Epicondylitis, lateral

• Lateral tendon injury
• Lateral tendonitis
• Lateral humeral epicondylitis
• Tennis elbow
• Lateral tennis elbow

• 726.32 Lateral epicondylitis

• M77.10 Lateral epicondylitis, unspecified elbow

• 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated With Localized Inflammation1

Description

• 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

Essentials of Diagnosis

• 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

General Considerations

• 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

Demographics2

• 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

Signs and Symptoms

• 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

Functional Limitations

• Pain with pinching, squeezing, holding heavy objects, wringing
• Pain with movements of the hand and wrist
• Loss of strength
• Difficulty with grasping activities

Possible Contributing Causes

• 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

Differential Diagnosis

• Radial nerve entrapment
• Bicipital tendonitis
• Rheumatoid arthritis
• Radiocapitellar arthritis
• Posterior interosseous nerve compression (radial tunnel syndrome)
• Osteochondritis dissecans of the ...