II. Epidemiology
- Incidence: 1-3% of U.S. adults per year
- Ages: 30-40 years old
III. Pathophysiology
-
Tendinopathy (not a Tendonitis)
- The term Tendonitis is a misnomer, as this is a degenerative tendon change, not an inflammatory change
- Much more common compared with Medial Epicondylitis (by factor of 4-10 fold)
- Affects the supinator Muscle tendons (and the extensor Forearm tendon) at their medial epicondyle origins
- Extensor carpi radialis brevis
- Occupational repetitive use injury is most common cause
- Named for the one-handed backhand swing related injury in tennis (but only affects 5-10% of tennis players)
IV. Causes
- Repeated overuse of Forearm flexors or extensors
- Minor tears of tendinous attachments at epicondyles
- Causative activities (Occupational Injury is more common than Athletic Injury)
- Golf or racquet sports
- Throwing sports
- Hammering
- Hand sanding
- Computer mouse use
V. Symptoms
VI. Signs
- Maximum tenderness localized to region 1 cm distal to the lateral epicondyle
- Provocative maneuvers eliciting pain
- Wrist extension against resistance
- Supination against resistance
- Pain on resisted wrist extension
- Pain on isolated resisted long finger (middle finger) extension
- Pain with resisted gripping
VII. Differential Diagnosis
-
Radial Tunnel Syndrome (or Posterior Interosseous Nerve Syndrome)
- Radial nerve Entrapment Neuropathy
- Radiocapitellar chondromalacia
- Osteochondritis Dissecans capitellum
VIII. Imaging: Elbow XRay
- Usually negative (evaluates more for differential diagnosis)
- Occasional traction spur may be seen
IX. Management: Initial pain management
- Rest
- Ice Therapy (Cryotherapy) for 20 minutes four times daily and after Exercise
- Moist heat or Ultrasound
- NSAIDs
- Tennis Elbow counterforce strap
- Dampens force transmitted to elbow from wrist, hand
- May offer initial benefit for comfort but Stretching and strengthening are preferred modalities given their much better efficacy
- Wrist brace may be preferred
- Activity restriction
- Avoid grasping in pronation
- Lift only with wrist in supination
- Ergonomic workplace and sports modifications
X. Management: Rehabilitation Exercises
- Physical therapy with Eccentric Exercises
- Painless passive wrist flexion
- Progressive resisted wrist extension
- Use elastic band tied between foot and hand
XI. Management: Refractory Cases
- Deep friction massage
- Dry Needling
- Blood and Platelet rich plasma injections
- Nitroglycerin Patch (one quarter of a 5 mg Nitroglycerin Patch)
-
Epicondyle Injection (Corticosteroid local injection)
- May be associated with worse longterm outcomes
- Coombes (2013) JAMA 309(5): 461-9 [PubMed]
- Long Arm Cast of elbow and wrist
XII. Management: Ineffective measures
- Corticosteroid Iontophoresis does not offer benefit
- Extracorporeal shock wave therapy is not beneficial
XIII. Complications
- Elbow Ulnar Collateral Ligament Injury
- Ulnar Nerve instability
XIV. Prognosis
- Self limited, expect full recovery
- Symptoms may persist for months
- Surgery for resistant cases only
Images: Related links to external sites (from Bing)
Related Studies
| Concepts | Disease or Syndrome (T047) |
| SnomedCT | 156659008, 268088003, 73583000 |
| Italian | Epicondilite, Epitrocleite |
| English | Epicondylitis, epicondylitis, epicondylitis (diagnosis), Epitrochleitis, Epicondylitis (disorder), Epicondylitis, NOS, Epicondylitis NOS |
| Japanese | 上顆炎, ｼﾞｮｳｶｴﾝ, ﾅｲｿｸｼﾞｮｳｶｴﾝ, 内側上顆炎 |
| Czech | Epikondylitida, Epitrochleitis |
| Spanish | Epitrocleitis, epicondilitis de húmero (trastorno), epicondilitis del húmero, epicondilitis del húmero (trastorno), epicondilitis de húmero, Epicondilitis |
| Portuguese | Epitrocleíte, Epicondilite |
| Dutch | epitrochleïtis, epicondylitis |
| French | Epitrochléite, Epicondylite |
| German | Epitrochleitis, Epikondylitis |
| Hungarian | Epitrochleitis, Epicondylitis |
Ontology: Tennis Elbow (C0039516)
| Definition (MSH) | A condition characterized by pain in or near the lateral humeral epicondyle or in the forearm extensor muscle mass as a result of unusual strain. It occurs in tennis players as well as housewives, artisans, and violinists. |
| Concepts | Disease or Syndrome (T047) |
| MSH | D013716 |
| ICD9 | 726.32 |
| ICD10 | M77.1 |
| SnomedCT | 24133009, 268088003, 156659008, 202855006 |
