LATERAL EPICONDYLITIS

aka "tennis elbow"

I. Definitions, pathophysiology, and epidemiology
  1. An overuse injury envolving extensor tendons in the forearm
  2. Usually associated with repetitive wrist movements, e.g. raquet sports, golf, some video games
  3. Initial inflammation is followed by chronic changes in the tendon ("tendinosis"), with microscopic tears and angiofibroplastic proliferation
  4. More common in patients > 40y
  5. More common in men than women
II. Clinical presentation
  1. Pain and tenderness at and distla to lateral epicondyle
  2. Pain with gripping objects
  3. Symtpoms often reproduced by resistance to supination or wrist extension, particularly with elbow fully extended and wrist in neutral position
  4. Diagnosis is usually clinical
III. Management
  1. Symptomatic treatment with ice and NSAIDs
  2. Activity modification (avoid lifting with wrist in pronation-"palm up" is best)
  3. Physical tehrapy (stretching and "eccentric strengthening" exercises)-Associated with better outcomes than corticosteroid injections beyond the short (6wk) time frame
  4. Corticosteroid injections can be helpful (provide relief for up to 6wks but no benefit in 3mo- or longer time ranges)
  5. Tendon release surgery is a last resort and no good controlled trials as of 2012
(Sources include Core Content Review of Family Medicine, 2012)