Lateral Epicondylitis

MANUAL MINORS

Lateral epicondylitis, also known as “tennis elbow,” is an inflammation or microtear of the tendons that insert at the lateral epicondyle of the humerus, where the forearm extensor muscles connect to the elbow.

This condition is commonly caused by repetitive wrist extension and forearm supination, such as in racket sports, manual activities, or jobs involving repetitive movements. Although more frequent in people aged 30 to 50, it can affect anyone exposed to these activities.

Diagnosis

Diagnosis is based on a clinical history of pain on the outer side of the elbow, worsening with movements involving wrist extension or forearm supination. During physical examination, pain is reproduced by palpating the lateral epicondyle or performing Cozen’s test, which involves asking the patient to extend the wrist against resistance.

Imaging studies are usually not necessary, but in persistent or severe cases, ultrasound or magnetic resonance imaging (MRI) may help confirm tendon inflammation or tears.

Differential Diagnosis

Pathology	Characteristics
Medial epicondylitis	Pain on the inner side of the elbow, related to repetitive wrist flexion
Olecranon bursitis	Swelling at the back of the elbow, unrelated to forearm use
Radial tunnel syndrome	Pain and weakness on the lateral side of the forearm, related to nerve compression
Radial collateral ligament injury	Elbow instability and lateral pain, especially after trauma
Radial head fracture	Lateral elbow pain after trauma, visible on X-rays

Emergency Management

Emergency management includes pain control using analgesics and non-steroidal anti-inflammatory drugs (NSAIDs), as well as ice application to reduce inflammation. Temporary elbow immobilisation with a splint or an epicondylitis brace may be recommended to relieve stress on the extensor tendons. In acute cases, relative rest should be advised, avoiding activities that exacerbate the pain, and the patient should be referred to physiotherapy for early rehabilitation.

Definitive Treatment

Definitive treatment for lateral epicondylitis is conservative, focusing on physiotherapy to strengthen the forearm muscles and improve flexibility, as well as modifying activities that cause the problem. The use of braces or straps for the elbow may also be beneficial.

In cases unresponsive to conservative treatment, corticosteroid injections or therapies such as extracorporeal shockwave therapy may be considered. Surgery to release the affected tendon is reserved for severe cases or those resistant to conservative treatment after 6 to 12 months of management.