Elbow / Wrist / Hand

Lateral Epicondylitis (Tennis elbow)

Definition

Lateral epicondylitis is inflammation in the insertion of the wrist dorsal flexors, accompanied by pain in the lateral elbow and lower arm.

Aetiology

The pain in lateral epicondylitis is caused by overload of one of the wrist dorsal flexors. Mucoid degeneration develops with neovascularisation. In primary care, the incidence is 1 in 1000/year.

Overload of the wrist dorsal flexors can be the consequence of co-existing shoulder, elbow or wrist restrictions. Moreover, sports such as tennis can play a role in causing lateral epicondylitis.

Segmental dysfunction of the cervical spine and cervicothoracic junction can play a role in the clinical picture. Therefore, in addition to evaluation of the shoulder function, it is very important to examine the cervical spine as well.

Signs and symptoms

In general, the symptoms are characterised by pain in the elbow provoked by activities involving the wrist dorsal flexors.

Diagnostics

Physical Examination

Examination of lateral epicondylitis mainly consists of muscle resistance tests of the wrist dorsal flexors. In addition, active and passive elbow flexion/extension and examination of the wrist and shoulder should also be included.

Additional Somatic Diagnostics

  • In the first phase of uncomplicated medial epicondylitis, no imaging techniques or blood tests are indicated.
  • When the complaints persist: Imaging techniques (MRI scan, CT scan, ultrasound) are required.
  • RAND-36 (quality of life)
  • VAS Pain (maximal, minimal, actual, average/week)
  • PCS (catastrophising)
  • HADS (fear and depression)

Additional Psycho-cognitive Diagnostics

Multidisciplinary Treatment

Whether or not somatic treatment is indicated is based on the pain diagnosis.  Based on the findings of the pain questionnaires, additional diagnostics and/or multidisciplinary treatment comprising various non-somatic treatments may be necessary.

Non-somatic Treatment

Somatic Treatment

Pharmacological treatment:

Other Treatments

Interventional Pain Treatment