Epicondylitis

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 5 Aug 2025

Last updated: 11 Mar 2025

Epicondylitis typically occurs during the 4th and 5th decades of life. Patients describe a history of activities contributing to overuse of the forearm muscles that originate at the elbow.

People with lateral epicondylitis experience tenderness approximately 1 cm distal and anterior to the lateral epicondyle. They report pain during resisted wrist and digit extension, and during passive wrist flexion with the elbow extended.

People with medial epicondylitis have tenderness along the medial elbow, approximately 5 mm distal and anterior to the medial epicondyle. Pain is exacerbated with resisted forearm pronation and resisted wrist flexion.

Most patients will have complete resolution of symptoms with arm rest and nonsteroidal anti-inflammatory drug therapy. Patients with continued symptoms may require further treatment, including physical therapy, injection therapy, or surgical debridement.

The principal complication is continued pain. All other complications may arise from interventions attempting to alleviate the pain.

Definition

Epicondylitis of the elbow is a condition associated with repetitive wrist, forearm, and elbow activities.[1][2] Both lateral epicondylitis (commonly known as tennis elbow) and medial epicondylitis (commonly known as golfer's elbow) are characterized by elbow pain during or following elbow flexion and extension. A combination of poor mechanics, microtears in areas of hypoperfusion, and a delayed healing response contribute to the pathophysiology of the condition.[3][4]

History and exam

Key diagnostic factors

history of repetitive recreational or occupational activity
past medical history of epicondylitis
smoking
elbow pain during or following 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)

Full details

Other diagnostic factors

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

Full details

Risk factors

increasing age (>40 years)
past 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

Full details

Diagnostic tests

1st tests to order

no initial tests (clinical diagnosis)

Full details

Tests to consider

elbow x-ray
computed tomographic scan of the elbow
MRI of the elbow
MRI of the cervical spine
electromyogram and nerve conduction studies
ultrasound of the elbow

Full details

Treatment algorithm

ACUTE

initial presentation

ONGOING

no response to initial treatment at 6 weeks

lateral epicondylitis refractory to treatment 6-12 months after initial presentation

medial epicondylitis refractory to treatment 6-12 months after initial presentation

Contributors

Authors

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

Consultant Hand and Upper Limb Surgeon

Wrightington Hospital

Appley Bridge

Wigan

Disclosures

ACW has received payment for education from Medartis and Wright Medical. His institution has received funding for research from Chemedica, ZimmerBiomet, Wright Medical, Stryker and Lima.

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

Consultant Trauma and Orthopaedic Surgeon

Peterborough City Hospital

North West Anglia NHS Foundation Trust

Peterborough

Disclosures

PMR declares that he has no competing interests.

Acknowledgements

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

Frank G. Alberta, MD, FAAOS

Associate Professor of Orthopaedic Surgery

Hackensack Meridian School of Medicine

Nutley

Disclosures

FGA declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

American College of Radiology. Practice parameter for the performance and interpretation of magnetic resonance imaging (MRI) of the elbow. 2021 [internet publication].Full text

American College of Radiology. ACR appropriateness criteria: acute elbow and forearm pain. 2024 [internet publication].Full text

Raman J, MacDermid JC, Grewal R. Effectiveness of different methods of resistance exercises in lateral epicondylosis - a systematic review. J Hand Ther. 2012 Jan-Mar;25(1):5-25. Abstract

National Institute for Health and Care Excellence. Autologous blood injection for tendinopathy. Jan 2013 [internet publication].Full text

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials
- Radial tunnel syndrome
- Radiocapitellar plica
- Osteoarthritis
More Differentials
Guidelines
- ACR Appropriateness Criteria: acute elbow and forearm pain
- Lateral epicondyle tendinopathy (LET) toolkit
More Guidelines
Patient information
Tennis elbow
More Patient information
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Epicondylitis

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic tests

1st tests to order

Tests to consider

Treatment algorithm

initial presentation

no response to initial treatment at 6 weeks

lateral epicondylitis refractory to treatment 6-12 months after initial presentation

medial epicondylitis refractory to treatment 6-12 months after initial presentation

Contributors

Authors

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

Disclosures

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

Disclosures

Acknowledgements

Peer reviewers

Frank G. Alberta, MD, FAAOS

Disclosures

Peer reviewer acknowledgements

Disclosures

References

Key articles

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials

Guidelines

Patient information

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice