Lateral Epicondylitis

Lateral epicondylitis is a tendonitis also known as tennis elbow although the majority of people with lateral epicondylitis have never played tennis. The condition causes pain on the outside portion of the elbow over a bony prominence termed the lateral epicondyle. Pain occurs with activities such as grasping, pushing, pulling and lifting. As the process progresses the pain may occur with limited activities or even at rest. Lateral epicondylitis most often occurs related to overuse. These activities include repetitive work, gardening, tennis, and golf. Of note, a separate entity termed golfer’s elbow or medial epicondylitis causes pain on the inside of the elbow. Lateral epicondylitis can also be related to direct trauma to the outside portion of the elbow. It is believed that overuse or trauma causes a microscopic tear in the origin of the extensor muscle. The diagnosis is often made on the history or the information that a patient gives the physician regarding their symptoms. An examination of the extremity helps confirm the diagnosis. X-rays are typically normal in lateral epicondylitis and not routinely performed. An MRI is occasionally obtained to help confirm the diagnosis and rule out other disorders.

Lateral epicondylitis is treated with a staged exercise program and often requires a therapist. The initial phase involves rest of the extremity until the acute pain improves. Nonsteroidal anti-inflammatory medications such as aspirin or ibuprofen may be helpful. The second phase includes a stretching program. The stretching exercises are focused on stretching the wrist extensor muscles. In addition to the staged program a corticosteroid injection or other therapy modalities may be helpful. Activity modification is one of the most important factors. It is recommended that activities that aggravate the symptoms are limited. Lifting should be performed with the palms turned upward (supinated). Frequent breaks from repetitive activities should be taken along with stretching before and after activities. The most common cause of lateral epicondylitis in tennis players is improper stroke technique. Players with tennis elbow often lead with their elbow while hitting the backhand although the problem can occur with any stroke. Correcting the stroke can resolve the problem. Use new balls each time one plays tennis. Ensure the racquet grip is the appropriate size. The racquet should be strung in mid-range and it is important to stretch before and after playing tennis.

The majority of patients with lateral epicondylitis are treated nonoperatively. Patients that have persistent pain despite months of nonoperative treatment are candidates for surgery. The surgical procedure is performed on an outpatient basis most often under general or regional anesthesia. The majority of patients undergoing the procedure will have improvement in their symptoms. The risks of surgery include some persistent pain, stiffness and infection.