Last reviewed: 20 Sep 2020
Last updated: 06 Apr 2018



History and exam

Key diagnostic factors

  • hx 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)

Other diagnostic factors

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

Risk factors

  • age 40 to 60 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

Diagnostic investigations

Investigations to consider

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

Emerging tests

  • Doppler and ultrasound of the elbow
More emerging tests

Treatment algorithm


Consultant Hand and Upper Limb Surgeon

Wrightington Hospital

Appley Bridge




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

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 monograph. LF, IM, DJS, and HBS declare that they have no competing interests.

Peer reviewersVIEW ALL

Associate Professor

Division of Orthopedic Surgery

University of Alabama




BAP declares that he has no competing interests.

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