Epicondylitis

Epicondylitis refers to the inflammation of an epicondyle or adjacent tissues. These bony projections, located on the medial and lateral aspects of the elbow at the distal end of the humerus, serve as attachment points for the forearm musculature. Inflammation at these sites can result from overuse of the muscles, often due to sports or job-related activities that stress the elbow.

Lateral epicondylitis, commonly known as "Tennis Elbow," is frequently associated with tennis athletes, whereas medial epicondylitis is often referred to as "Golfer's Elbow."

Signs & Symptoms

Epicondylitis presents with several characteristic symptoms:

• Elbow pain, exacerbated by elbow or wrist movement.
• A burning sensation in the forearm.
• Diminished grip strength.
• Tenderness upon palpation at the medial or lateral epicondyle.
• Pain or difficulty with wrist flexion or extension.
• Symptoms can interfere with sports or job-related activities.

Risk Factors

Several risk factors are associated with epicondylitis, particularly among the working population:

• Psychological distress and elbow joint movements for more than one hour per day.
• Force and repetitive motions like handling tools over 1 kg, handling loads over 20 kg at least 10 times a day, and repetitive movements for over 2 hours a day.
• Low job control and low social support.
• Obesity and smoking.
• Exposure to force, repetitiveness, and vibration, such as handling loads over 5 kg, high hand grip forces for over an hour a day, and working with vibrating tools for more than 2 hours a day.

Diagnosis

Diagnosis of epicondylitis typically involves an evaluation by a medical professional such as an MD, Doctor of Physical Therapy, or Occupational Therapist. The process includes:

• Collecting medical history and information on present symptoms and daily activities, including work-related tasks, hobbies, home responsibilities, and sports.
• Palpating the medial and lateral epicondyles to assess for pain or tenderness.
• Specific diagnostic tests for lateral epicondylitis include assessing resisted wrist extension and resistance to the middle finger. For medial epicondylitis, resisted wrist flexion and pronation are assessed.
• If a diagnosis cannot be confirmed through a physical examination, an MRI of the soft tissue surrounding the elbow may be indicated.

Pathophysiology

Epicondylitis occurs due to the overuse or degeneration of the musculature and tendons attached to the medial and lateral epicondyles. This overuse results in microtrauma and inflammation.

• Lateral Epicondylitis: The extensor carpi radialis brevis (ECRB) is most commonly involved, although other wrist extensors can also be affected.
• Medial Epicondylitis: This affects the wrist flexors, with the pronator teres and flexor carpi radialis being most commonly involved.

Treatment

Treatment for epicondylitis can be conservative or non-conservative:

• Conservative Treatment:
  • Ice (cryotherapy)
  • Rest
  • Oral NSAIDs
  • Physical or Occupational Therapy
  • Exercise (strengthening)
  • Topical steroidal cream
  • Corticosteroid injections
  • Iontophoresis
  • Ultrasound
  • Acupuncture or dry needling
  • Laser therapy
  • Wrist/elbow support bracing
• Non-Conservative Treatment: If conservative measures fail, surgical options include:
  • Surgical debridement of the affected tendons, usually the extensor carpi radialis brevis (ECRB) in lateral epicondylitis, and decortication of the lateral epicondyle.
  • Surgical debridement of the flexor-pronator group attached to the medial epicondyle may be indicated for medial epicondylitis.

Prognosis

Epicondylitis generally has a good prognosis and can be effectively managed with conservative treatment, often not requiring surgical intervention.

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Self-assessment MCQs (single best answer)

What is the common term for lateral epicondylitis?

Which muscle is most commonly involved in lateral epicondylitis?

Which of the following is NOT a risk factor for epicondylitis?

What is the primary cause of epicondylitis?

Which diagnostic test is used to confirm lateral epicondylitis?

What is the common term for medial epicondylitis?

Which of the following treatments is considered conservative for epicondylitis?

Which type of professional typically diagnoses epicondylitis?

What imaging technique may be used if physical examination is inconclusive for epicondylitis?

Which of the following is a symptom of epicondylitis?