Lateral Epicondylitis (Tennis Elbow)

Overuse injury of the hand, especially finger extensor tendons which originate in the lateral humeral epicondyle

Aetiology

  • Most commonly due to repeated or excessive pronation/supination and extension of the wrist (e.g. tennis players)

Pathophysiology

  • Micro-tears in the common extensor origin

Clinical presentation

Symptoms

  • Characterised by pain and tenderness over the lateral epicondyle to the attachment of the forearm
  • Pain is worse when stretching the muscles e.g. opening a jar
  • 10-20% bilateral

Signs

  • Flex elbow to 90° in pronation, pain on resisted middle finger and wrist extension

Investigations

  • Mainly clinical
  • USS and MRI may be required where diagnosis uncertain
  • Nerve conduction study should be carried out if there are any nerve symptoms

Management

  • Usually self-limiting
  • Conservative - rest, physio, injection of LA and steriods, brace (elbow clasp)
  • Surgical release for refractory cases - involves division and/or excision of some of the fibres of common extensor mechanism
    • Variable results