (approximately 10%),  surgery  may be performed and full recovery is achieved in more than 90% of cases. However it is necessary to be aware of  other causes which could be mistaken for the pain and symptoms  of epicondylitis.  Often, in cases of epicondylitis where  symptoms persist after treatment, other pathological conditions of the elbow may be responsible   ( elbow arthritis,   laxity ,   nerve compression about the elbow,   loose bodies,....) It should be remembered that epicondylitis can often be combined with other pathological conditions (carpal tunnel,    rotator cuff diseases of the shoulder, arthritis of the neck ...)

Like all tendonitis’, the common denominator is overuse. In lateral epicondylitis, the elbow is overused. Physicians believe that lateral epicondylitis is due to a series of repeated micro traumas which weaken and/or break some fibres  of the tendon involved; in tennis elbow, this is usually the extensor carpi radialis brevis. Pain is the result of an attempt by the body "to repair the lesions". Epicondylitis does not only affect tennis players. Other sports can also be responsible for the condition. Sports which involve repeated throwing e.g baseball. Also athletics. or  swimming. Epicondylitis can be observed commonly in people performing any stressful forearm activity: carpenters,  computer operators using a mouse and keyboard all day long, or even  in  politicians - who frequently shake hands.

Pain is localised around the lateral epicondyle, an area on the bony point of the outer elbow.  It    is increased by  sports  activity   (for example   the “return stroke” in tennis...) and tends to decrease with rest. Elbow motion is not lost and pain is not affected to changes in the weather. If the pain persists and the patient  is prevented from taking part in normal daily activities, a surgical operation is advised. A subjective feeling of weakness may be present in the arm and wrist. This weakness may be apparent during the simplest of tasks, for example when lifting a glass of water. In general pain is not felt during  the night    and   it   does not keep  the patient awake. (In these cases it is reasonable to consider  alternative  pathological causes...).

The diagnosis of lateral epicondylitis is based upon a clinical examination  carried out by a physician. Three principal symptoms of tendonitis are sought.   1) Pain is found during direct pressure over the epicondyle . If pain  is located lower, in front of the radial head,  in the region of  Fröhse’s  arcade     a different pathological condition must be investigated.   2)  Passive forced elbow extension, associated with wrist flexion is painful.   3)     Active forced extension of the third finger with the elbow and wrist  in  extension, must show the same symptoms.  

X-rays   

(Details)

Simple X-rays are sufficient to determine the presence or exclusion of osteoarthtritis. Rarely, echography can be used to evaluate tendonitis pathology  on the epicondyle.   In more complex cases MRI can often produce  additional information.

Lateral epicondylitis treatment is mainly preventative.  In   sports like tennis, modification of the players technique (for example adopting a two handed return stroke)  helps to prevent the onset of an epicondylitis. Equipment modification such as diameter of the racket handle and string tension are also sometimes effective. Medical treatments include the use of anti-inflammatory drugs combined with  physiotherapy  including electro stimulation, deep transverse massage, ultra sound etc. In some cases a cortisone injection can accelerate recovery and  remission of the symptoms. Another useful remedy is a  support band, wrapped around the forearm during stressful forearm activities. This  often reduces the pain. Of course, the best treatment for tennis elbow is to avoid the activity that causes the pain. Relative rest is advisable. The process usually resolves, but this may take an year or more. Occasionally, if symptoms persist and if the diagnosis  is   confirmed, surgical intervention is required

Rehabilitation is essential in obtaining a good result. The objectives of elbow rehabilitation are currently well established. The goal is, in any case, to begin moving the elbow soon after surgery. Full recovery takes about three months, but may be longer and the results are generally good.

(The information and advise expressed on the website is only of a general nature. It is absolutely vital that you follow “to the letter" the advise of your own doctor, surgeon and  physiotherapist.)

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