Lateral Epicondylitis (Tennis Elbow)

This condition comes under the umbrella of tendinopathy, its the irritation of the common extensor tendon that attaches to the medial epicondyle on the elbow. Its most common in sudden increase in usage in extension of the wrist.

Risk Factors

• Age

• Anatomical Deformities

• Diabetes

• Hypercholesterolemia

• Hyperuricaemia

• Inflammatory conditions

• Sudden increase in load

• Chronic comorbidities

• Smoking

• Footwear

• Medication (Corticosteroids, Quinolone Antibiotics, Statins, Aromatase Inhibitors)

Symptoms

• Pain around the tendon and tender to touch

• Stiffness – improved with movement.

• Increased pain after activity

• Localised swelling

• Crepitus (rare)

Treatment

Exercise Program

• Must be slowly progressive.

• Isometric – for early pain relief.

• Eccentric – Best evidence for main strengthening.

• Return to sport specific exercise.

Education

• Load management.

• Expected response to exercise.

• Pain relief – Medication, Cold therapy, Elevation.

• Managing Expectation – Not a quick fix.

• Discuss evidence base.

Other

• Steroid Injections (Evidence to cause future issues)

• Platelet Rich Plasma Injection (low evidence)

• Electrotherapies (low evidence)

• Surgery in severe cases (Evidence suggests similar outcomes to exercise)

Differential Diagnosis

• Rheumatoid Arthritis

• Cervical Radiculopathy

• Elbow OA

• Cubital tunnel syndrome

• Trauma or intra-articular loose bodies

• Malignancy (rare)

• Synovial fold syndrome

• Frozen shoulder

• Anterior interosseous nerve entrapment