Lateral epicondylitis of the elbow

Abstract

Lateral epicondylitis, also known as 'tennis elbow', is a very common condition affecting mainly middle-aged patients.The pathogenesis remains unknown but there appears to be a combination of local tendon pathology, alteration in pain perception and motor impairment.The diagnosis is usually clinical but some patients may benefit from additional imaging for a specific differential diagnosis.The disease has a self-limiting course of between 12 and 18 months, but in some patients, symptoms can be persistent and refractory to treatment.Most patients are well-managed with non-operative treatment and activity modification. Many surgical techniques have been proposed for patients with refractory symptoms.New non-operative treatment alternatives with promising results have been developed in recent years. Cite this article: Vaquero-Picado A, Barco R, Antuña SA. Lateral epicondylitis of the elbow. EFORT Open Rev 2016;1:391-397. DOI: 10.1302/2058-5241.1.000049.

Keywords: conservative management; lateral elbow pain; lateral epicondylitis; operative management; tennis elbow.

Fig. 1

a) Patient with pain (small blue circle) on the lateral epicondyle with resisted wrist extension and with the arm in full extension, alleviated by flexing the elbow. b) The mechanism by which pain is reduced might be the decreased tension of the extensor muscles against the superolateral aspect of the capitellum.

Fig. 2

Coronal T-2 weighted MRI image of a right elbow showing an injury of the insertion of the extensor muscles at the lateral epicondyle.

Fig. 3

Location of the site of greatest tenderness may be helpful in defining the diagnosis for further clinical testing and/or imaging techniques.

Fig. 4

Patient with lateral epicondylitis of the right elbow undergoing an open technique. Debridement of the ECRB has been performed and the joint is visible through the capsular defect present in this case. Perforation of the lateral epicondyle and reconstruction of the extensor muscles are optional additional techniques after debridement of the typical injury.

Fig. 5

Clinical photograph of a patient with lateral epicondylitis of the right elbow undergoing an arthroscopic technique. a) A capsular injury is observed in the superolateral aspect of the joint. b) After debridement and reconstruction of the extensor muscles with the help of an anchor the capsular defect has been repaired.