Epicondylitis

Epicondylitis is a topic covered in the 5-Minute Clinical Consult.

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Basics

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 (“golfer’s elbow”)
      • Involves the wrist flexors and pronators, which originate at the medial epicondyle
    • LET (“tennis elbow”)
      • Involves the wrist extensors and supinators, which originate 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
  • LET: 1.3%
  • MET: 0.4%

Etiology and Pathophysiology

  • Acute (tendonitis)
    • Rare, uncommon pathology
    • Inflammatory response to injury or sudden, violent contraction
  • Chronic (tendinosis)
    • Overuse injury
    • Repetitive wrist flexion or extension places strain across enthesis of flexor/extensor group.
    • 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
    • Extension/supination: lateral
  • Smoking
  • Obesity
  • Upper extremity forceful activities

General Prevention

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

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Basics

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 (“golfer’s elbow”)
      • Involves the wrist flexors and pronators, which originate at the medial epicondyle
    • LET (“tennis elbow”)
      • Involves the wrist extensors and supinators, which originate 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
  • LET: 1.3%
  • MET: 0.4%

Etiology and Pathophysiology

  • Acute (tendonitis)
    • Rare, uncommon pathology
    • Inflammatory response to injury or sudden, violent contraction
  • Chronic (tendinosis)
    • Overuse injury
    • Repetitive wrist flexion or extension places strain across enthesis of flexor/extensor group.
    • 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
    • Extension/supination: lateral
  • Smoking
  • Obesity
  • Upper extremity forceful activities

General Prevention

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

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