Epicondylitis

This condition consists of an inflammation of the tendinous insertions/origins of the forearm muscles at the elbow. They can develop at the outer or inner elbow. The more common lateral epicondylitis on the outer side is also known as "tennis elbow" since there is an association between this syndrome and the sport. The role of the affected muscles is to extend the wrist as well as the fingers. Medial epicondylitis is also known as "golfer's elbow" and affects the muscles, which flex the wrist and fingers.

Causes

Strenuous repetitive movements where the hand and/or fingers are extended (tennis elbow) or flexed (golfer's elbow) over and over can lead to inflammation of the muscles origin at the elbow. This syndrome often appears in 35 to 45-year-old patients.

Symptoms

The main symptom is pain at the outer or inner aspect of the elbow with possible radiation into the forearm. The pain increases with wrist and/or finger extension (tennis elbow) or flexion (golfer's elbow) against resistance. The symptoms can progress until the patient becomes unable to lift light objects because of pain.

Diagnosis

Diagnosis is based on case history and clinical examination. If necessary, additional X-ray examination can rule out an articular or bony injury.

In protracted or severe cases an MRI is used to estimate the extent of the injury or possible comorbidities.

Treatment

The treatment of epicondylitis is mainly conservative, not operative. It includes limitation or termination of the activities that cause the pain. A forearm bandage/soft brace can help to reduce tension in the affected muscles. Physiotherapy including stretching exercises is also helpful to enable the patient to return to normal activity. Medicinal interventions include anti-inflammatory medication and cortisone injections. Healing is often protracted and can take several weeks.

If conservative treatment is unsuccessful, surgery can be required. In this case, the degenerated inflamed muscular insertions are excised and the musculature is refastened. Often, sensory nerves that innervate the outer elbow region are shrunk at the same time (denervation).

Follow up care

Elbow and wrist are splinted for two weeks, followed by load-free mobilization, before stress is gradually increased. Return to full function realistically takes about six to eight weeks.