Lateral epicondylitis, otherwise known as tennis elbow, is a degenerative condition that causes pain on the outside of the elbow. Patients may experience quite extreme pain which radiates along the forearm.
In severe cases, patients may have difficulty extending their wrist and fingers and this may result in problems with even lightweight activities. Some patients may find that even holding small objects such as a glass of water or telephone, is too painful.
Patients often have a history of overuse of the elbow associated with the onset of pain. It is often associated with repetitive loading tasks which put strain on the tendon attachments on the lateral side of the elbow.
Many of the muscles that extend the wrist and fingers are anchored by a common tendon on the outside of the elbow. Some patients may develop degenerative change at this tendon insertion site, which may result in some tearing of the tendon and development of inflammation.
A plain x-ray is usually performed to look for any bony irregularity around the lateral aspect of the elbow. An MRI scan is sometimes useful to help define the area of disease and to exclude any other elbow pathology.
Treatment options usually start with simple non operative measures. Activity modification and avoidance of repetitive straining tasks are very important. If patients are failing to improve after a period of rest, a steroid injection may be considered.
Other treatment options such as a blood patch injection can be considered. Physiotherapy may also be beneficial. In most cases, the condition will gradually subside but it may take many months for the problem to resolve.
In resistant cases, surgery can sometimes be considered. This involves debridement of the degenerative portion of tendon. Even after surgery, it can take some time for the tissues to heal, and strengthening of the forearm musculature proceeds slowly.
Medial epicondylitis, or golfers elbow, is a similar condition but involves the common flexor tendon which anchors on the inside of the elbow. This condition is less common but can present with similar discomfort and limitation in function. Some patients may also experience irritation of the ulnar nerve which travels in close proximity.