| English | Elbows, Tennis, Epicondylitides, Lateral Humeral, Epicondylitis, Lateral Humeral, Humeral Epicondylitides, Lateral, Humeral Epicondylitis, Lateral, Lateral Humeral Epicondylitides, Lateral Humeral Epicondylitis, Tennis Elbows, Elbow, Tennis, TENNIS ELBOW, Tennis Elbow, lateral epicondylitis (diagnosis), lateral epicondylitis, tennis elbow, lateral epicondylitis (tennis elbow), Tennis Elbow [Disease/Finding], Epicondylitis;lateralis, radiohumeral bursitis, tennis elbows, epicondylitis lateralis, lateral humeral epicondylitis, Lateral epicondylitis of elbow joint (disorder), Tennis elbow - epicondylitis, Lateral epicondylitis, Tennis elbow, Lateral epicondylitis of elbow, Lateral epicondylitis (disorder), bursitis; radiohumeral, epicondylitis; lateral, lateral; epicondylitis, radiohumeral; bursitis, Lateral epicondylitis of elbow joint (disorder) [Ambiguous], Lateral Epicondylitis, lateralis epicondylitis |
| Dutch | laterale epicondylitis, tenniselleboog, bursitis; radiohumeraal, epicondylitis; lateralis, lateralis; epicondylitis, radiohumeraal; bursitis, Epicondylitis lateralis, Elleboog, tennis-, Tenniselleboog |
| French | Epicondylite externe, Épicondylite humérale latérale, Épicondylite, Tennis elbow, Épicondylite des joueurs de tennis |
| German | Tennisellbogen, laterale Epikondylitis, Epicondylitis radialis humeri, Epicondylitis lateralis humeri, Tennisellenbogen |
| Italian | Epicondilite, Epicondilite omero laterale, Gomito del tennista |
| Portuguese | Cotovelo de ténis, Epicondilite externa, Cotovelo de Tenista, Epicondilite Lateral do Úmero |
| Spanish | Epicondilitis lateral, Codo del tenista, epicondilitis externa, epicondilitis, epicondilitis externa de la articulación del codo (trastorno), Epicondilitis Lateral del Húmero, codo de tenista, epicondilitis externa de la articulación del codo (concepto no activo), epicondilitis lateral (trastorno), epicondilitis lateral del codo, epicondilitis lateral, Codo de Tenista, Epicondilitis Humeral Lateral |
| Japanese | 外側上顆炎, ｶﾞｲｿｸｼﾞｮｳｶｴﾝ, ﾃﾆｽﾋｼﾞ, 上腕骨外上顆炎, テニス肘, 上腕骨外側上顆炎 |
| Swedish | Tennisarmbåge |
| Czech | tenisový loket, Laterální epikondylitida, Tenisový loket |
| Finnish | Tenniskyynärpää |
| Russian | EPIKONDDISPLAZIIA, TENNISNYI LOKOT', EPIKONDILIT NARUZHNYI PLECHEVOI, EPIKONDILIT TRAVMATICHESKII, ТЕННИСНЫЙ ЛОКОТЬ, ЭПИКОНДДИСПЛАЗИЯ, ЭПИКОНДИЛИТ НАРУЖНЫЙ ПЛЕЧЕВОЙ, ЭПИКОНДИЛИТ ТРАВМАТИЧЕСКИЙ |
| Korean | 외측 상과염 |
| Polish | Łokieć tenisisty |
| Hungarian | Teniszkönyök, Epicondylitis lateralis |
| Norwegian | Tennisalbue, Epikondylitt, lateral, Lateral epikondylitt, Laterale epikondylsmerter, Epicondylitis lateralis humeri, Lateral epikondalgi |
Ontology: Enthesopathy of elbow region (C0158307)
| Concepts | Pathologic Function (T046) |
| ICD9 | 726.30, 726.3 |
| SnomedCT | 202858008, 202854005, 35185008 |
| English | Elbow enthesopathy unspecified, Enthesopathy of elbow, unspecified, enthesopathy of elbow (diagnosis), enthesopathy of elbow, Elbow enthesopathy NOS, Elbow enthesopathy NOS (disorder), Elbow enthesopathy unspecified (disorder), Enthesopathy of elbow region, Enthesopathy of elbow, Enthesopathy of the elbow region, Enthesopathy of elbow region (disorder), elbow region; enthesopathy, enthesopathy; elbow region, Enthesopathy of elbow region, NOS, Enthesopathy of elbow, NOS |
| Dutch | enthesopathie van elleboogstreek, niet-gespecificeerde enthesopathie van elleboog, elleboogstreek; enthesopathie, enthesopathie; elleboogstreek |
| French | Enthésopathie de la région du coude, Enthésopathie du coude, non précisée |
| German | Enthesiopathie des Ellbogens, unspezifisch, Enthesiopathie der Ellbogengegend |
| Italian | Entesopatia della regione del gomito, Entesopatia non specificata della regione del gomito |
| Portuguese | Entesopatia do cotovelo NE, Entesopatia da região do cotovelo |
| Spanish | Entesopatía del codo, no especificada, Entesopatía de la región del codo, entesopatía de codo, no especificada, entesopatía de codo, no especificada (trastorno), entesopatía de codo, SAI (trastorno), entesopatía de codo, SAI, entesopatía de la región del codo (trastorno), entesopatía de la región del codo, entesopatía del codo |
| Japanese | 肘部の腱付着部症, 詳細不明の肘部腱付着部症, ｼｮｳｻｲﾌﾒｲﾉﾁｭｳﾌﾞｹﾝﾌﾁｬｸﾌﾞｼｮｳ, ﾁｭｳﾌﾞﾉｹﾝﾌﾁｬｸﾌﾞｼｮｳ |
| Czech | Entezopatie loketní oblasti, Entezopatie loketní oblasti, blíže neurčená |
| Hungarian | Könyök enthesopathiája, nem meghatározott, Könyök régió enthesopathiája |
