Summary
Definition
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)
Other diagnostic factors
- normal range of movement at elbow
- normal sensation
- Tinel sign negative
- weak wrist extension (lateral epicondylitis)
- swelling
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
Diagnostic tests
1st tests to order
- no initial tests (clinical diagnosis)
Tests 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
Emerging tests
- ultrasound of the elbow
Treatment algorithm
initial presentation
no response to initial treatment at 6 weeks
lateral epicondylitis refractory to treatment 6 to 12 months after initial presentation
medial epicondylitis refractory to treatment 6 to 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
UK
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
UK
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
Brent A. Ponce, MD
Associate Professor
Division of Orthopedic Surgery
University of Alabama
Birmingham
AL
Disclosures
BAP declares that he has no competing interests.
Differentials
- Radial tunnel syndrome
- Radial capitellar plica
- Osteoarthritis
More DifferentialsGuidelines
- ACR Appropriateness Criteria: chronic elbow pain
- Practice parameter for the performance and interpretation of magnetic resonance imaging (MRI) of the elbow
More GuidelinesPatient information
Tennis elbow
More Patient information
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