Epicondylitis

Introduction

Epicondylitis is a medical condition that refers to inflammation or degeneration of the tendons that attach to the epicondyles of the humerus, the bony prominences on the inner and outer sides of the elbow. It is commonly classified into two types: lateral epicondylitis (tennis elbow), which affects the outer elbow, and medial epicondylitis (golfer’s elbow), which affects the inner elbow (1). Despite the names, these conditions are not limited to athletes; they can affect anyone who performs repetitive arm, wrist, or hand movements.

Epicondylitis is one of the most common causes of elbow pain, particularly among adults between the ages of 30 and 50. It can lead to discomfort, reduced grip strength, and difficulty carrying out everyday activities. While the condition is not usually serious, untreated cases can become chronic and significantly impact quality of life (2).

Symptoms

The symptoms of epicondylitis develop gradually, often starting with mild discomfort that worsens over time (1). Key signs include:

• Pain and tenderness around the elbow joint, particularly over the bony epicondyles.
• Radiating pain that may spread into the forearm and wrist.
• Weak grip strength, making it difficult to hold objects, shake hands, or turn doorknobs.
• Stiffness in the elbow, especially in the morning or after periods of inactivity.
• Increased pain with activity, such as lifting, typing, or twisting the forearm.

In lateral epicondylitis, pain is typically felt on the outer side of the elbow, whereas medial epicondylitis causes discomfort on the inner side. The pain usually worsens when performing activities that require gripping, wrist extension, or wrist flexion, depending on the type (2).

Causes

Epicondylitis develops due to overuse and repetitive strain of the forearm muscles and tendons. When the tendons that attach to the epicondyle are repeatedly stressed, tiny tears may occur in the tissue. Over time, this leads to inflammation, degeneration, and pain (2).

Some common causes include

• Repetitive movements of the wrist and forearm, such as swinging a racket, hammering, painting, or typing.
• Improper technique in sports or occupational activities can place excess strain on the tendons.
• Sudden increase in activity levels, such as lifting heavier weights or starting a new physical job.
• Age-related degeneration, where tendons lose elasticity and become more prone to injury.

In many cases, epicondylitis results from a combination of repetitive stress and poor biomechanics rather than a single traumatic injury.

Risk Factors

Certain factors increase the likelihood of developing epicondylitis, including:

• Age: Most common between ages 30–50 due to natural tendon wear and tear.
• Occupation: Jobs requiring repetitive hand and wrist movements, such as carpentry, plumbing, painting, or typing.
• Sports participation: Tennis, golf, baseball, weightlifting, and other activities involving repetitive arm use.
• Improper equipment use: For example, using a tennis racket with the wrong grip size or poor-quality tools.
• Previous injuries: Individuals with prior elbow or wrist injuries are more susceptible.
• Smoking: Reduces blood supply to tendons, impairing healing.

Diagnosis

Diagnosing epicondylitis involves a combination of medical history, physical examination, and sometimes imaging tests (1).

• Medical history: A doctor will ask about symptoms, occupation, hobbies, and recent activities that may have triggered pain.
• Physical examination: The physician may press on the elbow to check for tenderness and ask the patient to perform wrist or forearm movements to reproduce pain.
• Imaging tests
  • X-rays: Usually normal, but may rule out arthritis or fractures.
  • MRI or ultrasound: Helpful for detecting tendon tears or degeneration.

Diagnosis is primarily clinical, meaning it is often made based on symptoms and examination rather than advanced tests.

Treatment Options

The good news is that most cases of epicondylitis improve with non-surgical treatments. Management aims to relieve pain, promote tendon healing, and prevent recurrence.

•  Rest and Activity Modification
• Avoid activities that trigger pain.
• Use ergonomic adjustments at work or in sports to reduce stress on tendons.
• Ice and Heat Therapy
• Ice packs can reduce pain and swelling in the early stages.
• Heat may help relax muscles and improve blood flow in chronic cases.
•  Medications
• Over-the-counter pain relievers such as ibuprofen or naproxen help reduce inflammation.
• Topical gels and creams may also provide relief.
• Physical Therapy
• Stretching and strengthening exercises for the forearm muscles is essential.
• Eccentric exercises (where muscles lengthen under tension) are particularly effective for tendon healing.
• Therapists may use ultrasound therapy, massage, or shockwave therapy to speed recovery (2).
• Bracing or Splinting
• Counterforce braces or wrist splints reduce strain on the tendons during activity.
•  Injections
• Corticosteroid injections may provide short-term relief but are not recommended repeatedly due to side effects.
• Platelet-rich plasma (PRP) injections are being studied as a regenerative treatment to promote tendon healing
• Surgery
• Reserved for severe cases lasting more than 6–12 months without improvement.
• Involves removing damaged tendon tissue and reattaching healthy tendon to the bone.

Recovery varies, but most individuals see improvement within a few weeks to months with consistent treatment (3).

Living With Epicondylitis and Prevention

Epicondylitis can be frustrating, especially if symptoms interfere with work or daily life. However, with proper care and preventive measures, recurrence can often be avoided (3).

Lifestyle and prevention tips

• Warm up properly before sports or heavy activities.
• Use proper technique in sports like tennis or golf; consider professional coaching.
• Choose ergonomic equipment, such as tools and sports gear with an appropriate grip size.
• Take breaks during repetitive tasks to reduce tendon strain.
• Strengthen forearm muscles through regular stretching and resistance exercises.
• Listen to your body: avoid pushing through pain, which can worsen tendon damage.

For those living with chronic symptoms, pacing activities, wearing supportive braces, and engaging in physical therapy can help maintain function and prevent flare-ups (3).

References

1. Konarski W, Poboży T, Poboży K, Domańska J, Konarska K. Current concepts of natural course and in management of medial epicondylitis: a clinical overview. Orthop Rev (Pavia). 2023 Sep 9;15:84275. doi: 10.52965/001c.84275. PMID: 37701778; PMCID: PMC10495044.
2. Soares MM, Souza PC, Ribeiro AP. Differences in Clinical Tests for Assessing Lateral Epicondylitis Elbow in Adults Concerning Their Physical Activity Level: Test Reliability, Accuracy of Ultrasound Imaging, and Relationship with Energy Expenditure. Int J Environ Res Public Health. 2023 Jan 18;20(3):1794. doi: 10.3390/ijerph20031794. PMID: 36767167; PMCID: PMC9914816.
3. Park HB, Gwark JY, Im JH, Na JB. Factors Associated With Lateral Epicondylitis of the Elbow. Orthop J Sports Med. 2021 May 13;9(5):23259671211007734. doi: 10.1177/23259671211007734. PMID: 34036114; PMCID: PMC8127791.