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

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  • Tendinopathy of the elbow characterized by pain and tenderness at the origins of the wrist flexors/extensors at the humeral epicondyles
  • May be acute (traumatic) or chronic (overuse)
  • Two types
    • Medial epicondylitis (ME, “golfer’s elbow”)
      • Involves the wrist flexors and pronators, which originate at the medial epicondyle
    • Lateral epicondylitis (LE, “tennis elbow”)
      • Involves the wrist extensors and supinators, which originate at the lateral epicondyle
  • 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.


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

  • Common overuse injury
  • Lateral > medial
  • Estimated between 1% and 3%
  • LE: 1.3%
  • ME: 0.4%

Etiology and Pathophysiology

  • Acute (tendonitis)
    • 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, absence of 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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