Biomechanical analysis has shown that eccentric contractions of the extensor carpi radialis brevis (ECRB) muscle during backhand tennis swings, especially in novice players, are the cause of repetitive microtrauma that results in tears to the origin of the tendon and resultant lateral epicondylitis. However, this injury is not limited to tennis players. Although the term epicondylitis implies that inflammation is present, it is only present at the very early stages of the disease, classifying the condition more as a tendinosis.
Signs & Symptoms
- Pain at the lateral aspect of the elbow that often radiates down the forearm.
- Can be caused by a specific injury to the area, but often the pain is of gradual, insidious onset, further supporting its characterization as an overuse injury.
- Weakness in grip strength or difficulty carrying items in affected hand.
- Evaluation for lateral epicondylitis should begin with the cervical spine and be followed by the entire upper extremity
- A thorough shoulder examination is important because some patients have tight posterior capsules that may contribute to elbow pain.
(Research is inconclusive on statistical data for these tests)
Non-operative (Initial phase)
- Reduce pain, inflammation, edema
- Rest from aggravating activities
- Anti-inflammatory medication, phonophoresis, iontophoresis, deep friction massage (2–3 minutes, 2 times a day)
- Ice massage (5 minutes, 2 times a day)
- Elbow flexion/extension
- Wrist flexion/extension
- Forearm pronation/supination
- Grip strengthening (2–3 minutes, 2 times a day)
- Counterforce bracing
- Continue stretching, appropriate modalities, and bracing
- Initiate progressive pain-free resistive strengthening (3 sets of 15, 2 times a day)
- Wrist curls (0–0.9 kg [0–2 lb] progressing to 1.3–2.2 kg [3–5 lb])
- Elbow flexion/extension (0.9–1.3 kg [2–3 lb] progressing to 2.2–4.5 kg [5–10 lb])
- Forearm pronation/supination (0–0.9 kg [0–2 lb] progressing to 1.3–2.2 kg [3–5 lb])
- Shoulder strengthening to prevent disuse atrophy. Resume previously aggravating activities
- Continue stretching and strengthening, functional training, correct mechanics
- Ice after activity
- Gradual return to sport
- Maintenance stretching and strengthening program 3 times a week
- If no improvement, consult with orthopedic surgeon to explore other options
[Lateral Epicondylitis resources listed under References section]