Lateral Epicondylitis (Tennis Elbow)

Tendinopathy of the common extensor origin, most often the <strong>extensor carpi radialis brevis (ECRB)</strong>. Degenerative, not inflammatory, so "epicondylitis" is a misnomer.

Mechanism and risk

Repetitive wrist extension and forceful gripping cause microtrauma at the ECRB origin, outpacing repair.
Who: most cases are not from tennis. Racquet sports, golf, cricket, rowing, weightlifting, climbing, and manual or desk work (carpentry, cooking, computer use) are common.
Modifiable: repetitive gripping, poor technique (for example a faulty backhand), heavy racquet or string tension, load spikes
Non-modifiable: age 35 to 55, smoking
Systemic: diabetes, obesity, hypercholesterolaemia
Occupational: forceful gripping, vibration

Presentation

Pain at the lateral epicondyle, radiating into the forearm
Provoked by gripping, lifting, handshake, holding a cup
Focal tenderness about 1 cm distal and anterior to the epicondyle
Reduced grip strength

Test	Method
Cozen’s	Resisted wrist extension, elbow extended, forearm pronated
Mill’s	Passive wrist flexion, elbow extended
Maudsley’s	Resisted middle finger extension

Differential

Radial tunnel syndrome (posterior interosseous nerve), cervical radiculopathy, elbow arthritis, plica, posterolateral instability. Reconsider the diagnosis with atypical pain, trauma, restricted range of motion or swelling. Up to 11% of “failed” cases have another cause.

Management

Load management and activity modification: first-line.
Exercise therapy: eccentric and isometric loading of the wrist extensors is the cornerstone, with grip strengthening. Multimodal exercise beats passive modalities.
Counterforce brace: modest symptomatic benefit.
Topical NSAIDs: short-term symptoms.
Corticosteroid injection: short-term relief but worse outcomes at 6 to 12 months. Use sparingly, not by default.
Shockwave: reasonable in chronic cases. PRP: mixed evidence, may help chronic cases.
Surgery (ECRB debridement or release): only after 6 to 12 months of failed structured care.

Prognosis

Most cases resolve within 6 to 12 months of conservative care. Recurrence is common on return to provoking activity.

References

Pain Res Manag 2020, doi:10.1155/2020/6965381
Treatment Options for Tennis Elbow: Umbrella Review, Folia Med Cracov 2023, doi:10.24425/fmc.2023.147213
J Back Musculoskelet Rehabil 2022, doi:10.3233/bmr-210053

Medical disclaimer: this article is general information, not personal medical advice. Always consult a qualified doctor about your own situation.