Last reviewed: February 2018
Last updated: November  2017



History and exam

Key diagnostic factors

  • presence of risk factors
  • elbow pain during or after flexion and extension
  • exacerbation of pain with repetitive movement or occupational activity
  • decreased grip strength
  • pain at the lateral aspect of the elbow (lateral epicondylitis)
  • tenderness over the common extensor tendon (lateral epicondylitis)
  • positive extensor carpi radialis brevis stretch (lateral epicondylitis)
  • pain during resisted wrist and digit extension (lateral epicondylitis)
  • pain at the medial aspect of the elbow (medial epicondylitis)
  • tenderness approximately 5 mm distal and lateral to the medial epicondyle (medial epicondylitis)
  • increased pain with resisted forearm pronation or wrist flexion (medial epicondylitis)

Other diagnostic factors

  • normal range of movement at elbow
  • normal sensation
  • Tinel's sign negative
  • weak wrist extension (lateral epicondylitis)
  • swelling

Risk factors

  • age 40 to 60 years
  • medical history of epicondylitis
  • repetitive activities
  • poor mechanics during activities
  • improper equipment
  • inadequate physical conditioning
  • smoking
  • obesity
  • symptoms occurring on the same side as hand dominance

Diagnostic investigations

1st investigations to order

  • no initial tests (clinical diagnosis)
Full details

Investigations to consider

  • elbow x-ray
  • MRI of the cervical spine
  • CT scan of the elbow
  • MRI of the elbow
  • EMG and nerve conduction studies
Full details

Emerging tests

  • Doppler and ultrasound of the elbow
Full details

Treatment algorithm


Authors VIEW ALL

Consultant Hand and Upper Limb Surgeon

Wrightington Hospital

Appley Bridge




ACW is employed by Wrightington Wigan and Leigh NHS Turst, who research funding from Zimmer/Biomet, Integra, Lima, and Wright Medical.

Upper Limb Fellow

Upper Limb Unit

Wrightington, Wigan and Leigh NHS Foundation Trust




PMR declares that he has no competing interests.

Dr Adam C. Watts and Dr Paul M. Robinson would like to gratefully acknowledge Dr Len Funk, Dr Iain Macleod, Dr Daniel J. Soloman, and Dr Hugo B. Sanchez, previous contributors to this monograph. LF, IM, DJS, and HBS declare that they have no competing interests.

Peer reviewers VIEW ALL

Associate Professor

Division of Orthopedic Surgery

University of Alabama




BAP declares that he has no competing interests.

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