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Condition/Disorder Synonyms

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  • Lateral tendon injury

  • Lateral tendonitis

  • Lateral humeral epicondylitis

  • Tennis elbow

  • Lateral tennis elbow

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ICD-9-CM Code

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  • 726.32 Lateral epicondylitis

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ICD-10-CM Code

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  • M77.10 Lateral epicondylitis, unspecified elbow

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Preferred Practice Pattern

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Key Features

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Description

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  • Tendinosis of wrist extensor tendons that attach at the lateral humeral epicondyle

  • Normal collagen response is disrupted by fibroblastic, immature vascular response and an incomplete reparative phase

  • Early stages may display inflammatory or synovitic characteristics

  • Later stages may demonstrate microtearing, tendon degeneration with or without calcification, or incomplete vascular response

  • Pain in lateral elbow with resisted wrist extension and radial deviation with elbow extended

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Essentials of Diagnosis

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  • Tendonitis of the elbow rarely caused by acute trauma except in sports-related events, such as tennis

  • Usually affects middle-aged clients; aging process leads to decreased mucopolysaccharide chondroitin sulfate within tissues, making tendons less extensible

  • Age-related tissue changes for tennis elbow appear in patients aged 35 years and older

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General Considerations

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  • Tendinosis affecting the elbow is rarely acute unless direct trauma (then considered tendonitis)

  • Pain usually associated with activity, more so afterward

  • Onset of pain associated with wrist extension, elbow extension, and forearm pronation activities

  • Direct blows to lateral epicondyle can initiate symptoms

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Demographics2

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  • People aged 40 to 50 years

  • Accounts for 7% of all sports injuries

  • Male and females equally affected

  • 75% of patients are symptomatic in their dominant arm

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Clinical Findings

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Signs and Symptoms

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  • Pain of insidious onset

  • Active movement may reproduce pain

  • Passive movement of full wrist flexion with pronation and elbow extension reproduces pain at the lateral epicondyle

  • Resistive isometric: resisted wrist extension and elbow extension reproduces pain at lateral epicondyle

  • Elbow-joint movements should be full and painless

  • Palpation tenderness at lateral epicondyle within musculature of extensor digitorum and extensor carpi radialis longus; rarely involves extensor carpi ulnaris or extensor carpi radialis brevis

  • Rubor and warmth may be present over lateral epicondyle or associated muscle belly

  • Pain and tenderness over the lateral epicondyle

  • Pain response varies between dull ache, no pain at rest, sharp pain with activities

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Functional Limitations

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  • Pain with pinching, squeezing, holding heavy objects, wringing

  • Pain with movements of the hand and wrist

  • Loss of strength

  • Difficulty with grasping activities

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Possible Contributing Causes

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  • Occupations requiring repetitive use of hands for excessive periods of time

  • Direct trauma to tendon or wrist

  • Sports or occupational activities

    • Tennis, golf, bowling, football, archery, weightlifting

    • Carpentry, plumbing, mechanic

  • Most commonly results from repetitive forearm, wrist, hand motions

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