Epicondylitis

Description

• Tendinopathy of the elbow characterized by pain and tenderness at the myotendinous junctions or tendinous insertions of the wrist flexors/extensors at the humeral epicondyles
• Although commonly known as medial and lateral epicondylitis, without microscopic histologic examination, the more appropriate term is medial epicondyle tendinopathy (MET) and lateral epicondyle tendinopathy (LET).
• Most commonly secondary to chronic (overuse) pathology, although acute (traumatic) etiology can occur
• Two types
  • MET/common flexor tendinopathy (CFT) (“golfer’s elbow”)
    • Involves the wrist flexors and pronators, which have proximal attachment at the medial epicondyle
  • LET/common extensor tendinopathy (CET) (“tennis elbow”)
    • Involves the wrist extensors and supinators, which have proximal attachment at the lateral epicondyle
    • Most commonly involves the extensor carpi radialis brevis (ERCB) tendon
• May be caused by various different athletic or occupational activities
• Common in carpenters, plumbers, gardeners, and overhead athletes
• 75% of cases involve the dominant arm.

Epidemiology

• Predominant age: >40 years
• Predominant sex: male = female

Incidence

• Common overuse injury
• Lateral > medial
• Estimated between 1% and 3%

Prevalence

• MET: 0.4%
• LET: 1.3%

Etiology and Pathophysiology

• Acute (tendonitis)
  • Rare, uncommon pathology
  • Inflammatory response to injury or sudden, violent contraction
• Chronic (tendinosis or tendinopathy)
  • Overuse injury
  • Repetitive wrist flexion (MET) or extension (LET) places strain across enthesis of flexor or extensor group, respectively.
  • Degeneration, calcium deposition, fibroblast proliferation, microvascular proliferation, hyaline cartilage destruction, diminished restorative inflammatory response
• Aggravating activities
  • Tool/racquet griping
  • Shaking hands
  • Occupational (painters, mechanics, cooks)
  • Sports (golf, tennis, archery, pitchers)

Risk Factors

• Repetitive wrist motions
  • Flexion/pronation: medial epicondyle tendinopathy
  • Extension/supination: lateral epicondyle tendinopathy
• Smoking
• Obesity
• Forceful activities of the upper extremity

General Prevention

• Limit overuse of the wrist flexors, extensors, pronators, and supinators.
• Use proper technique when working with hand tools or playing racquet sports.
• Use lighter tools and smaller grips.