Makindo Medical Notes

Related Subjects: |Tennis Elbow |Golfer's Elbow

⚠️ Bilateral disease suggests a systemic condition such as a spondyloarthropathy. 🕑 Early diagnosis and management are essential to prevent chronic pain and functional impairment.

🎾 About Tennis Elbow

• Tennis Elbow (Lateral Epicondylitis) is pain & tenderness over the outer elbow 🦴.
• Caused by repetitive strain of forearm extensor tendons (esp. ECRB).
• Despite the name, 💼 anyone with repetitive wrist/arm use (e.g., plumbers, painters, office workers) can develop it.

🧬 Aetiology

• 🔄 Overuse injury: Repetitive wrist extension & gripping → microtears & degeneration.
• 🎯 Extensor Carpi Radialis Brevis (ECRB): Most commonly affected tendon.
• 🏗️ Occupational risks: Carpentry, plumbing, decorating, typing.
• 🎾 Sports: Racquet sports, weightlifting, throwing activities.

🩺 Clinical Presentation

• 💥 Lateral epicondyle tenderness: Localized “trigger spot” pain.
• 🖐️ Pain on wrist extension / gripping: Shaking hands, turning doorknobs, lifting mugs.
• ⬇️ Weak grip: Functional impairment at work & sport.
• 🌅 Morning stiffness: Worse on waking, improves with movement.
• 🔄 Chronic cases: Radiating pain down forearm.

🧾 Differential Diagnosis

• 🏌️ Golfer’s elbow: Medial epicondylitis (inner elbow pain).
• ⚡ Radial tunnel syndrome: Radial nerve compression.
• 💪 Triceps tendinitis: Pain posteriorly at elbow.
• 🧠 Ulnar nerve entrapment: Tingling in ring/little fingers.
• 🦠 Septic arthritis: Red, hot, swollen elbow (emergency 🚨).

🔎 Investigations

Diagnosis = mainly clinical 🩺, but tests help rule out mimics:

• 👉 Provocative tests: Pain on resisted wrist or middle finger extension.
• 🖐️ Palpation: Focal tenderness at lateral epicondyle.
• 📡 Ultrasound: Thickened tendon, tears.
• 🧲 MRI: Severe/atypical cases.
• ⚡ EMG: If nerve entrapment suspected.

💊 Management

• Conservative (first-line):
  • 🛑 Rest or modify activities.
  • ❄️ Ice packs after activity.
  • 💊 NSAIDs (short-term).
  • 👐 Physiotherapy: Stretching, eccentric strengthening, manual therapy.
  • 🦾 Elbow brace/strap to offload tendon.
• Injections:
  • 💉 Corticosteroid injections → short-term relief but risk tendon rupture if repeated.
  • 💉 PRP (platelet-rich plasma) sometimes used, evidence mixed.
• Other therapies:
  • 🌿 Acupuncture (adjunctive pain relief).
  • 🔊 Shockwave therapy (ESWT) in resistant cases.
• Surgery (rare, refractory cases):
  • 🔪 Arthroscopic debridement.
  • Open tendon release if failed >12 months of conservative care.

📈 Prognosis

• ✅ Most resolve within 6–12 months with conservative care.
• ⏳ Some cases persist chronically, especially with ongoing occupational strain.
• 🔄 Prevention: Ergonomic adjustments & forearm strengthening.

📚 References

• AAOS – Lateral Epicondylitis [orthoinfo.aaos.org]
• Mayo Clinic – Tennis Elbow
• Fitzpatrick JF, Ryan J. Sports Health. Rehabilitation of Tennis Elbow.
• Sevier TL, Portas WA. Curr Rev Musculoskelet Med. 2016.
• NICE Guidance – MSK pain management.