What is lateral epicondylitis?

Lateral epicondylitis is an age-related pain phenomenon that exists at the lateral side of the elbow.  The wrist extensor muscle, called the extensor carpi radialis brevis (ECRB), inserts on the lateral epicondyle of the elbow.  This muscle stabilizes the wrist in extension and more importantly gives it the strength and stability necessary for a “power grip.” It is thought that degeneration or tearing of the tendon, either acutely or over time, at the attachment to the elbow bone is the cause of symptoms in lateral epicondylitis. However, the exact pathophysiology of symptoms is unknown.

Who gets lateral epicondylitis?

One of the most common questions we hear regarding lateral epicondylitis is “I don’t play tennis, why do I have tennis elbow?” You have to keep in mind that this nickname is just that, a nickname; the condition is by no means limited to people who play tennis! Lateral epicondylitis is most common in individuals between the ages of 35-65 years old, regardless of their activity level. Sometimes a patient will report a sudden increase in pain, or it can be a more insidious onset. Furthermore, lateral epicondylitis is thought to be an overuse injury, but the actual pathogenesis is not fully understood.

What are the symptoms of lateral epicondylitis?

One of the classic symptoms of lateral epicondylitis is pain with pressure on the bony prominence of the elbow. Lateral elbow pain with power grip and pain with wrist extension are also hallmarks of lateral epicondylitis. There is often pain with passive wrist flexion as well.

 

How is lateral epicondylitis treated?

Google tennis elbow or lateral epicondylitis and you will find a thousand different treatment options for this condition. This proliferation of remedies tells us two things: lateral epicondylitis is a very common condition and perhaps we don’t know how best to treat it!

 

Even in the evidence-based literature, there are hundreds of papers studying different treatment modalities for lateral epicondylitis, but almost all treatment results are equal to placebo (in essence, doing nothing).  This includes bracing; injections of blood, platelets, or bone marrow; shock wave treatment; ultrasound-guided methods, etc. We do know that steroid injections into the elbow are worse than doing nothing and anti-inflammatory medications won’t work because lateral epicondylitis is not an inflammatory condition.

At the end of the day, doing nothing truly seems to work better than doing anything!

Our main goal with patients is to get them pain-free function. Therefore, we believe that early-stage exercises are the way to go for lateral epicondylitis. In theory, by exercising the specific muscles affected, the parts of the muscle still attached to the elbow will strengthen. This will allow the “torn” and “degenerative” areas to heal.  We have great success early on treating lateral epicondylitis with an exercise program. Often, we will use a few supervised therapy visits to ensure that the patient is doing the exercises appropriately.

 

Furthermore, we don’t believe that patients should stop activities because of lateral epicondylitis in order to allow it to heal.  Exercising it before the activity to warm up the muscle will allow the patient to compete in whatever exercise or sport they want.   It is, after all, a pain phenomenon.

 

In extreme cases, we do have surgical treatment, but it is typically reserved for longstanding symptoms lasting more than 6-9 months. The good news is that surgery is almost always effective. During this procedure, the muscle that is degenerative will be removed and the remaining tendon is sewn down to the bone.

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