Epicondylitis – Causes, Symptoms and Treatment
Epicondylitis is a painful condition affecting the bony prominences of the upper arm bone at the elbow, caused by overuse of the forearm muscles and tendons.
Things worth knowing about "Epicondylitis"
Epicondylitis is a painful condition affecting the bony prominences of the upper arm bone at the elbow, caused by overuse of the forearm muscles and tendons.
What is Epicondylitis?
Epicondylitis (also known as epicondylosis) is a painful condition of the elbow joint. It affects the epicondyles – bony projections at the lower end of the humerus (upper arm bone) where the forearm muscles and tendons attach. Repetitive strain, overuse, or degenerative changes at these attachment points lead to pain and reduced function around the elbow.
Types of Epicondylitis
Lateral Epicondylitis (Tennis Elbow)
Lateral epicondylitis, commonly known as tennis elbow, is the more prevalent form. It affects the extensor muscles of the forearm on the outer side of the elbow. It is frequently seen in manual workers, office employees, and athletes who perform repetitive arm movements.
Medial Epicondylitis (Golfer's Elbow)
Medial epicondylitis, also referred to as golfer's elbow, affects the flexor muscles on the inner side of the elbow. This form occurs less frequently than tennis elbow.
Causes
The primary cause of epicondylitis is overuse of the tendon attachments at the elbow, resulting from:
- Repetitive arm and wrist movements
- Sports activities such as tennis, golf, squash, or rowing
- Occupational tasks such as painting, typing, writing, or manual labor
- Heavy gripping or lifting activities
- Sudden, unaccustomed strain on the arm
In some cases, degenerative changes in the tendon tissue can also occur without a clear history of acute overuse.
Symptoms
Common symptoms of epicondylitis include:
- Pain on the inner or outer side of the elbow, which may radiate down the forearm
- Increased pain during gripping, lifting, or twisting the wrist
- Tenderness directly over the affected epicondyle
- Weakness in the forearm and hand
- In advanced cases: pain at rest
Diagnosis
Epicondylitis is primarily diagnosed clinically through a thorough medical history and physical examination. Specific provocation tests (e.g., the Thomsen test or chair test) are used to reproduce the pain by selectively stressing the affected muscle group.
In certain cases, additional imaging may be required:
- Ultrasound: To assess tendon and tendon attachment changes
- MRI (Magnetic Resonance Imaging): For unclear findings or suspected associated injuries
- X-ray: To exclude bony pathology
Treatment
Conservative Treatment
The vast majority of epicondylitis cases are managed conservatively. Treatment options include:
- Rest and activity modification to avoid the aggravating movements
- Physiotherapy and exercise therapy: Stretching and strengthening exercises to rehabilitate tendons and muscles
- Ice application for acute pain relief
- Orthoses and braces (e.g., epicondylitis clasp) to reduce stress on the tendon insertion
- Analgesic medications such as non-steroidal anti-inflammatory drugs (NSAIDs) as topical gels or oral tablets
- Corticosteroid injections for short-term pain relief in severe cases
- Extracorporeal shock wave therapy (ESWT) for persistent, treatment-resistant cases
Surgical Treatment
If conservative management fails to provide sufficient relief after several months, surgical intervention may be considered. Procedures involve releasing or removing degenerated tendon tissue (denervation or tendon release).
Prognosis
The prognosis for epicondylitis is generally favorable. With consistent treatment and activity modification, most patients achieve full recovery, although this can take several months. Recurrence is possible if the underlying causative factors are not addressed in the long term.
References
- Bisset L, Beller E, Jull G et al. – Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow. BMJ 2006;333:939.
- Nirschl RP, Pettrone FA – Tennis elbow. The surgical treatment of lateral epicondylitis. Journal of Bone and Joint Surgery 1979;61(6):832–839.
- Smidt N, van der Windt DA, Assendelft WJ et al. – Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis. Lancet 2002;359(9307):657–662.
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