Last reviewed: 29 Oct 2021
Last updated: 18 Feb 2021



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

  • increasing age (>40 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
  • female sex

Diagnostic investigations

Investigations to consider

  • elbow x-ray
  • magnetic resonance imaging (MRI) of the cervical spine
  • computed tomographic scan of the elbow
  • MRI of the elbow
  • electromyogram and nerve conduction studies

Emerging tests

  • ultrasound of the elbow

Treatment algorithm



Adam C. Watts, BSc, MBBS, FRCS (Tr and Ortho)

Consultant Hand and Upper Limb Surgeon

Wrightington Hospital

Appley Bridge




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

Paul M. Robinson, FRCS (Tr&Orth), BMedSci, MBChB (Hons)

Consultant Trauma and Orthopaedic Surgeon

Peterborough City Hospital

North West Anglia 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 topic. LF, IM, DJS, and HBS declare that they have no competing interests.

Peer reviewers

Brent A. Ponce, MD

Associate Professor

Division of Orthopedic Surgery

University of Alabama




BAP declares that he has no competing interests.

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