What Is It, Causes, Treatment, and More
Author: Lily Guo
Editors: Alyssa Haag, Ahaana Singh, Kelsey LaFayette, BAN, RN
Illustrator: Jillian Dunbar
Copyeditor: Joy Mapes
What is epicondylitis?
Epicondylitis refers to inflammation of the tendons, which are cords of tissue, that attach the forearm muscles to the elbow. The inflammation leads to tenderness in the tendon and elbow pain. Epicondylitis commonly occurs due to overuse of the elbow and involved tendons during sports, such as golf and tennis, or work-related activities that involve repetitive and forceful gripping and lifting.
What is lateral epicondylitis?
Lateral epicondylitis, or tennis elbow, is an inflammation of the tendons that attach the forearm muscles to the outside, or lateral aspect, of the elbow. The tendons involved are those that connect to the extensor carpi radialis brevis muscle, which sits on the lateral aspect of the forearm. These tendons are responsible for one’s ability to straighten the wrist and fingers.
What is medial epicondylitis?
Medial epicondylitis, also known as golfer’s elbow, is inflammation of the tendons that attach the forearm muscles to the inside, or medial aspect, of the bone at the elbow. Most commonly, the tendons connecting to the flexor carpi radialis muscle, which is located on the anterior surface (i.e., or front) of the forearm, are involved. The flexor carpi radialis is responsible for flexing the wrist (i.e., bending the hand inward so the palm faces the inside of the arm) as well as abducting the hand (i.e., moving the hand away from the body).
What causes epicondylitis?
Epicondylitis most often occurs in individuals who are 30 to 50 years old. It is typically caused by repetitive, and often forceful, motions in the forearm and wrist. Activities and occupations that require repetitive motions and heavy lifting -- such as plumbing, painting, carpenting, and butchering -- can predispose individuals to epicondylitis.More specifically, lateral epicondylitis is caused by motions that involve extending the elbow. As the elbow bends and straightens, the extensor carpi radialis brevis rubs against the bony bumps of the elbow, causing small tears in the tendon that result in pain and inflammation. On the other hand, medial epicondylitis is caused by motions that involve bending the wrist towards the palm, or flexing the forearm. This can occur when one swings a golf club or pitches a baseball. Similarly to lateral epicondylitis, medial epicondylitis can also be a tennis-related injury.
What are the signs and symptoms of epicondylitis?
The signs and symptoms of epicondylitis include a painful or burning sensation at the inner or outer part of the elbow, at times accompanied by weak grip strength and difficulty picking up or holding objects. An individual may also experience tremors, or shaking, in their hands. Occasionally, a numb or tingling sensation may start at the elbow and travel to one or more fingers.Symptoms of epicondylitis usually develop over time, starting off mild and slowly worsening over weeks and months. Therefore, there is usually no single specific, triggering event that causes the symptoms to appear. Most often, only the dominant arm is affected. However, both arms can be involved when the causative strenuous activity requires use of both arms.
How is epicondylitis diagnosed?
A clinician will conduct a thorough review of medical history and a physical examination. During the physical exam, the clinician may ask the individual to rest their affected arm on a table, with the palm facing up, and the clinician will bend the wrist against resistance. If the individual has epicondylitis, they will typically feel pain at the elbow upon bending.Diagnostic testing, such as X-rays and magnetic resonance imaging (MRI) scans, may be necessary to rule out other diagnoses, like arthritis (i.e., inflammation of the elbow joint) or herniated disks in the cervical spine, as these conditions can also involve radiating pain from the elbow. An electromyography (EMG) can be used to rule out nerve compression around the elbow, which could cause similar symptoms to that of epicondylitis.
How is epicondylitis treated?
Epicondylitis is treated by giving the affected arm, or arms, adequate rest, which often requires decreasing participation in sports and heavy lifting. Avoiding repetitive movements of the wrist and elbow may also be advised. Conservative treatments may include taking over-the-counter pain medications, such as nonsteroidal anti-inflammatories (NSAIDs), like ibuprofen or naproxen, as well as wearing a brace over the back of the forearm to prevent overexertion of the muscles and tendons. Additionally, physical therapy may be recommended to strengthen the muscles of the forearm. The physical therapist may also perform muscle-stimulation techniques to promote muscle healing or ice massages to reduce inflammation. In some cases, clinicians may recommend anti-inflammatory steroid injections, such as cortisone injections, in the affected area to help relieve symptoms.If symptoms do not improve with nonsurgical treatment, the doctor may recommend surgery. Surgery typically involves removing parts of the torn, injured muscle and reattaching the healthy parts to the bone. Depending on risk factors, such as age or past medical history, the surgeon may choose to perform an open surgery via an incision over the elbow. Another option is to perform surgery arthroscopically, using small incisions and miniature instruments.
How long does it take for epicondylitis to heal?
It can typically take 6 to 12 months to recover from epicondylitis using conservative treatments. If surgery is required, clinicians generally recommend that the individual undertake strengthening exercises to stretch the elbow and restore flexibility around a couple of months after surgery. Resumption of athletic activities usually depends on the individual, often 4 to 6 months after the surgery.
What are the most important facts to know about epicondylitis?
Epicondylitis refers to inflammation of the tendons surrounding the elbow, typically due to overuse and repetitive motions of the forearm. This leads to symptoms of tennis elbow and golfer’s elbow, which include pain, weakened grip strength, and possible numbness and tingling. Certain activities predispose individuals to developing either lateral or medial epicondylitis. Repetitive extension of the elbow puts the person at risk for lateral epicondylitis, or tennis elbow, while repetitive flexion of the elbow increases the risk of medial epicondylitis, or golfer’s elbow. Both pathologies can be diagnosed by reviewing medical history and the results of a physical examination and diagnostic imaging. Treatment may begin with conservative measures, such as rest and NSAIDs. More invasive treatments include corticosteroid injections and surgery. Epicondylitis usually heals with rest over the course of 6 to 12 months. If surgery is necessary, postsurgical strengthening exercises are often recommended, and individuals may be able to resume their daily activities around 6 months after surgery.
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Resources for research and reference
Liebert, P. (2020). Approach to sports injuries. In Merck manual: Professional version. Retrieved March 1, 2021, from https://www.merckmanuals.com/professional/injuries-poisoning/sports-injury/approach-to-sports-injuries
Summit Orthopedics. (n.d.). Lateral and medial epicondylitis. Retrieved March 1, 2021, from https://www.summitortho.com/services/elbow/lateral-and-medial-epicondylitis/
Johns Hopkins Medicine. (n.d.). Medial epicondylitis (golfer's and baseball elbow). Retrieved March 1, 2021, from https://www.hopkinsmedicine.org/health/conditions-and-diseases/medial-epicondylitis-golfers-and-baseball-elbow
Alaia, M., & Fischer, S. (2020). Tennis elbow (lateral epicondylitis). In OrthoInfo: Diseases & conditions. Retrieved February 19, 2021, from https://orthoinfo.aaos.org/en/diseases--conditions/tennis-elbow-lateral-epicondylitis/