What is Epicondylitis?
Epicondylitis is an inflammatory condition affecting the tendons that attach to the bony prominences (epicondyles) on the outer or inner aspects of the elbow. The two common types include:
- Lateral epicondylitis (tennis elbow): Affects the outer part of the elbow
- Medial epicondylitis (golfer’s elbow): Affects the inner part of the elbow
Epicondylitis in Australia
Based on the most specific data available for Australia, it can be estimated that approximately 180,000 people in Australia suffer from lateral epicondylitis (tennis elbow). It is most common in people 30-50 years old.
It’s important to note that this figure refers explicitly to lateral epicondylitis and may not include cases of medial epicondylitis (golfer’s elbow). Also, prevalence can vary over time and may be influenced by population demographics and occupational trends.
Causes of Epicondylitis
The leading causes of epicondylitis (including both lateral and medial epicondylitis) are:
Overuse & Repetitive Motions
Repetitive and often forceful motions in the forearm and wrist are the primary cause. This can occur through:
Sports activities (e.g., tennis, golf)
Occupational activities involving repetitive arm motions and heavy lifting (e.g., plumbing, painting, carpentry, butchering)
Specific Movements
Lateral epicondylitis: Caused by motions involving extending the elbow and wrist
Medial epicondylitis: Caused by motions involving bending the wrist towards the palm or flexing the forearm
Microtrauma
Small tears in the tendon that result from repetitive stress, leading to pain and inflammation.
Occupational Factors
- Handling tools > 1 kg
- Handling loads >20 kg at least ten times/day
- Repetitive movements > 2 hours/day
- High hand grip forces >1 hour/day
- Working with vibrating tools > 2 hours/day
- Psychological factors: Low job control
- Low social support
- Psychological distress
- Other risk factors: Obesity (for lateral epicondylitis)
- Smoking (for lateral epicondylitis)
Anatomical Factors
The position of specific muscles (like the extensor carpi radialis brevis) may increase their risk of damage due to rubbing against bony prominences during elbow movement.
It’s important to note that epicondylitis often results from combining these factors rather than a single cause. The condition develops gradually over time due to repeated stress on the tendons that attach to the epicondyle.
Symptoms of Epicondylitis
The main symptoms of epicondylitis include:
- Pain at the elbow, especially with movement
- For lateral epicondylitis: Pain on the outer part of the elbow
- For medial epicondylitis: Pain on the inner part of the elbow
- Burning sensation in the forearm
- Diminished grip strength
- Tenderness at the epicondyle when palpated
- Pain or difficulty with wrist flexion or extension
- Weakness when grasping objects
- Aching in the elbow area
- Pain that may spread down to the wrist, even at rest, if the condition worsens
- Pain when lifting or gripping small objects, like a coffee cup
- In some cases, tremors or shaking in the hands
- Occasionally, numbness or tingling sensation starting at the elbow and travelling to one or more fingers
- Symptoms typically begin mild and gradually worsen over weeks or months
- Pain when the wrist is bent against resistance during physical examination
It’s important to note that symptoms can affect daily activities, work-related tasks, and sports performance. Usually, only the dominant arm is affected, but both arms can be involved if the causative activity requires the use of both arms. The onset of symptoms is typically gradual, without a specific triggering event.
How is Epicondylitis Treated?
Epicondylitis is typically treated using the following approaches:
Rest and Activity Modification
- Giving the affected arm adequate rest
- Avoiding repetitive movements that cause pain
Decreasing participation in sports and heavy-lifting
Medications
- Over-the-counter pain medications like acetaminophen
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen
Physical or Occupational Therapy
- Specific exercises to strengthen forearm muscles
- Ultrasound, ice massage, or muscle-stimulating techniques
Bracing
Using a brace centred over the back of the forearm to rest muscles and tendons
Steroid Injections
- Cortisone injections around the lateral epicondyle to reduce inflammation
- Used sparingly to avoid weakening the tendon
Other Injection Therapies
- Platelet-rich plasma (PRP) injections
- NSAID iontophoresis (using diclofenac or pirprofen)
Electrotherapy
- Extracorporeal shock wave therapy
- Electromagnetic field therapy (limited evidence)
Ultrasonography
Provides modest pain reduction over 1-3 months.
Alternative Therapies
- Acupuncture (may provide short-term benefit)
- Topical nitroglycerin
Surgery
- Only considered if conservative treatments fail after 6-12 months
- Various techniques, including open, percutaneous, and arthroscopic approaches
The treatment approach typically starts with conservative methods and progresses to more invasive options if symptoms persist. A combination of these treatments is often used, tailored to the individual patient’s needs and response to therapy.
Epicondylitis & Dr Clem Bonney
Dr Clem Bonney can assist with the diagnosis, treatment and workplace modifications to enable rehabilitation from Epicondylitis. Epiconylitis can be a chronic condition that requires persistent and extensive support. Dr Bonney can also assist with referrals to experienced physical therapists and, when needed, surgeons.