What is lateral epicondylitis?

Lateral epicondylitis is an injury that occurs through overuse and involves the extensor muscles of the forearm and the lateral epicondylar region of the distal humerus.

Who gets it?

Lateral epicondylitis occurs in approximately 1.0-1.3% in men and 1.1-4.0% in women.

How does this happen?

Activities such as handling tools heavier than 1 kg, handling loads heavier than 20 kg at least 10 times per day and repetitive movements for more than 2 hours per day. It occurs though repetitive bending and straightening of the wrist for more than an hour per day. There are also strong associations of lateral epicondylitis with psychological distress.

What is the pathophysiology?

Microscopic tearing with reparative tissue (ie, angiofibroblastic hyperplasia) forms in the origin of the extensor carpi radialis brevis (ECRB) muscle. This microtearing and repair response can lead to macroscopic tearing and structural failure of the origin of the ECRB muscle.

How is it diagnosed?

The doctor should take a history that includes the biomechanics of what tasks are completed, how often you do those tasks, assess the biomechanics of the tasks and what weights are involved. They should also assess for other conditions that can mimic tennis elbow such an autoimmune disease and assess for contributing factors such as depression. They should then perform an examination to assess what movements causes pain in the arms.

What investigations should I have?

Usually, an ultrasound and x ray are all that is needed. Sometimes an MRI may be ordered but this would be unusual.

What treatment should I have?

The best for of treatment is to identify what causes the pain and avoid those actions. You may be referred to a physiotherapist for treatments. These should include eccentric strengthening as this has been shown to assist with both recovery and prevention of reoccurrence. This is done by lengthening the muscle while under load. Your doctor or physiotherapist can demonstrate how to do the right exercise for you.

Other Treatments

Tennis elbow brace: this may assist with pain relief but there is no evidence that it assists recovery.
Wrist brace: this provides an improvement in pain relief at 6 weeks but there is no other evidence that is assists with recovery at 12 months.
NSAID’s: will provide relief and in the long term may be more effective than steroid injections at 1 year.
Dry Needling: provides short term relief for up to 6 weeks, though there doesn’t appear to be longer term benefits at 1 year.
Steroid Injection: provides good short-term relief at 6 weeks though longer term physiotherapy is more effective at 1 year.
Autologous Blood and Plasma Rich Protein Injections: there is improvement in pain and USS measures with good short-term improvement 4-8 weeks. No evidence exists yet at 1 year.
Surgical Intervention: 6 months after treatment provides good results with 90% resolution of pain. Surgery is associated with the following risks: decreased grip strength and weakness with wrist dorsi-flexion.

How long will I take to get better?

Most tennis elbow suffers find resolution within 3 months. This condition is self-limiting in nature and, if you avoid trigging factors should resolve within 12 months.