Epicondylitis

Definition/diagnostic criteria Epicondylitis, commonly classified as lateral or medial, is a condition characterised by pain and tenderness around the epicondyle of the elbow. Lateral epicondylitis, known as tennis elbow, involves the extensor muscles of the forearm, whereas medial epicondylitis, or golfer’s elbow, affects the flexor muscles. The condition is primarily considered to be a tendinopathy, arising from overuse and repetitive strain, leading to microtrauma and degeneration of the tendon origin at the epicondyle.

Epidemiology Epicondylitis is a common musculoskeletal condition – the prevalence is 1–3% and the incidence 4–7 per 1000 people per year. Lateral epicondylitis is more common than medial. It typically presents in individuals between 35 and 50 years of age and affects both sexes equally. Risk factors include repetitive manual activities, especially those involving wrist extension or flexion against resistance.

Diagnosis
Clinical features: Diagnosis is predominantly clinical. Key features include:

• Pain and tenderness at the lateral or medial epicondyle.
• Pain exacerbated by specific activities, such as gripping, lifting or wrist extension/flexion.
• Reduced grip strength may be observed in more advanced cases.

Investigations: Routine imaging is not usually required. However, ultrasound or MRI may be utilised in cases where the diagnosis is uncertain or if there is a suspicion of other pathologies. Typical abnormalities on imaging, particularly ultrasound, might include tendon thickening, hypoechoic areas indicating neovascularisation, and collagen disarray.

Treatment The management of epicondylitis is typically conservative. Key components include:

• Rest and activity modification to reduce strain on the affected tendon.
• Analgesia, primarily NSAIDs, can be used for pain relief. Paracetamol may be considered as an alternative. Topical NSAIDs could be beneficial for those unable to tolerate systemic NSAIDs.
• Physical therapy, including stretching and strengthening exercises, is a cornerstone of management.
• Orthotic devices, such as braces or straps, can reduce symptoms by diminishing tendon strain.
• Local corticosteroid injections may be considered for short-term pain relief but are generally not recommended due to potential long-term negative effects on tendon healing.
• Other treatment modalities such as extracorporeal shockwave therapy, acupuncture, and platelet-rich plasma injections have been studied, but evidence of their efficacy remains inconclusive.

Prognosis The prognosis for epicondylitis is generally favourable, with most individuals experiencing symptom resolution within a year. However, some cases may persist longer, requiring ongoing management and possibly specialist referral. Recurrence is not uncommon, particularly if the precipitating activities are resumed without adequate preventive measures.